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HIV/AIDS Among Mexican Migrants and Recent Immigrants in California and Mexico

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HIV/AIDS Among Mexican Migrants and Recent Immigrants in California and Mexico INTRODUCTION HIV/AIDS Among Mexican Migrants and Recent Immigrants in California and Mexico Marı´a Teresa Herna´ndez, MPH,* George F. Lemp, DrPH, MPH,* Xo´chitl Castan˜eda, MPH,† Melissa A. Sanchez, MA,* Bart K. Aoki, PhD,* Roberto Tapia-Conyer, MD, MPH, MSc,‡ and Michael V. Drake, MD* his special issue contains original review articles by researchers from the University of TCalifornia and the Secretariat of Health of Mexico. The articles on epidemiology, pre- vention, and health care services review available published data and selected unpublished data on Mexican migrants in California specifically and across the United States. These articles identify research and intervention needs and, where available, document effective methods of outreach and interventions with the Mexican migrant population. An article addressing the issue within Mexico outlines the emerging data on the vulnerability of Mexi- cans migrating to the United States with regard to HIV, sexually transmitted diseases, and associated behaviors. Lastly, a concluding article presents an analysis of policies that serve as barriers or facilitators of prevention and care for Mexican migrants in California. All the articles offer compelling evidence for integrating tailored outreach, prevention, and health care services for the Mexican migrant population into the overall health care infrastructure of communities in California and Mexico. Patterns of transnational movement among Mexican citizens vary widely; therefore, the term migrant extends to all those groups of persons whose residence, work, and social patterns extend across the United States–Mexico border. This population includes individu- als at different stages of migration, their families, and individuals who are part of their social and economic networks in California and Mexico. Effective prevention and care strategies for Mexican migrants must focus on these populations as distinct migrant group who con- tribute economically to the communities where they reside. The California–Mexico AIDS Initiative was created by the University of California, Office of the President, in collaboration with the Secretariat of Health, Mexico, to address the epidemiology, prevention, health care services, and public policy issues with regard to HIV/AIDS, sexually transmitted diseases, and tuberculosis among Mexican migrant com- munities in California and within their originating communities in Mexico. This transna- tional collaboration is based on the premise that Mexican migrants in the United States are particularly vulnerable to infectious disease epidemics such as HIV, sexually transmitted diseases, and tuberculosis. The body of data presented in these articles supports this hypoth- esis and indicates that without intervention, these epidemics may expand more aggressively in the future, representing an emerging threat to Mexican migrants in California, along the California–Mexico border, and within Mexico. Received for publication June 2004; accepted September 2004. From the *Office of Health Affairs, University of California, Office of the President, Oakland, CA; †California–Mexico Health Initiative, University of California, Office of the President, Berkeley, CA; and ‡Secretarı´a de Salud, Mexico City, Mexico. Reprints: Melissa A. Sanchez, Universitywide AIDS Research Program, University of California, Office of the President, 300 Lakeside Drive, 6th Floor, Oakland, CA 94612 (e-mail: [email protected]). Copyright © 2004 by Lippincott Williams & Wilkins J Acquir Immune Defic Syndr • Volume 37, Supplement 4, November 1 2004 S203 SUPPLEMENT ARTICLE The Epidemiology of HIV Among Mexican Migrants and Recent Immigrants in California and Mexico Melissa A. Sanchez, MA,* George F. Lemp, DrPH, MPH,* Carlos Magis-Rodrı´guez, MD, MPH,† Enrique Bravo-García, BA,† Susan Carter, JD,* and Juan D. Ruiz, MD, DrPH‡ potential to increase the likelihood of an AIDS epidemic Summary: For Mexican migrants and recent immigrants, the im- within these populations. These factors include constant mo- pact of migration from Mexico to California has the potential to lead bility; cultural, linguistic, and geographic barriers to health to an increased risk for HIV infection. Until recently, the prevalence care services; a change in sexual practices; limited education; of HIV in Mexico and among Mexican migrants in California ap- psychosocial factors; isolation; discrimination; poverty; peared to be stable and relatively low. Recent studies have raised new 1 concerns, however, that the HIV epidemic may expand more aggres- chronic underemployment; and substandard housing. For ex- sively among this population in the coming years. Unfortunately, the ample, there is a hypothesis suggesting that migrants are more insufficient amount of data available within recent years makes it dif- likely to engage in high-risk sexual practices when moving to ficult to fully assess the potential for rapid spread of the HIV epidemic the United States, which consequently increases their risk of among this population. Consequently, there is a critical need for an HIV infection. Adoption of new sexual practices has often ongoing binational surveillance system to assess prevalence and been attributed to a need to seek companionship to compensate trends in HIV/STD/TB disease and related risk behaviors among this for the alienating aspects of the migration experience, fewer population both in Calfornia and within this population’s states of constraints or social controls on behavior, exposure to previ- origin in Mexico. This enhanced epidemiologic surveillance system ously unknown or unacceptable sexual behaviors and prac- should provide improved data on the subpopulations at the highest tices, or precarious economic circumstances that compel some risk for HIV/STD/TB, such as men who have sex with men, and should provide the opportunity to evaluate the impact of migration on migrants to exchange sexual services for food, lodging, or the transmission dynamics, risk behaviors, and determinants of be- money. Furthermore, the mechanisms behind this increased havior on each side of the border. It is essential that this potential risk of HIV infection include low levels of knowledge relating threat be assessed and that intervention programs are developed and to the mechanisms of infection and prevention, multiple part- implemented to combat this possible escalation in the HIV epidemic. ners, low condom use, and increased alcohol and drug use, including illegal drugs and self-injection of vitamins and anti- Key Words: Mexican migrant, HIV, AIDS, STD, prevalence, Cali- 2 fornia, Mexico, surveillance system biotics. Additionally, limited access to medical care and HIV testing while in California may delay diagnosis and treatment (J Acquir Immune Defic Syndr 2004;37:S204–S214) of HIV-infected Mexican migrants, which creates a higher probability of transmission.3 Clearly, understanding the mi- gratory patterns of Mexicans is a formidable challenge and es- lthough relatively little is known about the extent of the sential for developing a better understanding of the infectious AHIV/AIDS epidemic among the Mexican migrant and re- disease transmission dynamics and mixing within and between cent immigrant populations throughout California, there is Mexico and California. concern that these populations are at increasing risk for HIV infection. A confluence of migration-related factors has the MEXICAN MIGRANTS AND IMMIGRANTS The U.S. Census estimates for 2000 indicate that more than 8.7 million people of Mexican origin currently reside in Received for publication June 2004; accepted September 2004. 4 From the *Universitywide AIDS Research Program, University of California, California. This represents 26% of the state’s total population. Office of the President, Oakland, CA; †Centro Nacional para la Preven- Approximately, 3.8 million (44%) within this Mexican-origin cio´n y el Control del VIH/SIDA, Secretarı´a de Salud, Mexico City, population were born in Mexico, 55% of whom are male and Mexico; and ‡Office of AIDS, California Department of Health Services, 45% of whom are female.4 Sacramento, CA. Economic and social factors serve as the driving force Reprints: Melissa A. Sanchez, Universitywide AIDS Research Program, Uni- 5 versity of California, Office of the President, 300 Lakeside Drive, 6th for migration to California for this population. Furthermore, Floor, Oakland, CA 94612 (e-mail: [email protected]). more than 880,000 (23.6%) are naturalized, and more than 2.8 Copyright © 2004 by Lippincott Williams & Wilkins million (76.4%) are noncitizens.4 In the United States, Califor- S204 J Acquir Immune Defic Syndr • Volume 37, Supplement 4, November 1 2004 J Acquir Immune Defic Syndr • Volume 37, Supplement 4, November 1 2004 HIV Epidemiology Among Mexican Migrants nia is the principal destination for Mexicans, with approxi- HIV incidence data for Mexicans in California are currently mately 44% of Mexican immigrants residing in California.4 incomplete and unavailable. The US Census estimates clearly document the degree of representation of Mexican migrants and recent immigrants in EPIDEMIOLOGY OF HIV/AIDS IN MEXICO California. There is a high degree of variability among these Within the Americas, Mexico ranks third in terms of ac- point estimates throughout the literature, however. Such vari- cumulated AIDS cases after the United States and Brazil, with ability is often a result of the incomplete nature of data on this 72,864 cases reported as of December 2003.12 The Mexican
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