Articles

Study on sex tourism along the border, and its consequences

A recent study by researchers at the University of California San Diego, in cooperation with partners on both sides of the border, reveals some of the serious health consequences of sex tourism in Mexican border cities, and urges binational prevention efforts — focused on both the sex workers and their customers — in an effort to prevent the very real possibility of a generalized HIV/STI epidemic.

The paper, “Characteristics of Female Sex Workers With US Clients in Two Mexico-US Border Cities,” currently appears online and will appear in a forthcoming issue of the journal Sexually Transmitted Diseases. The paper reports on the initial stage of a behavioral-intervention study to promote safer sex, involving 474 female sex workers (FSW) in Tijuana, BC (across the border from San Diego CA) and 450 in Ciudad Juárez, Chih (across from El Paso TX), who had reported unprotected sex encounters in the previous 2 months and who had not previously tested positive for HIV. The subjects were interviewed on working and social conditions, financial need, risk behaviors, sociodemographic characteristics, and physical & psychiatric health, and they provided samples for HIV and STI testing.

The paper found that in comparison to the overall group of sex workers studied in Tijuana and Cd. Juárez, the subset who said they had US clients were younger on average than the group as a whole, and more likely to:

  • speak English,
  • engage in unprotected sex,
  • report risky behavior involving injecting drugs,
  • have syphilis titers (16% vs. 10% overall),
  • have gonorrhea (8% vs. 2%), and
  • test positive for HIV (30% vs. 20%).

In addition, the paper indicates that “FSWs reporting US clients also had greater numbers of male clients and were more likely to report earning more money for having sex without a condom… The practice of offering more money for unprotected sex is not unique to our settings, as it has been reported elsewhere. Since FSWs in Mexico are primarily engaged in sex work due to economic need, this practice threatens to undermine HIV and STI prevention efforts and should be actively discouraged.”

Although this paper specifically studied Tijuana and Cd. Juárez, the conditions and regulations surrounding the sex trade in those cities have been described as similar to those present in the “Zonas Rojas” or “Boystowns” in Matamoros, Reynosa, and Nuevo Laredo — so the study’s findings deserve attention in the South Texas health community as well. The paper is summarized in this article from the San Diego Union-Tribune, which also includes this link to the full text of the paper; it was also recently covered in this segment from PRI’s “The World”. Here’s the full citation:

Strathdee SA, Lozada R, Semple SJ, Orozovich P, Pu M, Staines-Orozco H, Fraga-Vallejo M, Amaro H, Delatorre A, Magis-Rodríguez C, Patterson TL. Characteristics of Female Sex Workers With US Clients in Two Mexico-US Border Cities. Sex Transm Dis [forthcoming]. doi:10.1097/OLQ.0b013e31815b0 OVID JumpStart link

Texas-Mexican Border Study finds pesticides a BIG problem.

HARLINGEN,TX— Air samples from homes of Hispanic mothers-to-be along the Texas-Mexico border contained multiple pesticides in a majority of the houses, according to a study conducted by the School of Medicine at The University of Texas Health Science Center San Antonio.
Several studies have reported that pesticide exposure may adversely affect mental and motor development of the infants during infancy and childhood. The new report is in the summer issue of the Texas Public Health Journal .

Click Here to read the entire story as it appears in the HSC News Publication, and what suggestions are being made to remedy the situation.  Story by Will Sansom and Sheila Hotchkin.

The dengue threat

The Express-News reported this weekend that the CDC is encouraging South Texas health professionals “to become aware of the diagnosis of dengue and dengue hemorrhagic fever [DHF]“, based upon a new confirmation by the CDC that at least one case from the 2005 outbreak of dengue in Brownsville was actually contracted within Brownsville itself, not in Mexico or elsewhere. The article suggests CDC epidemiologists are concerned about sharp increases in the incidence of dengue and particularly of the more serious DHF across Mexico, including in Tamaulipas, since 2000. The mosquito that spreads dengue, Aedes aegypti, lives in Texas, thus providing a possibility that the disease could move across the Mexican border and take hold in South Texas. [See also: CDC MMWR for 9 August 2007.]

Another recent Express-News article described local research in progress at the Southwest Foundation for Biomedical Research that is working toward development of vaccines for dengue; other recent news [English | Spanish] describes a clinical trial currently underway in Puerto Rico. However, progress cannot come too soon for thousands of victims of current outbreaks in Honduras, Puerto Rico and elsewhere [1] [2].

Type 2 Diabetes and Tuberculosis

Looking at data for TB patients in South Texas between 1996 and 2002, researchers at the UT School of Public Health have recently shed additional light on the relationship between type 2 diabetes and TB. Their report in a recent issue of the American Journal of Tropical Medicine and Hygiene highlights type 2 diabetes as a risk factor for developing TB as well as for a 5-day delay in mycobacterial clearance within the first two months of treatment.

U.S. Border Residents Seeking Care in Mexico

A study scheduled for publication in the November 2008 issue of AJPH examines the factors associated with Mexican-American border residents’ use of health services in Mexico. The authors, from UT-Pan Am and the UT School of Public Health in Austin, found that middle-income Mexican-Americans were more likely to seek care in Mexico:

“An interesting profile of users and nonusers of Mexican health care emerged from these findings; those at the opposite ends of the household income categories were less likely to use medical care in Mexico for entirely different reasons. Participants with household incomes below $7000 reported either Medicaid coverage or dependence on free or reduced cost medical care in the United States. Conversely, those reporting incomes higher than $30000 were more likely to have private health insurance and used US health care. Participants in the… middle-income categories were more likely to be uninsured and to use medical care in Mexico.”

A key conclusion is that, “… as the health care system in the United States becomes increasingly expensive relative to the alternative in Mexico, the incentive to cross the border for health care will remain an important option for border residents and an important dimension of the border’s social context.”

Undocumented Hispanics Less Likely to Use US Health Care Services

This brief article from HealthDay (via MedlinePlus Health News) summarizes the findings of a recent study that analyzed four specific subsets of data from the 2003 California Health Interview Survey to identify patterns in the healthcare choices and experiences of California Hispanics — patterns which are very much worth our attention here in South Texas.

The study, entitled “Health Care Access, Use of Services, and Experiences Among Undocumented Mexicans and Other Latinos,” analyzed responses from four specific subsets of the 42,000+ respondents to the 2003 CHIS: 1,317 undocumented Mexicans, 2,851 US-born Mexicans, 271 undocumented Hispanics from countries other than Mexico, and 852 US-born Hispanics from non-Mexican heritage. Results found that…

undocumented Mexicans had 1.6 fewer physician visits compared with US-born Mexicans; other undocumented Latinos had 2.1 fewer visits compared with their US-born counterparts. Both undocumented groups were less likely to report difficulty obtaining necessary health care than US-born Mexicans and other US-born Latinos. Undocumented Mexicans were less likely to have a usual source of care and were more likely to report negative experiences than US-born Mexicans. Findings were similar for other undocumented Latinos, with the exception of having a usual source of care. Patterns of access to and use of health care services tended to improve with changing legal status.

Here’s the citation for the complete study:

Ortega AN, Fang H, Perez VH, Rizzo JA, Carter-Pokras O, Wallace SP, Gelberg, L. Health Care Access, Use of Services, and Experiences Among Undocumented Mexicans and Other Latinos. Arch Intern Med 2007;167(21):2354-2360. http://archinte.ama-assn.org/cgi/content/abstract/167/21/2354

Valley Doula Program to support mother & baby health

Yesterday’s Valley Morning Star featured an article on doulas — trained childbirth educators/supporters — and a new Rio Grande Valley pilot program funded by an HHS grant that will offer free doula services to 100 women who are patients at the region’s community health centers, including Su Clinica Familiar in Harlingen and Nuestra Clinica del Valle in Pharr. The goal of the program is to measure the impact of doula involvement specifically on new mothers’ mental health and wellbeing; however, the article mentions some studies that have shown positive correlation between doula involvement (also called “continuous labor support” in the literature) and physical outcomes such as higher rates of breastfeeding intent and early introduction, reduced rates of c-sections in some first-time mothers, and reduced use of obstetric pain relief interventions. The two studies mentioned in the Valley Morning Star article are:

  • Mottl-Santiago J, Walker C, Ewan J, Vragovic O, Winder S, Stubblefield P. A Hospital-Based Doula Program and Childbirth Outcomes in an Urban, Multicultural Setting. Matern Child Health J [forthcoming]. doi:10.1007/s10995-007-0245-9. http://dx.doi.org/10.1007/s10995-007-0245-9
  • Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The Nature and Management of Labor Pain: Part I. Nonpharmacologic Pain Relief. Am Fam Physician 2003 Sep 15;68(6):1109-12. http://www.aafp.org/afp/20030915/1109.html [Open Access]

Two additional citations from the second article above give further insight into the research on doula intervention:

Your Diabetes Is My Diabetes

Don’t miss this great story (also available in Spanish) from the DHHS Office of Minority Health about Manuel Hernández and the social networks he created for Latinos with diabetes — tudiabetes.com (in English) and estudiabetes.com (in Spanish). Both of those sites were created using a free online tool called Ning that provides a platform, infrastructure and hosting for user-created social networks. The story of tudiabetes.com (only eight months old and a vibrant community of over 1400 members) and estudiabetes.com (six months old, 178 members) shows the power of using Web 2.0 tools like Ning to create new kinds of online communities connecting people with common interests — like those who have been affected by a particular health condition — in all corners of the globe.