AIDS and Migrants: A Perverse Association
The dangerous and perverse linking of migrants to AIDS,
characterizing them as “at-risk groups” and vectors spreading the HIV virus,
is rooted in cultural prejudices fed by numerous misleading statistics.
José Luis Rocha
The acquired immunodeficiency syndrome (AIDS) has earned a prominent place among the cruelest scourges to afflict humanity. The bottom line of its global impact so far is truly terrifying: 25 million deaths in 25 years and 40 million people infected with the human immunodeficiency virus (HIV), which causes AIDS. Each year 3 million people with AIDS die and another 4 million people are infected with HIV.
Before night falls…The fight against this masked plague has mobilized many good intentions and inspired devastating reflections. Cuban writer Reinaldo Arenas, who contracted HIV as an immigrant in the United States, wrote the following passage a few days before taking his own life, driven to despair by the multiplying symptoms of his deteriorating health: “I see that I am almost at the end of this presentation, which is actually my end, and I haven’t talked much about AIDS. I can’t do it; I don’t know what it is. Nobody really knows. I’ve visited dozens of doctors and it’s an enigma to them all. The AIDS-related illnesses are treated, but AIDS itself seems more like a state secret. I can state that if it is a disease, it’s unlike any other known illness.
“Diseases are the product of nature and therefore, like everything natural, are not perfect, can be fought against and even eliminated. AIDS is a perfect illness because it’s removed from human nature and its function is to finish off the human being in the cruelest and most systematic way possible. I have truly never known of such an invulnerable calamity.”
Every single hourAIDS is hitting Latin America and the Caribbean hard. According to UNICEF, the 2.3% prevalence rate for Caribbean countries is the second highest in the world. Over 2.1 million people are living with HIV in Latin America and the Caribbean, while around 240,000 on the mainland and another 53,000 in the islands were infected with HIV in 2004 alone. This is equivalent to 33 people per hour.
AIDS is currently the main cause of death among the 15-44 age group in the Caribbean, where it was responsible for the death of 36,000 people in 2004. That same year, AIDS also caused 95,000 deaths in Latin America. In other words, 15 Latin Americans and Caribbeans die from AIDS-related complications every single hour. Approximately 740,000 15- to 24-year-olds are living with HIV/AIDS in Latin America and the Caribbean, while in several Caribbean countries the number of 15- to 19-year-old female teenagers living with HIV is five times higher than the number of male teenagers with the virus.
Nicaraguan Ministry of Health figures as of March 2005 show 1,692 Nicaraguans with HIV/AIDS, of which 1,327 are between the ages of 14 and 35. But very different figures were released in an official report by the Joint United Nations Program on HIV/AIDS (UNAIDS), which in 2000 was already mentioning the figure of 4,900 Nicaraguans infected with HIV, an estimate it considered the “floor,” or lowest possible value, of the population actually affected. The “ceiling,” or highest possible value, was calculated at somewhere between 24,160 and 36,240 people. It has been widely recognized that the notable level of sub-registry in Nicaragua is a real problem.
Nicaragua’s financial, institutional Nicaragua has serious financial, institutional and educational impediments to tackling AIDS-related issues. In addition to the paltry amounts earmarked for public sector spending on health, which isn’t even enough to treat less complex and more traditional illnesses, there’s also limited governmental interest. Despite some still dispersed initiatives, such as the Ministry of Government’s project to train its prison officials to increase awareness among inmates, the National Development Plan, which contains all of the executive branch’s strategies in the areas corresponding to it, doesn’t even mention HIV/AIDS in the lengthy section on the health sector, and the Office of Human Rights Defense Ombudsman doesn’t have a seat on the Nicaraguan AIDS Commission (CONISIDA).
and educational limitations
Cultural-educational limitations appear to be an even greater obstacle than lack of financial resources. Awareness of the risk of becoming infected with HIV is notably low among the majority of the population. In one recent study conducted in five municipalities, 89% of those surveyed thought their municipality was AIDS free and 83% stated that AIDS is a problem that has nothing to do with their lives. Given such attitudes, discrimination continues unabated, particularly in the face of persistent erroneous ideas about forms of transmission that translate into attitudes of rejection.
In addition to the vulnerability implied by Nicaragua’s poverty levels, two other factors also require special attention. First, anti-retroviral treatments could end up a privilege for the most wealthy if the commercialization of generic medicines is in fact prohibited or substantially limited by the Central American Free Trade Agreement (CAFTA) with the United States. Second, the minimal health service coverage in the Caribbean coast region prevents any reliable knowledge of the true incidence of HIV/AIDS in that extensive region of the country, much less any effective treatment.
The laws of “legal globalization”There have been significant legal advances with respect to HIV/AIDS. Nicaragua had no set of legal standards governing detection, the handling of clinical results, prevention measures, response mechanisms for dealing with the epidemic or human rights protection until December 1996. That vacuum was partially filled by Law 238 on the Promotion, Protection and Defense of Human Rights.
This law guarantees the human rights of the whole of society with respect to the AIDS threat, has an educational prevention function and includes the ethical principles of non-discrimination, confidentiality, informed consent and personal autonomy. But due to a contradiction all too familiar in Nicaragua, its subsequent regulatory law has been identified as an obstacle to the encouragement of non-discrimination by establishing repressive measures—such as fines and the closing of hospitals—that do nothing to help create a propitious climate for HIV prevention and suitable treatment for those living with the virus. The original law’s promoters were seeking to protect the rights of people living with HIV and AIDS by informing and building awareness among the population; they were not looking to create new criminal categories.
Not only Nicaragua’s legislation, but also that of other Latin American countries and most of the planet, is an expression of legal globalization, of international rights that frequently find themselves swimming against the current of prejudices that are encouraged by the powers that be and end up imposing micro-visions and cosmovisions, sometimes co-opting the best of intentions.
The perverse association NGOs, their networks and certain multilateral agencies such as the United Nations Population Fund did a lot to ensure the crystallization of these laws of “global legislation.” But many threats are getting in the way of the conversion of that formal normative advance into common sense, a dominant vision and culturally consecrated practices. Let’s take a closer look at just one of those threats: the dangerous association of migrations and AIDS, which, for benign or perverse reasons, encourages a pernicious slide of the unit of analysis—and therefore of culpability—from “risky practices” to “at-risk groups.” At the heart of this slide is contempt towards minorities: people living with AIDS, migrants, ethnic groups, etc. The kind of unqualified association between migration and AIDS that often underlies all discriminating forces and appears in their analysis is prejudicial both to migrants and those living with AIDS.
of migrations and AIDS
What better way of justifying panic in response to migrants than presenting them as particularly inclined to HIV infection? What better reason to increase both fear of people living with AIDS and their segregation than assuming them to be mobile populations, bodies transporting the virus from region to region? Perhaps with the best of intentions, the UNIDOS Network of Capacity Building Assistance Providers insists that proximity to AIDS epicenters is a risk and demonstrates a correlation in the United States between states with a high AIDS prevalence and those with high migration levels.
In descending order, the states with the highest number of Latinos are California, Texas, New York, Florida, Illinois, Arizona, New Jersey, New Mexico and Colorado, while those with the highest number of AIDS cases are New York, California, Florida, Texas, New Jersey, Pennsylvania, Illinois, Georgia and Maryland. In other words, six of the nine states are the same for both categories. Presented with no further analysis on why those states have a greater AIDS prevalence, the association between migrants and AIDS allows a slide towards a doubly-reinforced fear. Thus migrants shift from being at risk to being a propagating risk, while people living with AIDS appear as a fear-provoking factor and are associated, for dark reasons, with the locations, appearances and styles of immigrants.
Many studies and preventive efforts have focused on the relationship between migrations and AIDS, running the risk of bolstering the worst causes despite the best of intentions. This relationship has been demonstrated in emblematic cases, such as that of Reinaldo Arenas, a migrant with AIDS. It is quickly forgotten that while his sexual conduct was considerably more risky in Cuba, as demonstrated by his memoirs, it wasn’t there that he contracted HIV.
Infected by the virus of ethnic purityAssociating migrants with AIDS is not, nor can it be, neutral in a world in which there are majorities who fear both migrants and AIDS. The different kinds of majorities and minorities have not always existed. Certain majorities are interested in being clearly discernable from the minorities. When they feel threatened by phenomena for which they have no explanation—such as globalization, the reduction in the purchasing power of their salaries, the deterioration of public services—they become infected by a virus that produces an itch for ethnic purity and begin to look for scapegoats to be exterminated, deported or controlled. Possessed by this virus, their identities become what anthropologist Arjun Appadurai termed “predatory.”
That obsession with purity, the terror that their whiteness could start to be tainted yellow, brown or black, is enough to make a large part of the 70% of the US population that is white—and non-Latino—feel threatened by the mere 12.5% of the population that is Latino. Appadurai has a term for this as well: “fear of small numbers.” But why fear small groups? To start with, because they’re associated with big groups: the Muslim minorities in India, the United States or England belong to a gigantic Muslim community, while the small group of Latinos residing in the United States have millions of family members in their countries of origin. And the relatively few people living with AIDS are part of a group that already has 40 million members worldwide.
Second, minorities can grow to such an extent that they could make today’s majority into tomorrow’s minority. Latino migrants multiply faster due to their higher birth rates and the family members who follow them over. And just as with a suicide bomber—a brutal example of a dangerous minority in that one person who blows himself or herself up destroys several hundred—each person living with AIDS might infect an infinite number of others with a virus that multiplies and crosses borders from body to body.
As demonstrated by US writer Susan Sontag, this line of thinking has been preached in declarations such as the charming one in 1987 by then-Secretary of Health and Social Services Dr. Otis R. Bowen urging people to remember that if you have sexual relations with another person you are also having sexual relations with everyone that person has had sex with in the last ten years. AIDS makes every sexual act promiscuous and therefore dangerous—unless it’s in a long-lasting, unfailingly monogamous relationship—and also makes it deviant, given that somewhere through the long chain of third parties all heterosexual relationships are also homosexual.
Epidemiological and migratory controlsMigrants and AIDS appear in the discourses where public health and the health of the social order intersect, and demand a control over conduct that translates into control of the body and sometimes of bodies. The profile of migrants is studied and their traffic penalized because those bodies in continuous movement have to be controlled. For the same reason people living with AIDS are subjected to the strictest epidemiological controls. Fear is what drives the treatment to which both categories of people are subjected.
Accounting technologies are also often manipulated and placed at the service of fear. This feverish desire to classify and tabulate is linked to the idea of social uncertainty. In an essay titled “Dead Certainty,” Appadurai detailed the ways in which “social uncertainty can drive projects of ethnic cleansing that are both vivisectionist and verificationist by dismembering the suspect body in their procedure. That is, they seek uncertainty by dismembering the suspect body, the body under suspicion. This species of uncertainty is intimately connected to the reality that today’s ethnic groups number in the hundreds of thousands and that their movements, mixtures, cultural styles, and media representations create profound doubts about who exactly are among the ‘we’ and who are among the ‘they’.”
AIDS helps make such a distinction possible. According to Sontag, “Illness is the dark side of life, a type of more expensive citizenship. All living people have this double citizenship, one within the realm of health and the other within the realm of illness.” Construing “them” as migrants, members of other ethnic groups and people living with AIDS, distinguishes them even more from “us.” Sontag notes that in the United States AIDS has increasingly become an illness of the urban poor, particularly blacks and Hispanics.
Surveys and figures that propagate prejudicesThe building of profiles, the classifications and tabulations of many “we’s,” are aimed at ensuring that certain groups and individuals aren’t like “them”… so they won’t become infected by AIDS or migration.
Those tabulations have produced thousands of studies that associate AIDS and migration. The study by the UNIDOS Network of Capacity Building Assistance Providers found that 81% of agricultural workers in the United Status are foreigners and 77% are of Latin American origin. The National Commission to Prevent Infant Mortality in turn estimates that 5% of farm workers are living with HIV/AIDS, over eight times more than the 0.6% figure for the total US population in 2004. All of this suggests that migrants not only end up in the AIDS epicenters, but are also effectively AIDS carriers. But we don’t know whether that relatively small group of farm workers was the object of a more painstaking analysis—or vivisection/verification—than the gigantic native population or even of other specific groups, such as hippies, skinheads, etc. Most of the studies either fail to mention this or fail to mention any substantive differences they might have found.
Other analyses focus on perceptions, measuring knowledge about AIDS and its prevention to issue judgments about the vulnerability of certain groups. It is not always true that migrants know less about AIDS than native populations and in some countries they actually know more, as shown in the above table.
Some studies insist on the migrants’ ignorance. One survey of migrant workers revealed the most extraordinary beliefs related to HIV transmission, with 48% saying it was acquired from mosquito bites, 33% that it was transmitted in public restrooms and 29% that it was contracted through mouth-to-mouth kissing. Added to this risk factor is the migrants’ behavior, a field in which we have a mixture of findings that range from case studies to conjecture. It is assumed that migrants are more open to contracting HIV due to new lifestyles and sexuality, added to a marked ignorance of sexually transmitted infections and how to prevent them.
Conjectures that propagate the virus of prejudiceIt is said that migrants have frequent contact with sex workers because of their distance from their partners and their rejection of sexual abstinence. It is stated that poverty makes migrants more likely to have contact with infected sex workers and to share needles when injecting drugs. The rape of migrants en route to their destination is also included among the factors that propagate the spread of HIV. For the most part, this assumes that AIDS is in the environment and stalks migrants in the form of needles, rape and sex workers, although the propensity of migrants to fall into such sexual or drug-related practices or to become infected with HIV after being raped is never compared with that the native population.
A large number of studies propagate the virus of the dangerous association between AIDS and migrants. Some use accounting techniques to study behavior. One, the “Survey of Condom-Related Beliefs and Perceived Social Norms in Mexican Migrant Laborers,” revealed that less than half of the males said they used condoms with occasional sexual partners. The same study showed that 44% of them said they had sexual relations with sex workers, with the married men more likely than the bachelors to use a condom. But these kinds of studies, which most abound as they are based on a small sample of migrants, fall into the trap of the “half-table fallacy” by failing to show the study group in relation to the broader population universe in which it is inserted.
Migrants and youth gang members:Youth gangs are another minority associated with AIDS and migration. Gang membership is presented as a highly contagious illness and treated as a public health problem by the Pan-American Health Organization. The police see youth gang members as a problem for social order, public safety and governability. Many of the gang members are migrants and one survey revealed that 63% of those interviewed in Los Angeles were Latinos. Might they be infected with HIV? That would be a triply lethal cocktail of threatening minorities: migrant AIDS-carrying gang members. No other association could better or more forcefully persuade people of the dangerous nature of youth gangs. No other link would highlight so effectively their epidemic nature and threat to public health.
A surprising study in Los Angeles
The City of Los Angeles AIDS Coordinator’s Office and the Center for HIV Identification, Prevention, and Treatment Services estimate the number of youth gang members at 39,000 in the city of Los Angeles and over 100,000 in the county. Even lacking any study on HIV among this population, these organizations took for granted a greater AIDS propensity among gang members given their attitudes towards HIV, their level of knowledge and their risky behaviors, including drug use, sexual promiscuity, rejection of condoms and fondness for tattoos.
Although the average age of the 300 people interviewed in this study was almost 21, only 48% of them had completed secondary school. Only 24.2% had medical insurance, 63% were unemployed and 37% said they didn’t have to worry about AIDS because they weren’t homosexual. In the previous 12 months, 65% had had casual sex, 48.7% had had sex while on drugs, 25.6% had had sex with multiple partners and 87.3% admitted using drugs. Almost 60% of those who injected drugs said they had shared needles with other people, 60% had been in prison at some point in their life and 39.3% had been tattooed outside of conventional and safe establishments.
But after providing all of this data on the reckless game of Russian roulette with HIV, none of the 144 youth gang members who agreed to take a blood test came out HIV positive. Furthermore, the survey again fell into the “half-table fallacy”: the situation of these young gang members was not compared to that of native and/or non-gang youths living in the same neighborhoods.
Pompous, deceitful formulations These weaknesses in the gathering of information, the limited evidence, the generalizations based on very localized case studies and the conclusions based on conjecture, all of which translate into weak analyses and findings, have not stopped the production of pompous and regrettable formulations.
regarding “dangerous minorities”
Let’s take a look at one example, written by a “gender and development specialist” who works for a UN agency: “The results show that the majority of migrants are young people who travel alone and adopt risky practices that favor HIV dissemination in urban frontier contexts where the sex trade is commonplace. It is also interesting to note the indirect vulnerability experienced by housewives whose partners cross the border and resort to sex workers and, occasionally, to sex with men.”
The same study goes on to argue that “this relation among gender-based vulnerability, mobile populations and frontier situations becomes particularly visible in relation to HIV/AIDS. Women’s triple vulnerability to the epidemic (biological, epidemiological and social) is accentuated both among women who cross borders (female migrants and sex workers, traders who provide services to male migrants) and among the partners of temporary or permanent male migrants. Studies carried out on the southern Mexican border with sex workers, truck drivers and the migrant population highlight the relationship between high population mobility for economic reasons and increased HIV/AIDS dissemination.”
This demonstrates the making of another dangerous association, one in which migrants appear closely linked to another dangerous minority: sex workers. And once again, no comparison is made between the situation of migrants and that of other groups. Why don’t any of these researchers aim in another direction? Has anyone seriously researched the relationship with sex workers of the upper and middle classes?
The involuted leap fromOnce HIV was isolated and identified as the cause of AIDS, epidemiology stopped talking about at-risk groups and incorporated the notion of risky practices. But as the focus of attention slipped and analysis became corrupted by the data-gathering process, we witnessed an involution that is bringing back the idea of at-risk groups in which migrants are persistently presented as particularly prone to HIV transmission.
risky behavior to at-risk group
For researcher Daniel Hernández, this implies a reversal of the conceptual advance achieved in the relationship between discrimination and HIV by reinforcing the idea that migrants represent a new risk group that, like homosexuals and sex workers, helps propagate HIV. We would appear to be returning to the primitive notion of risk groups, under the guise of “groups that maintain risky practices.” This label, previously applied to Afro-Americans and homosexuals, is now applied to migrants as well.
Some try to save the migrants’ reputation by distinguishing between risk—with its connotation of individual guilt—and vulnerability, a concept that alludes to social conditions. In their document on Movilidad poblacional y VIH/SIDA: contextos de vulnerabilidad en México y Centroamérica [Population Mobility and HIV/AIDS: Contexts of vulnerability in Mexico and Central America], Mario Bronfman, René Leyva and Mirka Negroni clearly explain this distinction: “While risk points to a probability and evokes an individual behavior, vulnerability is an indicator of inequity and social inequality and demands responses in the sphere of the social and political structure. It is considered that vulnerability determines the differential risks and should therefore be what is acted upon.”
But when it comes to waging the battle outside the semantic arena, to the practical use of the concepts, a behavior cannot always be pigeonholed exclusively as “risky” or “vulnerable” without making distinctions that verge on the ridiculous. People devoted to such affectations would say that doing business with sex workers is a risky behavior and only having the option of accessing the poorest and sickest of them is a factor of vulnerability. In practice, the study of the risky behaviors of vulnerable groups ends up criminalizing those groups more often than not. Aren’t tourists a risk?
The best intentioned studies linking migration and AIDS often take it for granted that migrants end up in the most risky environments. But that’s not always true. These studies ignore the fact that the risk is unequal for the migrants depending on whether the environment they are leaving has a greater or lesser degree of prevalence than in their country of destination.
Let’s take the case of Central American migrants. According to ONUSIDA estimates, Belize has the highest AIDS rate (2% of the population), followed by Honduras (1.6%), Panama (1.5%), Guatemala (1%), El Salvador (0.6%), Costa Rica (0.6%) and Nicaragua (0.2%). In other words, the risks are not always the same. If we take the United States as the destination, with its 0.6% rate, then Guatemalan, Belizean and Honduran migrants end up in an environment that is on average less risky. Obviously any complete analysis would have to consider both the rates for specific locations and individual behaviors. And if considering such factors presumably obliges us to suppose that migrants are living in more dangerous environments than the national average—as in the case of the farm workers in the UNIDOS survey—and have more risky behaviors, one can’t help noticing that El Salvador’s rate is the same as the US rate even after an annual average of 11,539 Salvadorans were deported in 1992-96, 11,215 in 1998-2002 and 15,468 in 2003-2004. If those deportees were located in the epicenters of HIV influence and couldn’t help but adopt reckless practices due to the ignorance, machismo and sexual appetites that stereotype Latino migrants, why didn’t their return have a greater impact on El Salvador’s AIDS/HIV rate?
Costa Rica’s HIV/AIDS prevalence is the same as those of El Salvador and the USA even though it only has 72,494 migrants in the United States—compared with 833,803 Salvadorans—and just 526 deportees in 2003-2004. So where does this HIV infection level come from? Many factors are obviously at play, but let’s turn our attention to tourists, a group that flows towards Costa Rica more than to any other country in Central America. Costa Rica receives over a million tourists a year. In 2005 the figure was 1,659,167, of which 746,108 were from the United States.
Could they be a high-risk factor? Of course they could, but who’s criminalizing tourists, particularly US tourists? Nobody has dared even think about stigmatizing a social group that generated US$1.5 billion in Costa Rica in 2005, although many know that certain members of that collective group arrived after having their appetites whetted by shows like the Entertainment Channel’s Wild On program, with its promise of easy, wild sex with hot, liquored-up natives.
While it would be foolhardy to suppress tourism, where at the very least are the manuals advising prudence and safe sex on the part of tourists and their potential partners? They certainly aren’t being produced by the Central American Integration System, whose brand new web site “Central America, so small... so big!” proudly displays these buoyant figures on tourism.
Unmasking the powerWe can thus conclude that there are at-risk groups and there are at-risk groups. The ideologies of terror, with their slippery argumentation, produce certain at-risk groups and exclude others. As in castling, we are led to think not of the migrants’ risky conditions, but of the migrants themselves as the risk. Instead of presenting them as vulnerable within a dangerous environment, they appear as a vector of the danger. If accepted at all, their vulnerability is offered as a factor in the propagation of social and somatic pathologies.
What better justification for booting migrants out of the country or stopping them from entering than considering them a public health threat, given that they were already a threat to the social order? Article 54 of the new Costa Rican migratory law is the best example of the convergence of such a double segregation: “Foreign people will be rejected at the moment they attempt to enter national territory and they will not be authorized to enter, even if they possess a visa, if they are found to be in any of the following situations... b) Carrying, suffering from or having been exposed to infectious/contagious or communicable diseases that could imply a risk to public health.”
The Sensenbrenner bill, aimed at rejecting and controlling migrants in the United States, also includes repressive measures in this respect and many people have already been deported for having AIDS. This is a form of social and ethnic cleansing peddled as a prophylaxis.
These issues and their inter-relations deserve further study, which would help unmask the perverse backward slides and supposedly technical treatments that either innocently or maliciously conceal the political interests at play. And once the masks have been removed, we might discover yet another face of unjust power.
José Luis Rocha is a researcher for the Jesuit Service for Central American Migrants (SJM) and a member of envío’s editorial council.