In 2019, the Mexican government cut all funding for civil society organizations, including those funded via the National Center for the Prevention and Control of HIV and AIDS, which was responsible for most of the country’s syringe service programs. When the pandemic hit a year later, the US-Mexico border closed, throwing the drug supply into chaos and disrupting cross-border health care services.
“This is a recipe for an HIV epidemic,” said Dr. Stephanie Strathdee, a lead researcher at La Frontera, an ongoing study tracking transmission among high-risk groups at the US-Mexico border. “All of a sudden, we found this cluster of new infections.”
Pre-pandemic, the HIV incidence rate—the percentage of HIV-negative people who test positive each year—among La Frontera participants was under 2 percent overall. But in February 2022, the incidence rate for those living in Tijuana jumped to 11 percent, a figure Strathdee described as “astronomical.” Among non-heterosexual participants, the HIV incidence rate was almost 19 percent.
The border had reopened a few months prior in November 2021, but cross-border “drug tourism” had never really stopped. Many US residents had continued the long-standing practice of procuring cheaper drugs from Tijuana, where a bag (una recarga) of heroin in Tijuana costs around $2.50 to $3 USD. HIV transmission had continued to take place while the border was closed—it was only prevention and treatment services unable to get across.
“What happens on one side, whether it’s COVID or HIV or syphilis or TB, will go to the other side,” Strathdee told Filter.
The stage was set long before the border reopened.
Rosario Padilla Garcia founded Tijuana’s Centro de Servicios SER in 2011. The harm reduction organization is just blocks from the border, in an area where rates of sex work and injection drug use are high. As someone living with HIV, Padilla Garcia knows how critical it is to offer rapid, accessible blood-borne disease testing.
SER focuses on the area’s most vulnerable populations, including people of marginalized genders and sexualities, people who inject drugs and people who engage in sex work. And people living with HIV, who are so often at the intersection of these.
Padilla Garcia was not surprised to learn of the new outbreak. The stage was set long before the border reopened.
A decade ago, the Global Fund to Fight AIDS, Tuberculosis and Malaria sponsored syringe programs in Tijuana, providing over 55,000 syringes per month. But in 2013, it reclassified Mexico as an upper-middle income country and withdrew the funding with little warning. The number of syringes SER and other groups were able to distribute dropped below 11,000 per month, and has shrunk down to nearly nothing today.
When federal funding was cut in 2019, the nearly $50,000 USD that SER had been receiving annually dried up overnight. It currently receives no government funding.
“Let’s say before we could give [each participant] 10 syringes a week,” Padilla Garcia told Filter. “Now we’re like, jeez, here’s two or three.”
“When you’re in withdrawal, it doesn’t matter where the syringe comes from.”
Tijuana is home to around 10,000 people who inject drugs, of whom 3.5 percent were estimated to be living with HIV in 2019 (an incidence rate of 2 percent is already considered high). Among them is Jesus who lives in the Tijuana River canal—a part of the border where hundreds of people, including those deported from the US, gather in encampments.
HIV risk here is four times higher than elsewhere in Tijuana. Jesus, who has been using heroin for 20 years, found out that he had contracted HIV during one of his regular La Frontera checkups last year. Like so many others in the border city, he’d been sharing syringes.
“When you’re in withdrawal, it doesn’t matter where the syringe comes from,” he told Filter via Facetime. But “now that I have this problem, I buy syringes, or I get them from a friend, so that I don’t impact anyone else.”
Antiretroviral medications for treating HIV aren’t available within Tijuana. The nearest clinic that provides them is on the outskirts of the city. La Frontera offers free transportation to participants who need it, but even so the barriers to care remain too high for many. Jesus, who wasn’t able to take the rides offered and can’t afford the trip on his own, still hasn’t received treatment.
“It’s hard to watch something you’ve worked so hard to build go to shit.”
PrEP medications, which protect against HIV transmission for those who do not have it, are not available in Tijuana either. So groups like SER aren’t able to offer either preventative medication nor treatment, only testing.
SER is fighting for survival, fighting to provide even the bare minimum to Tijuana’s most vulnerable as they face overlapping crises of stigma, police violence, poverty, lack of sterile use supplies and lack of a safe drug supply.
“It’s hard to watch something you’ve worked so hard to build go to shit,” Padilla Garcia said. She hopes that if the federal government won’t provide lifesaving services for PWID, it will at least restore funding to those who will.
Photograph via US Department of Commerce. Some interviews have been translated from Spanish.