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AIDS on the Border BY JULIA GILDEN FROM HIS OFFICE at Centro de Salud Familiar La Fe, a community health-care clinic in El Paso, executive director Pete Duarte has seen a number of battles for survival along the border. “Last year we had an epidemic of measles. The year before it was hepatitis. Now it is tuberculosis,” he said. But for Duarte and other community health professionals on the 2,000mile-long international border, the most potentially devastating threat to public health is posed by AIDS. While cases of the disease have reached a plateau in most urban centers, they are on the rise in rural areas. The number of people who the precursor to AIDS, is also rising dramatically along the border. And many more carriers know little or nothing about the immunesystem-destroying retrovirus they harbor, say alarmed healthworkers. AIDS is spread through sexual intercourse, sharing needles in IV drug injections and, rarely, by contaminated blood used in transfusions. Since testing, usually only performed by request, may not reflect the number of people infected, health professionals use the incidence of sexually transmitted diseases as an indicator of the presence of HIV. Over the past five years, border clinics have reported sharp rises in syphillis, gonorrhea and chlamydia. Another indicator of a probable rise in HIV and AIDS is increased admissions to detox clinics by IV drug users, say border drug counselors at La Fe, El Paso’s largest community clinic. Yet, official statistics are not that alarming: 133 cases of AIDS so far in El Paso, plus a few thousand cases of HIV that health officials hope will go no higher, now that public information campaigns are under way. Community health workers in the trenches, however, aren’t so optimistic. Thousands of families, workers, opportunists, and tourists cross the Rio Grande daily, making towns on both sides of the border into single geographic units. But cultural and economic differences have erected a seemingly impassable barrier to containing health hazards, said Duarte and his colleagues. They worry that border residents who engage in high-risk behavior like multiplepartner sex and IV drug use are unwittingly spreading the disease due to inadequately funded health education and treatment policies, lack of information, and cultural values that make it difficult to confront the problem. Julia Gilden is a freelance journalist in San Francisco. “The prevailing attitude is, ‘It can’t happen to me. It’s a white gay male’s disease,” said Petra Reyna, executive director for Centro Medico, another community clinic in El Paso. Many AIDS victims in border towns are gay men who left their homes to find work in urban centers, agreed Southwest AIDS Committee Executive Director Terry Call. “We are experiencing a lot of ‘coming home’ syndrome in El Paso,” Call said of the patients who have returned in the final stages of their disease to their families. But 30 percent of the AIDS Committee’s clients are heterosexual, Call said, including a growing number of women infected by their male partners. Convincing many Hispanics, especially recent arrivals to U.S. culture, that they could be at risk requires a leap of faith on their part, which may help explain why AIDS and HIV are found among Hispanics at nearly twice the rate of any other ethnic group in the United States, according to Public Health Reports. In a culture that refuses to acknowledge homosexuality or bisexuality and where any kind of sexual behavior outside of marriage is taboo, a small lie about any high-risk activities is preferable to public scrutiny of one’s private life. In Duarte’s opinion, the relatively low official incidence of AIDS and HIV along the international border mostly indicates insufficient contact by the health care community with high-risk individuals a consequence of the low priority given health care at the federal and state level. Moreover, it is difficult to convince people unfamiliar with an exotic deadly disease \(that may not produce testable antibodies or symptoms for up to 10 face. “Nobody does outreach to the undocu mented,” said Duarte, who testified about border health problems to Congress last year. “Sometimes I ask a white middle-class audi ence if they know whether their maid has been tested for tuberculosis or any other diseases she could pass on.” The main reaction is usu ally an uncomfortable choking, he recalled, adding that parents were doing no better at educating their children about the potentially deadly consequences of promiscu UNTIL RECENTLY, Juarez was the ity and drugs. traditional party pad for Texas youths. New laws raising the legal drinking age and closing bars at midnight were designed to remedy the city’s severe problems with alcoholism, and may have a salutory effect on the overall health of teenagers, as well. But, noted Duarte, “Fifty percent of the high-risk kids we should reach are out of schoolthe middle-class kids get all the education.” Meanwhile, the birth rate among teens is growing rapidly. “You see more and more 15year-old girls with two babies,” said Norma Ramirez Minjarez, La Fe’s HIV counselor. It has become a status symbol, she added, a direct consequence of promiscuous sex. The problem is not only getting the information to youths who think they are immortal, but couching it in terms that will override their immediate emotional urges. Public-ser 1 1,” e . 1 THE TEXAS OBSERVER 1 1