Prevention Programs Target Migrants

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Science  28 Jul 2006:
Vol. 313, Issue 5786, pp. 478-479
DOI: 10.1126/science.313.5786.478
On the move.

Tapachula's Casa del Migrante provides temporary shelter—and HIV prevention education—to 7000 migrants each year.

TECÚN UMÁN, GUATEMALA, AND TAPACHULA, MEXICO—In late November 2005, more than a month after Hurricane Stan walloped Guatemala and southern Mexico, the border in Tecún Umán was still closed because of damage to the bridge that connects the two countries. But the unofficial border crossing remained open for business. From daybreak until sundown, rafts fashioned from truck tires and wood planks shuttled people across the Suchiate River that separates this spicy border town from Mexico. A policeman stood watch much of the time, gladly ignoring the illegal migration for a small fee.

HIV negotiates the border with similar ease, carried by the constant flow of people. And this border in particular has helped clarify the theory that migration is a significant driver of the AIDS epidemics in this region—and the world at large. “In the beginning, it wasn't easy to convey the message that migration has something to do with HIV/AIDS,” says sociologist Mario Bronfman, an Argentinean native who in the 1990s led groundbreaking studies that looked at migrants in Tecún Umán and 10 other “transit stations” in Central America and Mexico. Bronfman, who works with the Ford Foundation in Mexico City, says, “Now that we have hard data, it's very clear there is a problem.”

Bronfman's studies assessed knowledge and opinions about HIV/AIDS at each transit station. As Bronfman and his colleagues reported in the journal AIDS in 2002, a long list of factors puts migrants at higher risk of HIV infection: poverty, violence, few available health services, increased risk-taking, rape, loneliness, and large numbers of sex workers—all of which aptly characterize Tecún Umán today. They also found women to be more vulnerable because of “transactional” and “survival” sex that they had in exchange for food or protection during their travels.

Educavida, a nongovernmental organization sponsored by the United Nations Population Fund to do HIV/AIDS education and prevention, targets the wide array of migrants who temporarily call this town home. “Some stop here because they're thinking of the American dream, and this is a place along the route,” says Educavida's director, psychologist Brigida Garcia. (No solid figures exist on how many Mexicans and Central Americans migrate to the United States each year, but experts estimate that they number more than 1 million.) Today's clients include a Nicaraguan mother of three who sells sex in one of the town's many brothel/bars, an Ecuadorian man en route to the United States, and an HIV-infected woman who was a U.S. resident for 12 years and returned to her hometown a few years ago. Educavida does HIV testing, but Hugo Rivera, a clinician who works with the group, says he has little to offer people who test positive other than a referral to other locales that have antiretroviral drugs. “You do the examinations, and then they leave,” says Rivera.

And migration shows no sign of abating. Annelise Hirschmann, head of Guatemala's National AIDS Program, says the country's longstanding civil war that ended in 1996 still spurs migration, as families try to reunite. “The secondary issues that surround the war definitely feed the epidemic,” she says. Studies have shown that Mayans, who constitute about half of the country's population, are also at high risk because they travel frequently for agricultural work. And Hurricane Stan is just the latest natural disaster to drive Guatemalans from their homes. “There's a mass exodus of young people going to the States right now because of Hurricane Stan,” says Dee Smith, a Maryknoll sister in Coatepeque who runs the HIV/AIDS-oriented Proyecto Vida. “They had few opportunities before Stan.”

No visa necessary.

Migrants freely cross the Suchiate River between Guatemala and Mexico.

At the Casa del Migrante in Tapachula, Mexico—the closest big city and the first stop for many who cross at Tecún Umán—there is more hard evidence that migrants face an increased risk for HIV infection. This church-run lodging, which offers HIV/AIDS education, distributes a questionnaire to the 7000 people who pass through each year about their sexual lives during the journey. In 2004, fewer than 20% of the men reported having used condoms, and about 8% of the women said they had been raped. “Amigo Migrante,” reads a poster near the entrance. “For HIV/AIDS, no border exists.”

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