Crossing Paths

The global incidence rate of HIV has decreased by over a third since 2019, and over half since the epidemic peak in 1995.¹ Even the number of San Diego County residents diagnosed with HIV has dropped, the incidence rate being less than half of what it was from 1993 to 2018.² Why is it that just 20 miles south of San Diego lies such a staggeringly high incidence rate of HIV within at-risk groups as compared to those same at-risk groups in San Diego? 

The second largest city in Mexico, Tijuana, is situated on the US Mexico border.³ Home to the San Ysidro port of entry, an estimated 150,000 people cross either way daily and over 46 million northbound crossings occur yearly.⁴⁺⁵ Over half of Tijuana’s residents are migrants, however the majority of residents were born in Mexico.⁵⁺⁶

The incidence rate of HIV+ people is about the same in Tijuana as it is in the United States.⁷ Mexico is considered to be “low prevalence, high risk” in regards to HIV, and the distribution of the infection varies by location.⁸ The difference lies when looking at the rates within at-risk communities, concentrations of HIV in Tijuana overlap in some groups such as intravenous drug users, female sex workers, their clientele and male sex workers.⁷⁺⁹

While sex workers must obtain a permit from Servicios Médicos Municipales, many don't, which has led to a slight uptick in HIV+ female sex workers.

Within Zona Roja, an approved red light district area in Tijuana, drugs and prostitution run rampant. While sex workers must obtain a permit from Servicios Médicos Municipales, many don't, which has led to a slight uptick in HIV+ female sex workers.⁹⁺⁵⁺¹⁰ However, overall Tijuana has been narrowing the gap in the number of men and women that have HIV.¹¹ This could be in part due to the social stigma surrounding the LGBTQ+ community, “straight” men unknowingly passing the infection to their wives after utilizing the services of homosexual male sex workers.¹¹ 

At a 2022 conference, University of California San Diego researchers presented data surrounding a recent HIV outbreak in Tijuana. Caused in part by international drug tourism, it was not inhibited by the border closure due to COVID-19. They found the HIV incidence rate among Tijuana drug users had jumped to an unheard of 11%. The rate for San Diego drug users that crossed the border in pursuit of purchasing drugs was 2.77%, but this was still higher than the incidence rate of San Diego drug users that do not cross the border for drugs. This group's incidence rate was 0%.¹² From 2020 to 2021 the number of HIV/AIDS cases in the state of Baja California had risen 106%, suggesting a direct correlation with the COVID-19 pandemic.¹³

HIV incidence rates in Tijuana had been slowly waning, in some measure due to an effort by the Global Fund for HIV to create more widely available resources for the general public and at-risk groups. Funding and governmental support was slowly reduced, and the genesis of COVID-19 meant there was even less money and resources to allocate to prevention and outreach.¹²

Unregulated sex work, intravenous drug use and a highly mobile population have allowed the problem to compound. An outreach program started by the Federal Ministry of Health hoped to educate and assist at-risk communities. Condonetasare vans provide resources like rapid HIV tests, new needles and condoms to neighborhoods that are considered high risk for HIV transmission. They are decorated with caricature condoms in an effort to break the stigma and conservatism surrounding sex and sex education in Mexico. ¹¹⁺¹⁴

“Within Tijuana at large, people really aren’t very well informed about HIV at all.”

Photographer Malcolm Linton and journalist Jon Cohen followed this beat closely for their book “Tomorrow Is a Long Time: Tijuana's Unchecked HIV/AIDS Epidemic.” When interviewed for Mother Jones Magazine Cohen stated, “There’s no coordinated, aggressive testing program or outreach program… If you are infected in San Diego and attend a good clinic, the people who care for you will closely monitor how you’re doing… If you don’t show up for an appointment, an outreach worker may contact you… None of this exists in Tijuana.”⁷ Linton stated, “Within Tijuana at large, people really aren’t very well informed about HIV at all.”⁷ 

Antiretroviral therapy (ART) drugs are available for free in Mexico to those eligible via health care, however the system struggles to meet the demand and incorrect regimens being prescribed hampers the ability for widespread change.¹¹⁺¹⁵ When interviewed for the Border Report, Edoardo Rodríguez, assistant director of Tijuana’s office of diversity and inclusion, agreed. Rodríguez stated, “The state’s health care system needs to adopt a program, it can’t be just one site where people can get tested, we need more sites to accommodate everyone.”¹⁶

Sources on bottom of page.