AIDS epidemic in Tijuana

Transgender sex worker Fernanda Sanchez waits for clients at night on a street in Tijuana’s red light district. Transgender women and gay men have the highest HIV infection rates of any group in Tijuana. Selling sex further increases risk, as does smoking crystal meth, a drug used by many Tijuana sex workers including Fernanda. She knew how to protect herself from the AIDS virus but said that “sometimes the customers are very bad and make you do it without condoms.” In November 2014 she tested positive for HIV. She said she was not worried much about living with the virus and she did not immediately seek treatment. What she did fear, she said, was la burla—the mockery. Fernanda said she once had a sex worker’s registration card but no longer bothered because no one asked for it. The card shows sex workers have registered with the municipal health department and are receiving monthly tests for HIV and other sexually transmitted infections. If they are found to be infected with HIV, the card is revoked. Fernanda grew up as the son of a butcher in the city of Lazaro Cardenas on Mexico’s Pacific coast. She left home at the age of 14 to perform in a drag bar in Zihuatanejo, a nearby beach town. She got heavily into cocaine and started injecting olive oil into different parts of her body to look more female. After moving to Tijuana, she had extensive plastic surgery on her face and body. She still had male genitals, which she said was important for business. Male-to-female transgenders often have male clients who like to receive anal sex but do not identify themselves as gay. In their minds, there is no stigma if they are having sex with a woman, even if she has a penis.

AIDS epidemic in Tijuana

Sergio Borrego, who helps run Tijuana’s Albergue Las Memorias HIV/AIDS hospice, puts a net over the face of Pedro Robles, 51, to prevent flies bothering him as he dies of AIDS. Pedro arrived at Las Memorias with full-blown AIDS six days earlier but because of bureaucratic delays in Tijuana’s medical system he received no HIV medication and died without having seen a doctor. Doctors and nurses occasionally visited Las Memorias but the hospice had no trained medical staff. Borrego said that for the most part he was “the nurse and the doctor.” Pedro spent 14 hours being driven to Tijuana in an ambulance from his home in Loreto because Las Memorias was the only AIDS hospice on the entire Baja California peninsula.

The fight against HIV and AIDS is as prevalent now as it ever was. Today more than ever, world leaders and international institutions are pushing to fight against these infections. Through prevention, there is strong hope to stop at least ninety percent of all spreading infection by 2020. Still, there are places all over the world that struggle to keep up with the solution. Photographer Malcolm Linton and writer-journalist Jon Cohen have documented hundreds of people who are directly affected by this epidemic and countless others involved in its fight. Their book, Tomorrow Is a Long Time: Tijuana’s Unchecked HIV/AIDS Epidemic documents the struggle as it stands in Tijuana, Mexico. Many of these people are victims of deportation from the US due to lack of proper papers or petty crimes. These folks find themselves in a desperate situation, living however they can. Some are homeless, use drugs, or are forced into sex work. Further, many have no ties to Tijuana in any way; some have spent their whole lives in the US and don’t speak Spanish.

Tijuana’s population is 1.3 million, with a large portion of that number being residents who are not permanent. These transient and displaced residents make up a huge number of those who already have or are at risk of contracting HIV/AIDS. For a long time, it was unclear where and how these viruses were spreading. Only until epidemiologists from UCSD (University of California, San Diego) came were professionals able to start identifying and locating these high-risk individuals. Tijuana finds itself with this large population of HIV/AIDS victims due to the unfortunate truth that many authorities, both national and international, use Tijuana as a sort of dumping ground for these people. Services that are being provided now in Tijuana, in tandem with the UCSD, are helping bring much needed care to this surprisingly substantial group of people.

HIV is three times more prevalent in Tijuana than in Mexico at large. The number of infected is estimated in the tens of thousands, due in part to the high population of deported and displaced. Only eleven percent of those infected are able to afford or receive HIV care. Tijuana is overcrowded, making access to hospice care and clinics incredibly scarce. Aiding the situation takes time and compassion. This fight happens through the shedding of stigma and awareness brought forward by images. The work in Tomorrow Is a Long Time is difficult, at times bleak, at other moments terrifying. Its detail and attention are mirrored by Linton and Cohen’s access to these people. These men are not tourists, often times going into the field with medical professionals to care for patients. This honesty and closeness is evident in the empathy of the words and photographs.

Tomorrow Is a Long Time is a document of many peoples’ tireless work in Tijuana, including Linton and Cohen. What strikes us most about their book is how interconnected so many people are. Doctors, teachers, administrators, students, photographers, writers, psychotherapists, men, women, families, gay, straight, transgender, are all intertwined. There is no easy solution. It’s with the hope and potential of this work that a little good begins. Linton himself admits, “It’s this work that helps break down a traditional barrier that may exist between people who are destitute and marginalized.”

These syndromes have the power to separate; there are people still being cast out and ridiculed. Linton and Cohen’s book is clear: the images are not about casting out. They are made with the hope of creating solutions. There is closeness in these communities. “I wanted to catch people doing what they were doing,” Linton says. The photographs are moment to moment; anything could happen next. There is a huge amount of uncertainty in this disease. Tomorrow Is a Long Time: Tijuana’s Unchecked HIV/AIDS Epidemic is full of difficulty; the images and text take time; they almost hurt. They present us with a challenge that pushes many to rise to the occasion; this work is slowly making Tijuana a better place than it was. HIV and AIDS is a social problem; it won’t disappear from Tijuana overnight. Linton and Cohen’s fight is a universal fight. It’s worth having.

“This disease will be the end of many of us, but not nearly all of us. And the dead will be commemorated and we’ll struggle on with the living. And we aren’t going away. We won’t die secret deaths anymore. The world only spins forward. More life.” – Prior Walter of Tony Kushner’s Angels In America.

AIDS epidemic in Tijuana

Outside her makeshift shelter in a section of the Tijuana River Canal known as El Bordo on the U.S. border, Reyna Ortiz holds a syringe in her mouth before injecting heroin. The canal was home to hundreds of people who injected drugs and had a relatively high prevalence of HIV/AIDS. Reyna was in one of the highest risk groups for HIV: a female who injected drugs and had regular unprotected sex with a male addict who was also injecting. Born in Michoacan in 1968, Reyna was taken by her parents to San Pedro, a suburb of Los Angeles, when she was a year old. She started using heroin in her teens, and at 23 she did a six-month prison stint for robbery. Another bust at 28 led to a three-year sentence and, when it ended, deportation to Tijuana. She had never been to Mexico. Reyna snuck back into the United States, eventually finding work as a clinical nurse associate at a center for the elderly, but another arrest led to a second deportation to Tijuana. When the U.S. government stepped up border security after 9/11, she did not even consider trying to return and settled in El Bordo. Reyna checked into a rehab center in late 2014 and took her first HIV test in three years: she was uninfected.

AIDS epidemic in Tijuana

Police and medical examiners check the body of a man who died of an apparent drug overdose in El Bordo, the section of the Tijuana River Canal that runs along the border with the United States. According to Reyna Ortiz, a homeless El Bordo resident who injects heroin, the man was rocking himself for two hours before he died. She said he had been hit by a car a few weeks earlier and was released from hospital on the day he died. Heroin addicts develop a tolerance, so overdoses can easily happen when people stop using regularly and then start again. In San Diego, police in 2014 joined several other U.S. cities and started to carry a nasal spray that contains naloxone, an antidote to opiate overdose. Tijuana in 2015 still had no such program. The canal was home to hundreds of people who injected drugs and had a relatively high prevalence of HIV/AIDS. Sharing syringes greatly increases the risk of HIV infection.

AIDS epidemic in Tijuana

Christian missionaries frequently visited the Tijuana River Canal to bless people addicted to heroin, such as Salome Quintero, a 43-year-old heroin user who lived in a nearby manhole with four others. Salome became addicted in his twenties and had been to rehab six times. Almost every day he injected with a syringe already used by someone else, a practice that greatly increases the risk of infection with HIV. The canal, which runs along the US border in this section known as El Bordo, was home to hundreds of people who injected drugs, mostly heroin, and who had a relatively high HIV prevalence.

AIDS epidemic in Tijuana

Dr. Patricia Gonzalez (seated, right) presses on a patient’s neck at a Friday first-aid clinic that she began in July 2014 in the Tijuana River Canal. The canal was home to hundreds of people who injected drugs and had a relatively high prevalence of HIV/AIDS. Abscesses typically develop in the arms and legs, but many longtime heroin users blow out veins in their limbs and have to resort to injecting into their necks. Gonzalez, local director of the El Cuete cross-border research project into HIV/AIDS and injecting drug use, was frustrated that so many of the participants came to her downtown office with untreated medical conditions. In the canal, she and her staff cleaned wounds, performed HIV tests, and distributed condoms. They also referred people to better equipped clinics such as Prevencasa, which provides space for a Saturday program called Health Frontiers in Tijuana, run by medical students. Gonzalez’s team stayed for three hours and typically treated about 30 people.

AIDS epidemic in Tijuana

Martha Patricia Ruiz, 53, was one of many women who sold sex in Tijuana’s Zona Norte red light district. Her spot was across the street from the office of the El Cuete research project, which investigates the link between injecting drug use and HIV. In 2012 she had an HIV test at El Cuete that came out positive. Martha Patricia ran away from her parents’ home when she was in fifth grade after being beaten by her father with an electrical cable. She came to Tijuana at 34 to get away from her husband, a trapeze artist who owned a circus in Chihuahua. She cleaned houses in Tijuana until she met a woman in a taxi who offered her a place to stay and introduced her to sex work. “I really didn’t want to, but I told myself I had to,” she said. She soon developed a serious heroin addiction. Martha Patricia went in and out of rehab but said at the end of October of 2013 that she had not used heroin in seven months. She said she had about five regular clients, and she disclosed her HIV status to them as well as insisting on using a condom. She went on and off antiretrovirals.

AIDS epidemic in Tijuana

Sex worker Oscar Villareal, 28, smokes crystal meth one evening in his room at a boardinghouse in downtown Tijuana. Crystal meth is a powerful aphrodisiac used by many of the city’s sex workers. Oscar called himself Beto by day and would cruise a local park for clients as a gay man, but at night he became Alessandra, Alé for short, who worked the clubs and the streets of the red light district. Oscar said Alé made more money than Beto but that the life he shared with his two alter egos was “very balanced.” As a young child Oscar lived in Tijuana but at eight he moved to Wisconsin on a visa with his aunt and a sister. He regularly returned to Tijuana to see his mother, and he had his first sexual experience there when he was 10. He said he began to let older men touch his genitals in return for candy. Back in Wisconsin he continued to trade sex with older men for treats and money. In his teens a Greek restaurant hired him as a dishwasher eventually promoted him to crew leader. He married and had a son, entertained as a female impersonator, and bought a new Ford Focus. Then in 2010 he had a car accident and was found to have no license or insurance, which led to his arrest and the discovery that his visa had expired. After six months at an immigration detention center a judge granted him a “voluntary departure.” Oscar had his first HIV test in Wisconsin when he was 18 and when he took another in 2013 he was still uninfected. He tested positive in 2014.

AIDS epidemic in Tijuana

Sergio Gonzalez (left) lies on his bunk in Tijuana’s La Mesa prison, where he was jailed the previous February for holding more crystal meth than legally allowed. He was arrested while out with friends in Tijuana on a weekend pass from Albergue Las Memorias, an HIV/AIDS hospice where he was living with his wife Araceli Contreras and son Eduardo. Araceli died that August after she stopped responding to her antiretrovirals. Sergio was not allowed to attend her funeral. Eduardo became a ward of state and was taken to live at EUNIME, a local orphanage where half the two dozen children were HIV-positive.

AIDS epidemic in Tijuana

Eduardo Gonzalez cleans his teeth before bed at EUNIME, a Tijuana orphanage where about half the two dozen children were HIV-positive. Eduardo arrived at EUNIME after his father Sergio was jailed for drugs and his mother Araceli died of AIDS at Albergue Las Memorias, a hospice where the family was living on the edge of the city. Eduardo was happy at EUNIME and received appropriate HIV care and medication.

All images © Malcolm Linton/Polaris

Caption text by Jon Cohen

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