Science Guardian

Times front pager full of questionable assumptions hails AIDS expansion south of the border

Conflict with peer reviewed science invisible to paper of record

Meme inspired fantasy yields research bounty for 2008

The front page of the paper of record continues to carry stories to agitate the hearts of all those who worry about the poor, the weak and the underprivileged, such as the migrant workers who underpin the roaring 21st Century US economy, with its 15,000 households with $9.5 million or more to spend in income annually, some of them with more than $1 billion coming in.

Unfortunately, the coverage of HIV∫AIDS, with all its enthusiasm for the drugs and concern for those in Africa and Asia who cannot yet get them supplied by the US tax payer, is a constant concern for every reader who is scientifically informed, since every reporter handling the topic is apparently unread in the science and a stranger to even the basic truths that have been established in this area, in particular the result that HIV positivity is absolutely not transmitted between the sexes according to the largest study ever conducted in the US on this aspect of the vexed paradigm.

That one paper by the admirable HIV∫AIDS research general Nancy Padian should be forwarded to Marc Lacey, who wrote the front page story today on migrant workers who return from the US to Mexico with HIV infections affter seeking extra-marital comfort north of the border, and thus endanger and kill their wives and children, some of whom cannot get the antiretroviral drugs they need to ward off the deadly effects of HIV, at least in the short run.

If the Padian paper is accepted at face value, uncompromised by Nancy’s specious backpeddling on the AIDSTruth site, it tells us that HIV transmission between the sexes in normal sex is nil, just as reason and conventional science, which tells us that antibodies are not infectious, would indicate. Even politely accepting Nancy’s rather ineffectual, non-peer reviewed disavowal, her best rate of 1 in 1100 is still quite inadequate to support the story of hard working Mexican migrants picking up HIV from incautious assignations while they are in the US and then infecting their wives and children, let alone the famous global pandemic.

To put it bluntly, there is a serious disconnect – of the order of the Grand Canyon – between the maximum Padian rate of transmission and the lurid imagination of the researchers spinning tales where rape and prostitution support a still to be seen “explosion” in Mexican positive HIV tests.

Especially when her paper actually said 1 in 1100 man to woman and much, much less – 1 in 8800 – woman to man (lowered to 1 in 10,000 in her AIDSTruth disavowal!), making the chances of a Mexican migrant contracting HIV from a prostitute virtually nil.

But in the meme-fevered brain of Marc Lacey and his editors, the story is a Mexican version of the Ugandan long distance drivers visiting prostitutes at every stop and decimating their home villages with AIDS when they return to their wives.

But AIDS is spreading quickly in rural Mexican states with the highest migration rates to the United States, researchers say. The greatest risk of contracting AIDS that rural Mexican women face is in having sex with their migrant husbands, a new study found, a problem that is compounded by their husbands’ refusal to use condoms.

Research has shown that migrants have more sexual partners than those who stay at home. For women, life on the road brings risks of rape and sexual abuse. For many migrants, being displaced from their homes and families is a lonely experience, one that prompts them to form new relationships in the United States.

Adding to the problem, both Mexico’s northern and southern borders have become magnets for prostitutes and drug dealers, drawn by the flow of migrants north.

Not even the fact that the research is ongoing and apparently has yet to provide comparative figures to establish higher rates and spread – at least none at all are quoted – is allowed to restrain the busy Lacey from painting this lurid picture complete with the deaths of Mexican babies and bewildered Mexican husbands and wives accused of lying under the threat of the stigma when they claim not to know how they could possibly have contracted the Virus.

But the stigma surrounding AIDS in Mexico is such that even migrants who have contracted the virus dismiss the notion that extramarital affairs were a factor.

Another H.I.V.-positive migrant, a mother of three named Ana María who is now taking government-dispensed antiretroviral drugs, had gone to the United States with her husband and worked long hours in a fast-food restaurant and hotel in Chicago. She, too, found out she carried the virus after giving birth at a Chicago hospital.

“Many people get infected there and then bring it back here,” said Ana María, who is in her early 40s. “I don’t know how we get infected but it could have been in the hospital there.” Her husband, who migrated with her and is also infected, nodded in agreement.

“I thought the crossing was the worst thing in my life,” she said, sitting on the front step of her home in a village outside of Puebla. “We saw human bones and clothes in the desert. There were robbers there, who would rape the girls and take all the money they could. I thought that had to be worst. Now, I have this.”

The piece is filled with speculation from researchers about the sociological trends at work which seems just as imaginative and ungrounded in evidence as the theories of the Mexicans themselves.

Many migrant husbands have sex with people more likely to have H.I.V., have limited access to health care and frequently cope with “the social isolation of the migrant experience by seeking comfort in sexual intimacy,” Jennifer S. Hirsch, a professor of public health at Columbia University, wrote in The American Journal of Public Health in June.

She found that unfaithful migrant husbands who were otherwise devoted to their wives were often the highest risk. They were more likely, she said, to seek sex with prostitutes while in the United States and less likely to have long-term relationships with other women.

The risks were compounded because the subject of unfaithfulness is frequently taboo within relationships. “Men’s long absences lower the reputational risk of infidelity by ensuring that it occurs far away,” she wrote.

At Puebla General Hospital, Dr. Indiana Torres said 22 percent of the 1,000 or so cases of H.I.V. and AIDS that her clinic handles can be traced to migration, mostly to the New York area. A new more spacious clinic is under construction to handle the load.

The story actually reports that there is no explosion yet in HIV positive figures in Mexico, which are half the US rate, and shows no sign that the expansion of AIDS into Mexico is anything more than the expansion of HIV testing by researchers into more remote villages than before.

AIDS has not yet exploded in Mexico and is focused mostly among prostitutes and their clients, and drug users and gay men, experts say. The AIDS rate here is still considerably lower than that in the United States, nearly half as low, according to United Nations statistics published in 2006. The H.I.V. infection rate for people ages 15 to 49 in the United States is about 0.6 percent, compared with 0.3 percent in Mexico, the United Nations says.

Yet the high-risk behavior that various surveys have documented among many Mexican migrants worries researchers. “Our concern is it could take off in this population in the future,” said Dr. Lemp, who is leading a joint United States-Mexican study of migrants and AIDS.

But no doubt there is nothing that will stop the the exploitation of whoever can be found to test positive in Mexico without regard to any objections that might be made by people who can actually compare what is going on with the literature, which is not high on the reading list of any busy AIDS researcher nowadays it is clear, even as they add to it.

After all, the next World AIDS Conference is scheduled for Mexico City next year, so naturally the hot research area is now south of the border. Presumably they expect the Mexican nation to be suitably grateful for this paving the way to supplying it with the drugs their research will reveal that it needs.

See Mexican Migrants Carry H.I.V. Home:

The New York Times
July 17, 2007
Mexican Migrants Carry H.I.V. Home
By MARC LACEY

PUEBLA, Mexico — Cres has spent almost half his 32 years working in the United States, in the fields of California and Texas and the factories of Chicago and New York. His wife and three children were with him some of the time. But he was alone for long spells, and it was during one of those periods that he figures he contracted H.I.V.

“I don’t know how or where or when I got it,” said Cres, who spoke on condition that he would be identified only by his nickname. He paused whenever his pregnant wife entered the darkened home, built with his paychecks from America. “I don’t have any idea who it was with. I don’t want to know. I just want to go ahead with my life.”

Migrant workers like him go to the United States with dreams of new prosperity, hoping to bring back dollars. But some are bringing back something else as well, H.I.V. and AIDS, which they are spreading in the rural parts of Mexico least prepared to handle the epidemic.

As sweeping proposals for immigration-law changes founder in the United States, the expanding AIDS crisis among the migrants is largely overlooked on both sides of the border. Particularly in Mexico, AIDS is still shrouded by stigma and denial. In the United States, it is often assumed that immigrants bring diseases into the country, not take them away.

But AIDS is spreading quickly in rural Mexican states with the highest migration rates to the United States, researchers say. The greatest risk of contracting AIDS that rural Mexican women face is in having sex with their migrant husbands, a new study found, a problem that is compounded by their husbands’ refusal to use condoms.

Research has shown that migrants have more sexual partners than those who stay at home. For women, life on the road brings risks of rape and sexual abuse. For many migrants, being displaced from their homes and families is a lonely experience, one that prompts them to form new relationships in the United States.

Adding to the problem, both Mexico’s northern and southern borders have become magnets for prostitutes and drug dealers, drawn by the flow of migrants north.

“Migration leads to conditions and experiences that increase risks,” said George Lemp, an epidemiologist who directs the University of California’s AIDS research program and is studying the spread of the disease among migrants. “Migrants are vulnerable. They are isolated. They are exposed to different sexual practices. They have language barriers to services and there is a lot of depression and loneliness and abuse.”

AIDS has not yet exploded in Mexico and is focused mostly among prostitutes and their clients, and drug users and gay men, experts say. The AIDS rate here is still considerably lower than that in the United States, nearly half as low, according to United Nations statistics published in 2006. The H.I.V. infection rate for people ages 15 to 49 in the United States is about 0.6 percent, compared with 0.3 percent in Mexico, the United Nations says.

Yet the high-risk behavior that various surveys have documented among many Mexican migrants worries researchers. “Our concern is it could take off in this population in the future,” said Dr. Lemp, who is leading a joint United States-Mexican study of migrants and AIDS.

The first AIDS cases diagnosed in Mexico in 1983 were found among migrants, researchers say. Since then, studies have continued to show that migrants to the United States make up a significant percentage of those contracting the disease.

The percentage of Mexicans with H.I.V. who have lived in the United States fluctuated between 41 percent and 79 percent in the 1980s and early 1990s, studies have shown. But since 1992, Mexico has not reported comprehensive figures.

Still, recent studies show the risks that migrants face. A study financed by the California-Mexico AIDS Initiative found that more than a third of the migrants at job-pickup sites in Los Angeles had been offered money by men for sex. About a tenth of the migrants, desperate to earn a living, have agreed, the study found.

Many migrant husbands have sex with people more likely to have H.I.V., have limited access to health care and frequently cope with “the social isolation of the migrant experience by seeking comfort in sexual intimacy,” Jennifer S. Hirsch, a professor of public health at Columbia University, wrote in The American Journal of Public Health in June.

She found that unfaithful migrant husbands who were otherwise devoted to their wives were often the highest risk. They were more likely, she said, to seek sex with prostitutes while in the United States and less likely to have long-term relationships with other women.

The risks were compounded because the subject of unfaithfulness is frequently taboo within relationships. “Men’s long absences lower the reputational risk of infidelity by ensuring that it occurs far away,” she wrote.

At Puebla General Hospital, Dr. Indiana Torres said 22 percent of the 1,000 or so cases of H.I.V. and AIDS that her clinic handles can be traced to migration, mostly to the New York area. A new more spacious clinic is under construction to handle the load.

“They think that because it’s the United States, it’s safer,” Dr. Torres said. “It’s their fantasy and it’s not true.”

One of the women in the emergency room at the hospital, a 25-year-old mother who spoke on condition of anonymity, said her husband had infected her after returning from a long stay in Washington State.

She found out that she carried the virus only after giving birth to a girl who was born with H.I.V. and died. An older daughter also contracted the virus from birth. The woman and her husband have since separated.

Doctors say routine screening for H.I.V. is not common, and many people find they are carrying the virus only after births or going to hospitals for other reasons.

“I don’t know what’s going to happen now,” the woman said through tears and an oxygen mask to aid her breathing after she was admitted with a possible tuberculosis infection, which her weakened immune system may have permitted.

Mexico provides antiretroviral drugs even to poor migrants without health insurance, but the challenge for them is reaching the cities where the drugs are dispensed. The transportation costs strain their budgets. Taking time off from work for doctor’s visits is another challenge.

The government has also slowly begun to acknowledge the problem, sending health workers into the countryside to visit returning migrants and teach them about the risks they face on the road. One program is called “Go Healthy, Return Healthy.”

Government health workers are focusing their prevention efforts not just on returning migrants but on those who intend to go. A variety of approaches have been used, from comic books to soap operas. The messages focus on the causes of AIDS, the benefits of condoms and the dangers of sharing needles.

But the stigma surrounding AIDS in Mexico is such that even migrants who have contracted the virus dismiss the notion that extramarital affairs were a factor.

Another H.I.V.-positive migrant, a mother of three named Ana María who is now taking government-dispensed antiretroviral drugs, had gone to the United States with her husband and worked long hours in a fast-food restaurant and hotel in Chicago. She, too, found out she carried the virus after giving birth at a Chicago hospital.

“Many people get infected there and then bring it back here,” said Ana María, who is in her early 40s. “I don’t know how we get infected but it could have been in the hospital there.” Her husband, who migrated with her and is also infected, nodded in agreement.

“I thought the crossing was the worst thing in my life,” she said, sitting on the front step of her home in a village outside of Puebla. “We saw human bones and clothes in the desert. There were robbers there, who would rape the girls and take all the money they could. I thought that had to be worst. Now, I have this.”

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