Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track D: Social Science: Research, Policy & Action
prevalence was 30.6% (52/170), but it differed by exposure and geographic origin group:
38% among (IDUs), 10.2% among non-injecting drug users; 63.9% among Brasilian and
23.5% among Columbian transsexuals.Three seroconversions occurred during II 2 persons/years (p/y) of observation (rate = 2.7 per 100 p/y): all of them occurred among
Columbian transsexuals (rate= 10. I per 100 p/y); one of 3 seroconverters was IDU and
one reported having a known HIV partner, but all the 3 participants did nriot report a regular condom use with the clients. During the follow-up, a reduction in drug taking practices
at risk for HIV infection was not observed; howeve, only 13/62 (20.9%) IDUs reported
needle sharing. By contrast, a statistically significant increase in regular condomn use was
observed: in the whole sample (61.2% vs 47.6%, p<O.01), among HIV positive patients
(76.9% vs 46.2%, p<0.0 1O), among Brazilian (77.8% vs 58.3%, p<0.05) and Columbian (85.5%
vs 58.8%, p<0.05) transsexuals.
Conclusions: The number of immigrants contacted by our program emphasizes the need
for easy access to care and treatment for marginalized populations often involved in practices at risk for HIV infection. Counselling seems to be effective in promoting safer sex within this population groups.
Laura Spizzichino,VialeTiziano 108, 00196 - Roma, ItalyTel.: 39-6-3232329, Fax: [phone], emai: [email protected]
Tu.D.2904
TWO BORDERS, ONE COUNTRY: SEXUAL BEHAVIOR OF MIGRANTS AND
HIV INFECTION RISK PRACTICES AT MEXICO'S SOUTHERN AND NORTHERN
BORDERS.
Bronfman PM.,* Rubin-Kurtzman, J.** *CONASIDA / Instituto Nacionai de Salud Publica,
M6xico; **Pacific Institute for Women's Health, U.S.A.
Two mechanisms frequently associated with the geographic spread of HIV are international
travel and labor migration. Despite their presumed association, there is relatively little
research on the migration - HIV/AIDS relationship.Two important issues to consider are
the direction in which the infection spreads in specific regional contexts and the factors
which increase the risk of HIV among migrants.
This paper will present findings from two studies of the sexual behavior of migrants and the
adoption of HIV-risk behaviors in different regional contexts. As the process of globalization
strengthens links between people and labor markets in distant places, it is increasingly
important to understand the impact of migration on health and the spread of diseases such
as HIV/AIDS.
The first study focuses on the sexual practices of Mexican migrants to Los Angeles.The
specific research question is how migration to Los Angeles has contributed to changes in
the sexual practices of Mexican migrants and increased their risk of HIV.Two hypotheses
are advanced.The social behavior hypothesis argues that migrants to Los Angeles are likely
to engage in high risk sexual practices which increase their risk of HIV infection because
they seek companionship to compensate for the alienating aspects of the migration experience, there are fewer constraints or social controls on their behavior, they are exposed to
sexual behaviors and practices previously unknown or unacceptable to them, and precarious economic circumstances compel some migrants to exchange sexual services for food,
lodging or money ("survival sex").The mechanisms of infection hypothesis argues that the
increased risk of HIV among Mexican migrants is associated with four factors: low levels of
knowledge regarding the mechanisms of infection and prevention, multiple partners, low
condom use, and increased drug and alcohol use.
The second study considers the sexual behavior of migrants at the border between Mexico
and Guatemala.The trans-border city of Ciudad Hidalgo, Mexico and Tecun Unian,
Guatemala is located on the commercial north-south truck route along the Pan American
Highway. It also is a stopping point for undocumented male and female migrants fi-om
Colombia, Panama and Central America who spend an average of 3-6 nionths in this location working to earn additional money for the trip to the United States and arranging the
contacts necessary to insure their safe arrival at their final destination. Among the migrants
are many women who sell sexual services to the truckers in order to finance their journey
The goal of both studies is to clarify the dynamics of the migration process associated with
the spread of HIV. Both studies utilize qualitative research techniques including in-depth
interviews with regular and key informants and ethnographic fieldwork to consider how
variations in the regional context lead to differences in the adoption of HIV/AIDS risk
behaviors.
Mario Bronfman, Calzada De Tlalpan 4585 2DO. Piso ColoniaToriello Guerra Delegacion
Tlalpan, Mexico, D.F.C.P I 4050.Tel: 528- I 8-87, 528-19-49.
Tu.D.2905
MIGRATION, COMMERCIAL SEX AND HIV INFECTION: PROBLEMS AND POSSIBLE
INTER VENTIONS
Uribe-Zdinia Patricia*, Bronfman M*, Sejenovich, G**, Rodriguez, S**, Halperin D', Ortiz
Vi, de Case LE*, del Rio C*. *CONASIDA and Colegio doe a Froiiteia Suc Mexico.
Introduction: HIM prevention interventions are difficult in areas where theie is hig h population turnover as occurs at border regions. In Mexico's southern bon-der with G; atemala
migration in closely linked to commercial sex and thus, because these migrants are illegal.
they have limited access so health care. Because HIM infection is an increasing problem in
Central America from where most illegal migrants come to southein isexico, we siought to
identify useful and effective interventions that could be used in these region to limit the
spread of HIM infection.
Methods: We evaluated between 1994 and 1995 patterns of migration occurring in two
cities (Tuxtla Gutidrrez and Ciudad Hidalgo) in the southern Mexican state of Chiapas and
analyzed these key issues that facilitate or make difficult an education~al inlers'erion directed to migrant commercial sex workers in these cities. We used both qualitatise as well as
quantitative strategies to collect information. Analysis of the qualitative data was performed
by trained personnel and quantitative data was analyzed using SPSS.
Results: In both cities commercial sex is practiced in areas strictly regulated by local authorities who perform mandatory health evaluations including HIM testing. Inely thiee percent
of commercial sex workers are illegal migrants from Central Amecica wtre sic.y air average

of 3 months at any specific site.Their clients include: truck drivers, the military, customs
agents and locals, thus clients tend to be also very mobile.The level of iclre-,,cr0 about

Tu.D.2904 - Tu.D.2908
HIV/AIDS and STD prevention is very poor in both populations (CSW and clients).They
frequently state that HIV testing is how they protect themselves, they believe that HIV
infection is "something that shows" and they don't use condoms regularly We identified
those factors that may facilitate or make difficult a possible intervention. Additionally possible interventions to be carried out in this region where identified.
Conclusions: Any prevention strategy must involve local authorities and health officials from
the region. Because of high mobility, interventions must not be directed to the population
but rather to specific fixed points such as brothels, customs, bars, and other places where
truck drivers and the military tend to congregate. AIDS information must include dynamics
that improve self-esteem, as well as discussion about issues related to organization, economic and cultural aspects of the region and those targeted in the intervention. It is necessary to establish mechanisms that make decision makers aware of results f-rom research and
intervention studies in order to develop coherent policies.
Patricia Uribe Zuniga, Claz. de Tlalpan 4585 2do Piso. Col.Toriello Guerra, Deleg.Tlalpan
Mexico City Mexico Tel.: [phone].4848 Fax: [phone]
Tu.D.2906
HIV/AIDS IN A MIGRANT EXPORTER MEXICAN STATE
Santarriaga, Martha., Magis, C., Loo, E., Baez-Villasenor, J. del Rio, C. National AIDS Council
(CONSIDA), Mexico.
Objective:To evaluate the local impact the AIDS epidemic in Michoacan of the MexicoUnited States migration.
Methods:The National AIDS Registry and the Michoacan Sentinel surveillance database
were used. Sociodemographic profile and risks practices were also evaluated.
Results: Up to December 1995, 7 I 5 AIDS cases have been reported in this state. In 1989
the proportion of cases among men having sex with men was 27%, I 6% were bisexual
men and I 6% heterosexual. By 1995 the cases amongnmen having sex with men decreased
to 22%, in contrast cases among bisexual men increased to 23% and heterosexual cases
rose to 33%. In this state, male rural AIDS cases are increasing at a rate of 793 per 100,000
inhabitants.This rate is in the 75 percentile. From 1990 to 1995, 14,000 persons (homosexuals, bisexuals, and heterosexuals) have volunteered to participated in a name-linked sentinel surveillance in Michoacan. In 199 I seroprevalence in homosexual males was 3.6% and
0.86% in heterosexuals. In 1995 the seroprevalence for homosexual men was 12.7% and
3.4% for heterosexual.Thus seroprevalence increased threefold among homosexual men
and fourfold among heterosexual men.
Conclusions:The links between U.S. temporal migration and AIDS in Mexico have been
already established. Mexicans that travel to work in the U.S. and return to Mexico often
engage in high risk sex or drugs in places where they are exposed to higher HIV seroprevalences.This mechanism is already contributing to a heterosexualization of the AIDS epidemic in Michoacan a rural state in Mexico wich exports a large number of temporary migrants
to the U.S., a trend warranting further studies.
Martha Santarriaga, Calz. deTlalpan 4585 2do Piso. Col.Toriello Guerra, Deleg.Tlalpan
Mexico City Mexico.Tel: [phone].4848 Fax: [phone]
Tu.D.2907
OUT OF AFRICA;AIDS, RACE AND SOCIAL POLICY IN THE PETER MWAI AFFAIR
Heather Worth. New Zealand AIDS Foundation
Issue: The political, media and social policy response to New Zealand's only common law
case involving infection with HIV.
Project: The Peter Mwai case bore many resemblances to the Canadian Charles Ssenyogga
incident. Mwai, a Kenyan musician in New Zealand on a visitor's permit, was charged with
six HIV r elated offences.The charges rested oen a number of allegations:That he was HIV
positive, that he was aware of his positive status, that he understood the implications of
unprotected sex and he insisted on not using condoms.This paper examines the responses
of the media, politicians and public policy makers to the Mwai case.
Results: HIV and AIDS accentuates corporeal struggles around sexuality, gender and race.
The Peter Mwai case highlighted these paradoxical intersections which pit gender and race
around issues of bodily pollution, purity, and otherness. It generated generalised public outrage.The media took a prurient interest in Mwai, in his Africanness and his so-called sexual
predatory 'nature'. A number of politicians used the case as an opportunity to argue for
mandatory HIV testing of immigrants and refugees. However, there was little made of the
fact that the case raised important public policy issues about New Zealand society and
women's ability to insist on condoms.
HeatherWorth, PO Box 6663, Wellesley St, Auckland, Austrailia Ph [phone]
Fax:[phone] e-mail: [email protected]
Tu.D.2908
HIV ANTIBODY TESTING AMONG FILIPINO MIGRANT WORKERS: POLICY
IMPLICATIONS FOR PREAND POST TEST COUNSELING
Resurreccien Peter and Fleras J. ReachOut AIDS Education Foundation, Philippines.
Issue: Accredited laboratories performing HIM antibody tests to Filipino migrant wor-k applicants are net able to provide pre and pest test counseling due to the large number of
applicants arid a lark of skilled counselors. As such, breaches in confidentiality and individual
rights to testiirg are violated.
Project: Reachctut AIDS Education Foundation embarked on a project that provided a laboiatory-based pro and post test counseling to migrant work applicants. Procedures for the
release of test results by private recruitment agencies and laboratories wei'e surveyed
which indicsted that most clinic and recruitment personnel were net aware and insensitive
to issues on HIM testing. Nearly half of migrant work applicants who were provided coonsoling did not know they were being tested for HIM antibodies. Counseling data indicated
that more than half of the applicants engaged in risky sexual activities in the last six months
prior so thie inter-views, and a quarter of them wore clearly in the window period.
Result: Close to ten percent of the total somber of migrant work applicants deployed
every syear weie reached in two years. Mid project evaluation indicated that applicants were

more aware of risky practices and ways to reduce risks while working overseas.Two laboratories have requested for a training of their staff on counseling.,,O
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