Addressing HIV/AIDS and Tuberculosis at the US-Mexico Border: A Collaborative Approach

5. HIV/AIDS and TB at the Border Blanca Lomeli Regional Director, North America

6. HIV: 34-46 million infected Worldwide • Each day 15,000 infected (5.4 mill. new infections per year) • Over 50% of new infections –individuals between 10-24 years of age. • 18.8 million deaths (cumulative) • 5 M new infections and 3 M deaths in 2003 10 individuals infected/ minute Tuberculosis • Global Epidemic 9 Million people developed • TB in 2003. 2 million died. • Higher increase in rates in African Countries • where AIDS epidemic is stronger. • 48/100 thousand people, infection rate in Baja • 69% of cases in SD originate outside the US

7. HIV and TB: Similarities • Chronic, infectious diseases, high stigmatization • Stronger impact in developing nations • Long-term treatment required (6-9 mo for TB only) • Debilitating effect, fatal diseases • Co-infection is common given affected immune system • Preventing HIV is crucial for TB Control

8. Gender considerations: • Progression from infection to disease is quicker in women than men • Culture affects women’s access to health care services • ‘Vulnerability’, domestic violence, increases HIV risk • Lack of ‘empowerment’ puts women at risk and prevents them from demanding quality services • Risk-taking behaviors prevalent in men put them at risk for HIV • Higher mobility in men increases risk of infection for TB

9. The Nature of the Epidemics • HIV/AIDS is a hidden epidemic. You don’t know you have an epidemic until its too late. • Initially the epidemic stays concentrated in groups whose behavior puts them at high risk: • Sex workers • Migrant laborers (interact with sex workers; injecting drug use) • Injecting Drug Users • Men who have sex with men • Street children/Abused children • Soldiers (interact with sex workers) • Women • Unless contained, the epidemic moves from these group to the general population, through the “sexual networks” of those who are infected.

10. The Nature of the Epidemics • Tuberculosis is a silent epidemic. It is believed to be under control. • The epidemic affects the most vulnerable. Often the forgotten. Poverty, immune system affections and addiction fuels TB. • TB is acquired by ‘breathing’ the bacteria from an infected individual. It affects the lungs and the entire body. Fatal if left untreated. • An ‘infectious’ (smear positive) TB case can infect up to 15 individuals every year. • Treatment requires 6-9 months. Individuals often stop medication after a few weeks if feeling better. This happens when no follow-up is provided and it creates resistance. MDRTB is much more difficult to manage and cure and more expensive. • DOTS –Directly Observed Therapy Short course. Health workers visit patients at home and watch them take the medication. It is a WHO goal to provide DOTS to at least 85% of the cases and ensure treatment success.

11. PREVENTION OF HIV IS POSSIBLE -Why has the HIV/AIDS epidemicbeen so hard to beat? Individual Challenges: The Gap between Knowing & Doing Fertility Pressure Poverty/ Short-term Survival Traditional Beliefs/Taboos/ Stigma Gender Roles Civil Unrest/ War Life Expectancy/ Future Thinking Substance Abuse Health Status/ STIs

12. TB Control –The Challenges Individual and System Challenges TB Control –the challenges Low awareness No detection Poverty: no access to MDRTB meds Traditional Beliefs/Taboos/ Stigma Gender Roles Migration: Difficult follow-up Low collaboration/ No Tx continuity Substance Abuse HIV + Status

13. HIV-AIDS and TB at the US-Mexico Border The Challenging Context • High population mobility- 12 million people -400 million crossings/year (1999) -close to 90 million crossings/year SD-TJ • 40% of population (5M) live in California-Baja California • Diseases and border issues, know no borders –people and politics do.. • Need for collaboration on binational issues • Not enough systems or infrastructure for binational collaboration in place

14. HIV-AIDS Border Challenges…Context, Continued • Decreasing interest of public at large • Lack of awareness of TB situation • Insufficient prevention and care services (Mexico) • Differences in policies, case definition, treatment, language, etc. • Different approaches to border issues (“not good” for US, “better off” for Mexico) • Lack of collaboration between “east” & “west”

15. Key prevention/control strategies Binational Collaboration is Needed.. • Increase HIV/prevention • Improve prevention, treatment and control of Sexually Transmitted Dieseases • Combined HIV and TB treatments through DOTS + • Increase awareness and detection • Long term commitment • Reduce poverty, increase access to healthcare

16. PCI US-Mexico Region Offices National City: BHI and BRO Mexicali: BHI Tijuana: PCI Tijuana (MSC) and BHI Programs Mexico City

17. Examples of PCI US-Mexico HIV/AIDS and TB programs • Masculinity project • RH School-based project • ‘Empowerment’ of women

18. ‘SOLUCION TB’ project • 100% TB program funded by USAID • Expansion of community-based DOTS workers • Increase Treatment success rate From • 65% to 85% • Focus areas –Mexicali and Tijuana (80% of TB • Cases in Baja) • 2004-2008 • Will develop a ‘replicable’ model • USAID $1.5 Million, PCI to raise $500K for project

21. Programmatic Challenges and Lessons • Uneven funding for US (more) and Mexico (less) • Budget crisis affecting social programs, increased needs • NGOs facing greater challenges and increased needs • Fluctuating political commitment • Lack of interest on HIV-AIDS from public at large, and lack of awareness about TB situation

22. Border Opportunities • Interest in collaboration • Increased border visibility (since NAFTA) and expressed political support • Increased participation and recognition of PVO/NGO community • Committed HIV/AIDS NGO community

23. Thank you/Gracias..