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Global Health Matters

July - August, 2008  |  Volume 7, Issue 4

HIV border "sub-epidemic" could spread, researcher says

A "dynamic HIV sub-epidemic" at the U.S. border, possibly caused by co-existence of a flourishing drug and sex trade, could be a harbinger of resurgence throughout Mexico and Central America, a prominent AIDS researcher predicts.

Dr. Steffanie Strathdee, a Fogarty Framework grantee from the University of San Diego, coauthored a commentary with Dr. Carlos Magis-Rodriguez in the Journal of the American Medical Association, citing high rates of sexually transmitted infections among injection drug users and female sex workers.

The paper was released at the 17th annual International AIDS Conference in Mexico City, the first held in Latin America. It calls for "shared responsibility" for recognizing and treating sexually transmitted diseases between bordering countries everywhere.

Efforts to integrate HIV and STI diagnosis and treatment are needed, on both sides of the San Diego-Tijuana border, they said. It warned, "Unless HIV prevention is scaled up immediately, Tijuana's HIV epidemic could become increasingly generalized."

Because most of the methamphetamines and much of heroin destined for the United States moves through Tijuana, and because of easy passage of people, prostitutes and infection, "In Mexico, a dynamic HIV sub-epidemic on its northern border with the United States now threatens its designation as a country of low prevalence and high risk," the authors wrote.

They said the increased HIV prevalence and high mobility in both directions across the border "may represent what lies ahead for Mexico and possibly Central America."

Strathdee and Magis-Rodriguez also suggest that because two-thirds of Tijuana's residents migrate from other regions of Mexico, those who acquire HIV may be spreading it when they return home.

Also, they say, because of the stigma attached to homosexuality, many gay and bisexual women are also having sex with women, which "may be contributing to a feminization of Mexico's HIV epidemic."

"Mexico's Evolving HIV Epidemic." Steffanie A. Strathdee, Carlos Magis-Rodriquez. JAMA. 2008;300(5):571-573.