By Ceci Connolly
Washington Post Staff Writer
Wednesday, July 23, 2008
SAN YSIDRO, Calif. -- AIDS rates in the nation's Latino community are increasing and, with little notice, have reached what experts are calling a simmering public health crisis.
Though Hispanics make up about 14 percent of the U.S. population, they represented 22 percent of new HIV and AIDS diagnoses tallied by federal officials in 2006. According to a survey by the Kaiser Family Foundation, Hispanics in the District have the highest rate of new AIDS cases in the country.
So far, the toll of AIDS in the nation's largest and fastest-growing minority population has mostly been overshadowed by the epidemic among African Americans and gay white men. Yet in major U.S. cities, as many as 1 in 4 gay Hispanic men has HIV, a rate on par with sub-Saharan Africa.
Blacks still have the highest HIV rates in the country, but language difficulties, cultural barriers and, in many cases, issues of legal status make the threat in the Hispanic community unique. For those who arrived illegally, in particular, fear of arrest and deportation presents a daunting obstacle to seeking diagnosis and treatment.
"Officials need to stop downplaying or ignoring what's happening among Latinos," said Oscar De La O, president of Bienestar, a Latino service organization. "We are at the center of the storm."
Even with the United States embroiled in a fierce debate over immigration policy, the problem of AIDS in Latinos had received scant attention from political and public health officials. At the Centers for Disease Control and Prevention, where only two of 17 approved HIV programs target Hispanic Americans, officials have added Spanish-language hotlines, confidential testing sites and other initiatives aimed at filling the gap.
"Hispanics are overrepresented in this epidemic, and we need to target our efforts to them," CDC epidemiologist Kenneth Dominguez said in an interview.
Officials do not have a precise tally of HIV infection nationwide, because many states have not reported figures to the CDC. The 22 percent, a figure that has not been previously released, includes 33 states and Puerto Rico, but not California, where more than 37 percent of the population is Hispanic.
"You combine the economic pressures, loneliness and immigration worries, and it pushes these individuals to be a hidden population," said Frank Galvan of the Charles Drew University of Medicine and Science in Los Angeles.
The consequences, however, go well beyond the Hispanic community. If the United States does not begin to "make a dent" in the swelling crisis of HIV among Hispanics, Galvan said, "it will continue to spread to other populations."
The nexus of AIDS and migration -- the reality that viruses know no borders -- will gain fresh prominence at the International AIDS Conference next month in Mexico City. It is a nexus that plays out in dramatic fashion in San Ysidro and other communities along the U.S.-Mexican border, where the tensions associated with immigration tend to exacerbate an already stigmatized illness.
"Migrants tend to be lonely, separated from their family or partners," Dominguez said. "They do not have health insurance. They may turn to drugs or alcohol. All of these put a migrant at higher risk."
Mauro Ruiz's story fit that profile.
Growing up gay in Mexico, the 35-year old felt the pain of his family's shame. He fled north of the border, as many do, in search of a better life. There, he thought, he could live openly and thrive.
But Ruiz's fantasy never quite materialized. The pay at a local restaurant was better than the $3.50 an hour he earned working for the Mexico City government, but he thought that washing dishes was demeaning. Struggling with English, he made few friends. Most of all, the freedoms he sought in California quickly became his undoing.
Unleashed from the stigma that cloaks homosexuality in Mexico's conservative, machismo culture, Ruiz sought refuge in San Diego's gay bars and bathhouses. There, he discovered friendly American men and crystal methamphetamine.
"I had no idea meth was so addictive," he said. "It takes away your inhibitions. I started associating with people I wouldn't normally."
It was not long before Ruiz contracted HIV. As is the case with many Latinos, his disease had nearly reached full-blown AIDS before it was diagnosed. "I was scared as hell, really, really afraid," he said in a near-whisper.
Ruiz's arc from newly liberated migrant to fighting for his life typifies the experience of many gay Latinos, said Rafael Diaz, an AIDS expert at San Francisco State University.
Many are "objectified" by white men who view them as exotic. They play subservient roles to partners with citizenship or money. The "triple oppressive experiences of poverty, racism and homophobia" lead many to risky behavior, Diaz said. "People are looking for respite and relief from a sense of isolation, economic deprivation and low self-esteem. Sometimes sex is the place where men find that."
Hispanic women confront similar cultural challenges.
Rosario Mancillas was raised to believe that "if you have HIV and you are a woman, you are a prostitute."
The 45-year-old lesbian epitomizes today's increasingly common bi-national, border-straddling existence. She was born in Brownsville, Tex., but raised in the Mexican state of Sinaloa. When she got a job at a Costco store in Chula Vista, Calif., she chose to live across the border in Tijuana, where rents are cheaper and the culture more familiar.
Yet even as she adopted a more American lifestyle, Mancillas's attitudes and beliefs were firmly rooted in her traditional Mexican upbringing. Feeling pressure to give her parents a grandchild, she investigated a sperm bank. But the prospect of insemination seemed cold and impersonal. Then a gay friend offered to try to impregnate her.
The brief heterosexual detour did not produce a baby, but she did contract HIV, discovering the infection three years later when she was stricken with terrible stomach pain. Mancillas went with her father to a hospital in Tijuana.
"My English is not good, and I felt more comfortable in my own language, my own culture," she said in Spanish. The Mexican doctor told Mancillas's father that she had AIDS -- and six months to live. Neither man told her. Three days later, a nurse broke the news.
Her partner and her friends all disappeared. A priest asked her: "What kind of life have you led that God would punish you in this way?"
Still, Mancillas considers herself lucky. With the help of a California doctor, her six-month death sentence has extended to more than 11 years. More important, she noted, she is a U.S. citizen, eligible for legal protections and disability benefits.
That is not the case for Rosalia Vargas, 41. She frets daily about her undocumented status and worries about what will happen to her 5-year-old son, who is not infected, if she is deported.
She had not planned to leave her small town in the state of Veracruz. But in 1994, when an aunt needed help with a disabled child, her parents put her on a bus headed north.
Like Ruiz, Vargas was simultaneously thrilled and terrified by her new surroundings. Unchaperoned for the first time, she strolled through parks, shopped and socialized on her own. She met a man.
"He told me I was special, and I felt very flattered," she said. Soon, she was living with the charming Mexican American. But his behavior confused her.
"He used to go out in the middle of the night for no reason," she said. "Sometimes his friends came to the apartment and went in his room and closed the door."
She discovered medications in a drawer but could not decipher the English on the bottles. One day, she returned from babysitting to find him on the floor, covered in his own vomit. They rushed to a hospital, where the doctor said her drug-dealing partner had AIDS.
"I felt a cold chill. I lived with him for three years and we never used condoms," she said, tears trickling down her cheeks. "Mexican women don't even know what a condom is. All we know is if you talk about condoms, you are promiscuous."
Vargas's experience is an example of what San Francisco State University professor Hector Carrillo calls "cultural dissonance." He said: "The real challenge is that they are entering new situations or contexts."
Even after her boyfriend died four months later, Vargas postponed having an HIV test, afraid that authorities would find her.
Such late testing is common -- and of great concern to health officials, said the CDC's Dominguez, because delays mean earlier death and increased spread of the virus.
Vargas, it turned out, was HIV-positive.
"As immigrants, many times we lose our identity when we cross the border," said De La O. He worries that harsh policies toward HIV-positive immigrants create "another underground in which people cannot access treatment but will not leave the country."
Mauro Ruiz is one of them.
Now fluent in English and having advanced to shift supervisor at the restaurant where he works, he is hoping for the law to change. Until then, he keeps to the shadows of society.
"If I'm able to work, I can stay here," he said. "But if not, I will have to go back to Mexico and I will die."
This report was supported by the Project for International Health Journalism Fellowship, a part of the Henry J. Kaiser Family Foundation's Media Fellowships Program.