February 6, 2008
There's nothing like hearing the results of studies directly from those who actually conducted the research. It is these women and men who are transforming HIV treatment and care. In this interview, you'll meet one of these impressive HIV researchers and read an explanation of the study she is presenting at CROI 2008.
Hi, my name is Melissa Sanchez. I'm with the California HIV/AIDS Research Program within the University of California Office of the President. The poster [I am presenting] today is a causal analysis on the effect of migration on HIV high-risk behaviors among Mexican migrants.1 This was a study done in 2005 in response to the concern that there is a very low prevalence of HIV in Mexico, but Mexico is surrounded by a much higher HIV prevalence both on the north border -- the U.S. -- and in Central America.
The prevalence in the United States among 15-to-49-year-olds is 0.6%. In Mexico it's 0.3%. It's as high as 2% in Belize, 1% in Guatemala, 0.6% in Honduras and 0.6% in El Salvador. Mexico is surrounded by areas with a much higher prevalence of HIV. There is a concern on both sides of the border. In response to that concern, a bi-national project was developed on both sides of the border. We were looking at Mexican migrants and the potential for an increase in high-risk behaviors as a result of the migration experience. This has been hypothesized many times in the past but no one has ever [formally studied this question] -- they've looked at associations, but never actually looked at a causal impact of migration.
This study is trying to achieve that by asking our study participants about their risk behaviors prior to migration and after migration. They serve as both the case and the control for this study. We implemented this study in both Fresno county and San Diego county [in California]. It included a 35-minute survey, and we drew blood and urine. We did HIV testing and STI [sexually transmitted infection] testing, looking at syphilis, gonorrhea, hepatitis B, hepatitis C and chlamydia. We didn't see a lot of HIV, but we did see a lot of sexually transmitted infections, which certainly indicates that there is the risk of an HIV epidemic.
What kind of sexually transmitted diseases did you find?
A high prevalence of chlamydia, a fair amount of syphilis and a fair amount of hepatitis C. We did not find any gonorrhea.
We sampled from three types of venues: male work venues, which would be the agricultural work fields and job pick-up sites; bar/club venues, where we were targeting our high-risk population, specifically men who have sex with men; [and] community venues, [where] the focus was trying to recruit women -- we went to churches and Laundromats. About 20% of the Mexican migrant population in California is female. That was our way to achieve a comparable representation of the population.
[According to] the results, we have an increase in high-risk behaviors after migration -- which had been our hypothesis -- specifically in sexual partners who were sex workers. There was an increase in actual sex work among Mexican migrants and also an increase in sexual relations while under the influence of drugs or alcohol.
On the flip-side of things, we saw a decrease in low condom use [i.e., never, rarely or sometimes using condoms]. But to counteract that argument, there was also a lot more sex going on after migration. So, there was increase in sexual partners, but an increase in condom use.
Another interesting phenomenon: There was a decrease in the use of needles after migration. In Mexico, it's common practice to share needles within a family to administer antibiotics and vitamins. There is limited access [to needles] in the U.S.
We're not talking about illicit drugs here?
For the most part this is not illicit drugs. Especially with farm workers, this is common practice: For hard labor, they believe that the most effective way of staying healthy is administering vitamins via needles. That is something that is very culturally specific. In Mexico needles are very accessible: You can go to a pharmacy, over the counter, it's very simple to get needles. But in the U.S. that's not the case. Therein lies the difference. They're not accessing [needles] in the United States.
These risks were seen in the males. How did the females compare?
The higher risk is in the male population, which is 80% of our study and 80% of the [Mexican migrant] population in California. Amongst the women, we did not see any dramatic changes other than the use of needles. They, too, were not using needles as much after migration.
Are there sex workers for females? In this community -- or any community?
Keep in mind this is a sample size of 94. Two-point-one percent -- we're talking about two people -- [were women who had a sex worker as a sexual partner after they migrated]. Several of the women were from bars and clubs, and they were actually sex workers who had partners that were sex workers. Yes, female or male. That's unique, but we were able to enroll several sex workers from our study at the bars and the clubs.
I see you're showing some photographs on the poster.
This is a very tragic representation of living conditions. This specifically is an image from San Diego county, where our Mexican migrant population is having to resort to living in the hills. Certainly, some of that has to do with poverty. Obviously, a huge part of that has to do with poverty, but also the fact that for many, they're undocumented and they're trying to reside far from [civilization]. This is a very common representation of living conditions for Mexican migrants while they're here in the United States.
The farms where they're employed, do they realize where they're living?
Yes. In many cases, the farm owners develop camps for the farm workers. This one in particular is not a farm. Living conditions are very poor on the farms. It's tragic.
Our concern is that we're not seeing a high prevalence of HIV yet. [Though] we are seeing a substantial prevalence of high-risk behaviors. It has the potential to expand.
I think one of the most interesting things is that most people in the United States have seen, especially in urban centers, groups of Mexicans, for instance, in parking lots near Home Depot.
Job pick-up sites. That's one of our types of venues.
It's interesting to know that if they don't get picked up by construction sites during the day, they might end up with someone who will offer them money for sex work.
There are actually Web sites developed now where they give tips to people who want to approach Mexican-migrant, job-pick-up-site workers and actually recruit them. They are told, "Go after three o'clock, when there is a clear indication that there is no work coming for the day."
You mean these Web sites are for people who want to buy sex work from them?
They target young, young men. Thinking, "Well, they're going to be more naive, they're perhaps more desperate to make some money given that they're not going to get a landscape job during the day," or whatever the possibility. We actually had several people who collected data for the study who were approached in their past experiences.
So, this is quite common.
It's very common. Frank Galvan of Charles R. Drew University of Medicine and Science actually did a study that's just been published specifically looking at job pick-up sites and how day laborers are being approached in the late hours of the day for sex work.2
Is there any outreach to these workers telling them, if they're going to do sex work -- even by accident -- how to protect themselves?
For our study we certainly did that. I don't know if Frank Galvan's study did. I would guess so. I don't know what kind of prevention message he put out there, but it's an interesting study. Certainly, we had reports of [sex work] throughout our study, too.
This was all in California?
This was all in California, in Fresno county and San Diego county. We had a border county [San Diego] and a central, very agriculturally based county, which is Fresno.
Are you continuing to look at this population?
Absolutely, yes. This was the first step, looking at the epidemiology and trying to figure out where the epidemic is, if there is in fact an epidemic brewing. The second step [is] prevention, the third step [is providing] clinical care and access to care, and the fourth [is] policy. We are a grant-administrating organization, so we are putting out our phase for prevention. Certainly, the policy and the clinical care/access to care issues are coming in tangent with that. There are four stages to the initiative.
Great work. Thank you very much.