Tijuana's AIDS Epidemic Is a Binational Threat

On the Front Lines of Mexico's AIDS War

Angel Cabrera patrols Tijuana in search of drug users and commercial sex workers, providing them with condoms and clean needles in an effort to stop the spread of AIDS in one of the busiest land border crossings in the world.
(Video By Nancy Donaldson -- washingtonpost.com)

"Before, it was taboo to even talk openly about condoms," said Jorge Saavedra, chief of Mexico's AIDS office. "Groups still oppose condom use, but at least we can mention the word."

The shift came about after a sustained push by health leaders to discuss condom use in a scientific context, rather than focusing on moral implications. Saavedra's own story became part of the narrative. He is gay and HIV-positive and not afraid to talk about it, a startling approach for a Mexican official.

He argues that needle exchange, like condoms, is a public health strategy.

"We are not giving needles to people who are not drug users. We're giving needles to people who are already using those drugs," he said in an interview. "This is a way to avoid HIV infections."

In Tijuana, 20 miles south of San Diego, Cabrera conducts fieldwork for researchers studying transmission patterns in the highly mobile, economically distressed, binational population.

As an 8-year-old in Mexico City, he sniffed glue, and at age 12 he hopped trains to the border with two teenage toughs, "Devil" and "Hunchback." Glue led to marijuana, then cocaine and finally heroin.

He would live for a stretch in Tijuana, then sneak into the United States. He sold drugs to American tourists, smuggled cash for the cartels and even stole from a family that took him in. He was "always looking for action," he said.

At his most desperate, he sold his body to men for sex. For 25 years, Cabrera engaged in every type of high-risk behavior. Only a life-threatening case of tuberculosis motivated him to quit and take a job in rehab. By his own admission, it is a near-miracle that he is not infected with HIV.

Cabrera's former cross-border existence mirrors the lives of many here who shuttle back and forth for financial, cultural and legal reasons. In 2007, U.S. Customs and Border Protection counted 38 million legal border crossings from Tijuana into California. Often, the virus that causes AIDS moves with them.

"It's really deportation that's driving the epidemic," said Strathdee, who has documented significantly higher HIV rates in deported drug users. "They're stuck in Tijuana with no job, no home, no resources. They end up turning to a life of crime, and if they are selling their body or addicted to drugs, they're tempted to have unprotected sex for more money."

Cabrera was one of them, which makes him ideal for outreach, Strathdee said. "He has been on the other side of the needle," she said.

"I'm an addict," Cabrera agrees, as he turns down an abandoned dead-end street known as "the hole."