September 21 - September 27, 1995

EVERY FRIDAY NIGHT, Alex Roper drove from Tucson to Nogales, Sonora, to stand in the heat of hundreds of warm male bodies packed into cantinas along Avenida Obregon. From his twenty-first birthday on, Roper and his friends fed their addiction to the raunchy, sensuous night scene--oceans of men, just off work, jammed together side to side, front to back.

By 2 a.m., quarts of beer were still streaming from the bar, moving past the steamy crowd of heads in a sea of jukebox ranchera rhythms. Occasionally a knife fight broke out when security guards were out of sight. The only women around were those wanting money. Men in drag circulated. When Nogales policias came through, the men of the night were hauled away to jail for a day or two.

Roper and his buddies braved the wallet and jewelry lootings in the cantina baños, relishing other risky prospects in the sultry atmosphere of promiscuity. They'd always meet macho, married men or other seemingly straight "hombres," who appreciated sex, as long as they were a "top." In Mexico, and many other countries, the colloquial definition of gay is dependent on the assumed sex position. If you're giving it, you're not homosexual; if you're getting it, you are. The ideal man is "straight."

Few openly gay bars exist in Sonora. Nogales has none. But throughout Mexico, cantinas are meeting places for men of all classes. In Nogales, as in other cities, a handful of cantinas serve as safe havens for men to find men for sex.

Just $150 bought Roper a weekend with a Mexican lover. Dining out and sleeping in Nogales lairs became ritual. He never paid for sex, but sometimes offered his weekend companions 30 pesos for taxi fare home. His lovers, often married with families, included lonely factory workers, lawyers and doctors.

Roper always brought Condoms to Nogales, but rarely disclosed his AIDS status. Even in the '90s, Roper quickly learned condoms weren't popular among his sex partners. He insisted they use lubricant jelly; many had previously used oily hand creams or nothing at all. "I'd tell them it's not just for me but for the women you're with."

IN SONORA, ONE of Mexico's most affluent and conservative states, nearly 60 percent of HIV cases are men who have sex with men, according to March '95 government statistics. Reporting AIDS cases to the secretary of health in Mexico City became a legal requirement only in 1986. Since social stigma for testing abounds, international and national health officials believe Mexico's actual HIV incidence is considerably higher than statistics indicate. The World Health Organization estimates for each HIV case reported in Mexico, there are at least four additional unreported cases out there--people undiagnosed or those who don't report to the state health department.

Many Sonorans associate HIV with gay foreigners and call it the "gringo gay disease," or the disease that strikes rich men who travel a lot. Earlier informal studies indicated a substantial correlation between migration and the incidence of HIV. A former health official says many of the early HIV cases were Sonorans who crossed the border for entertainment--some would buy American Levis, shampoo and porn flicks to sell back in Sonora. Agricultural workers who flocked across the border to Arizona also had high infection rates.

Young men heading north for work often are liberated for the first time from small community constraints and Catholic Church dictates, writes Mario Bronfman, a sociologist at the Colegio de Mexico research institute. Bronfman has documented the correlation between migration and AIDS transmission. Workers may pursue gay relations that would mean ostracism in their home villages. Back at home, they resume heterosexual relations with their wives and girlfriends (In March, heterosexual HIV comprised 18 percent of Sonora's cases, according to the Public Health secretary. The numbers are steadily increasing.

In Latin America, family interdependence is valued. Out of respect for parents, a gay man doesn't usually make the decision to blast out of the closet, says psychotherapist and longtime AIDS activist Guillermina Contreras-Arriola. "They will first satisfy the expectation of getting married and having a family. Later they might fulfill their need to be in relationships with men," she says.

While early statistics on HIV infections were thought to be higher along frequently traveled routes from the United States through Sonora, by early this year, individuals in villages off the gringo trail were turning up positive in increasing numbers. Mexico now suffers the fourth-highest AIDS toll in the Western Hemisphere. Since the beginning of Mexico's documentation of HIV infections less than a decade ago, rates in Sonora have increased eleven-fold.

In a largely Catholic environment, where the pope's edicts against Condoms and homosexuality are clearly voiced, outsiders say the climate is prime for unprotected sex--increasing the probability of HIV spreading.

ON A WINDY March morning, Dr. Luis Guerrero navigates down crowded Nogales side streets where most touristas don't venture. The infectious disease specialist is one of a handful of Nogales, Sonora, physicians treating AIDS patients. He formerly directed Centro Información Para La Salud (CISAL), one of the government-run HIV health clinics in Nogales. Guerrero holds dual U.S. and Mexican citizenship. Through his HIV program coordinating position with Arizona's Santa Cruz County Health Department, he has an astute perspective on people living with AIDS on both sides of the border.

Inside CISAL, at the back end of a government-run drug and alcohol detox center, several nurses in starched uniforms and stiff, white hats await Guerrero. Bright stucco walls, shiny linoleum floors and expansive tables with neatly stacked brochures oddly emphasize the empty corridors and clinic rooms. In 15 months, the clinic staff has taken only 150 blood samples. Eight were HIV-positive--all were men who'd had sex with men.

Asked about the vacant lobby, Guerrero explains people fear coming in for the test because of the stigma associated with showing up at an HIV clinic. Thus, the nurses must go out on the streets, to schools, maquilas (factories), churches and into colonias (neighborhoods), promoting free tests, safer sex and bleaching I.V. needles.

Nurse Maria de la Luz Villarino can be seen around the churches Santuario Guadalupe and Purisima Concepción, where the homeless frequently find meals and a place to sleep. It's there she meets men and women resorting to street sex because they're broke.

ONE ANONYMOUS physician living in Sonora for 20 years says he's never seen a condom distribution campaign as strong as in Nogales. But sources say due to funding, the clinic is still frequently in low supply.

Villarino insists the government provides the clinic with everything it needs: blood sample tubes, needles and gloves. Free exams are offered by the clinic. Sometimes medications are not available, says Guerrero. But if the patient can wait, arrangements are made for medications and treatment (See related story on health care for HIV). But even for those with better connections, the wait is too long.

The Mexican government's HIV prevention crusade is touted by many U.S. AIDS activists as unreserved. Although the pope preaches monogamy and is opposed to homosexuality as well as condom use for heterosexual couples, observers say the church and government historically operate separately in Mexico.

Condoms are discussed openly, despite religious critics' complaints condom education is connected to the United Nation's International Monetary Funds' push for population control. Government-sponsored brochures depict how to correctly use a condom.

Since the late '80s, as many as five daily government-sponsored TV spots have brought the HIV prevention message to TV screens across Sonora. TV talk shows and radio call-in programs are common. Guerrero says in the six TV programs he appeared on, he often spoke candidly about condom use.

As Mexico's AIDS cases explode past 22,500, the national education strategy for HIV-prevention continues to target what health officials call the highest risk groups: all women, prostitutes, teens, maquila (factory) and health workers, men who have sex with men, as well as I.V. drug users (I.V. drug use is one of the fastest-growing risk behaviors in Nogales, say Mexican health officials).

Hemophiliacs are not considered high risk, officials say, because in the '80s, most Sonorans with the blood disorder couldn't afford factor eight and nine--later discovered at times to be contaminated with HIV. Yet others voice concern there are no comprehensive hemophilia centers in Sonora and hemophiliacs potentially infected with HIV-contaminated plasma are not annually tested.

Dr. Henry Richard Viater, manager of Sonora's 48 blood banks, says since 1988 each unit of blood has been tested for HIV antibodies. Mexican health officials say HIV transmission through transfusions was higher before the government's rigorous testing policy and that's what the statistics represent. But those numbers may climb. According to a '94 World Health Organization paper, there's an average 10-year gap between HIV infection and AIDS onset.

Unlike many other economically depressed countries, Mexican health officials acknowledge the threat of HIV and are avidly pursuing public education. Hugo Vilchis-Licon, an epidemiologist with the Pan American Health Organization, says Sonora is one of Mexico's best states in working on HIV-prevention, education and treatment.

Most dramatic is the government's HIV prevention program in the schools. In Nogales, where the census forecasts youth as nearly half of the residents, sources say most parents don't lament the government's involvement in HIV education as does the religious right movement in the U.S.

Hector Gonzalez, a biochemist working for the quasi-governmental task force National Commission for AIDS (CONASIDA), draws blood for HIV antibody testing in Guaymas and San Carlos. On his own time, Gonzalez gives HIV prevention talks to teens in the schools. Not one school in Guaymas has rejected his talk in their biology curriculum, he says. During his descriptive discourse, Gonzalez hands out condoms and discusses sex toys.

"(The students) are open about everything," he says. "We talk about all sexual practices--anal, vaginal, oral, S&M."

But grassroots HIV prevention educators working the streets in Guaymas, Hermosillo and Nogales say the weak end of the government's crusade is enforcement of confidential testing and treatment for those carrying HIV. For the unemployed, they point out, medications are difficult to come by unless paid for out of pocket, which most Sonorans can't afford.

Dr. Melba Muñiz, coordinator for CONASIDA in Mexico City, verifies the government's first priority is prevention. Treatment comes second.

Whether realistic or not during Mexico's current period of economic austerity, Sonorans with AIDS say for their quality of life to improve, government funds must be more equitably distributed toward hospital care, routine tests, medications and food supplements. Government health officials would argue treatment is available to those in need. They say employees working government jobs receive medical privileges. And for those without health insurance, the process may be convoluted and uncertain, but eventually treatment can be arranged.

Sonorans generally travel to the U.S. for reasons other than medical treatment, says Guerrero. Even though Mexico has a national policy requiring strict confidentiality with HIV test results, several sources say unauthorized releases of information are not uncommon. What's more, stories are constantly circulating about HIV-infected government workers losing their jobs. "Confidentiality is a problem," says Guerrero, "just like it is in the U.S."

FIFTY-TWO HOURS of waiting had passed since Raul Medina checked himself into a Social Security hospital in Hermosillo. After an admissions interview, the blood tests, more questions and the examination, Medina was assigned to a private room in the middle of a long, scarcely traveled hall in the hospital's isolation ward.

As Medina lingered alone, anticipating his doctor's visit, he questioned whether he'd made the right decision in coming to the hospital. Lack of energy had worried him for months. Then a former companion died of AIDS.

As the 26-year-old accounting student nervously awaited his lab results in his sequestered hospital bed, he watched nurses, technicians, janitors, even the kitchen staff crowd around his doorway in shifts. Listening to the murmuring outside his room, he heard someone say, "There he is, the infected one."

By the time Medina's physician told him about his HIV-positive status, his entire family also had been informed.

The day Medina returned to The University of Sonora to continue his studies, he noticed silence among his friends. Acquaintances avoided eye contact. He didn't put it all together until a passerby yelled, "Infected faggot!"

He learned from a friend that one of the hospital workers had broken the government HIV confidentiality law. From there, word spread.

Neighbors yelled obscenities and threatened Medina's family. They pounded on the door to his family's home, insisting they move. At school, his brother was constantly harassed and teased.

"I was taunted for being gay and for (being) infected. It was (considered) one and the same," says Medina tearfully. "People would walk up to me and tell me they were glad I had AIDS."

Medina's story isn't uncommon for Sonorans with HIV. Two years ago, Guadalupe Robles suffered similar public humiliation in Ciudad Obregon. The 25-year-old teacher was just recovering from the shock and grief of her husband's AIDS-related death. She also was adjusting to her own AIDS diagnosis along with that of her one-year-old daughter's.

She was refused treatment for two painful molars after she revealed her HIV-positive status to her dentist. Her babysitter's family disinfected their rambling one-story house and refused to continue watching her child. Soon the entire colonia knew of Robles' diagnosis.

"Even though the (Mexican) government has made a big effort in dealing with HIV," she says, "the biggest problem is the (community) attitude."

It's a problem that won't go away soon. And the number of victims continues to grow.

Prostitutes And HIV

By J.E. Relly and Jim Wright

AT A CORNER near the border fence in Nogales, Sonora, a balding Alaskan between fishing stints asks the gentleman shining his shoes where he can find a woman for a little action. When he doesn't receive an answer, he walks one block away and asks several women coming out of a hotel.

Prostitution is an accepted part of Mexican society, says Dr. Eleazar Garcia, a physician who formerly practiced in Sonora. In any city, you can find the Zona de Tolerancia, an area where sex workers are commonly found cabarets and bars.

Survival sex is a common means of quick income in Nogales, particularly for those working their way up from South and Central America, says Garcia, who once did research surveillance work on sex in the border town.

While maquilas (factories) pay workers $4 or $5 for a full day's work, a sex worker can make $10 to $20 per person giving blow jobs. Interviewees told Garcia that after five nights of sex, they had enough money to jump the border fence and, with the help of a coyote, make it to Phoenix or L.A.

Theresa Mendez, HIV coordinator for Mariposa Community Health Center in Arizona's Santa Cruz County, says their clinic outreach workers give HIV education to the so-called "tunnel kids," who regularly have survival sex.

While prostitution is counted as a profession by Mexican health officials, it's not considered legal by the government. There are only 10 documented AIDS cases among prostitutes in Sonora, according to March '95 statistics from the Mexican Secretary of Health. Officials say that although the HIV numbers point to I.V. drug use as more of a problem than prostitution, the statistics don't show how many of those infected would rather admit to drug use than sex for money.

Not surprisingly, health officials indicate their numbers under-represent infections--in Hermosillo alone there are an estimated 700 sex workers--20 percent male. Community activist Enrique Perez Gomez says many sex workers don't participate in the government screenings (which include HIV tests every three months) because a positive test puts them out of business.

One health official says in the early morning hours, police make sweeps of the cabarets (brothels) checking sex workers for government-issued health cards. Those without cards are hauled into jail for the night. The next day they're taken to the health department and tested for sexually transmitted diseases and HIV.

Garcia, who for two years directed an Agua Prieta clinic treating sexually transmitted diseases, says at times sex workers were brought into his clinics drunk. Sex workers often said that if they suggested their clients use condoms, they'd fear he/she was sick. Generally, says Garcia, sex workers wouldn't mention condoms and would leave the decision up to their clients.

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September 21 - September 27, 1995

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