After peaking in 1993, the number of newly diagnosed AIDS cases in San Diego County continues to decline each year. But although AIDS in the United States as a whole is in decline, the proportion of those cases diagnosed in ethnic minorities is on the rise. Fewer and fewer new AIDS cases occur in whites, while more and more of them occur in African Americans and Latinos.
The rate of AIDS cases in Latinos surpassed that of whites in 1996 and has remained higher ever since, according to a 2002 report by San Diego County's Health and Human Services Agency. Among clients of county HIV counseling and testing services in 2001, Latinos were the ethnic group with the largest share of positive tests.
Enter Entre Fronteras, a San Diego State University-affiliated research center dedicated to the study of HIV and AIDS among Latino populations along the California-Mexico border. Founded in January 2000, the center was recently awarded $425,000 a year for the next three years by the University of California's University-wide AIDS Research Program.
“What we're hoping to find out is the risk behaviors unique to the Latino populations,” said Carol Sipan, research coordinator for Entre Fronteras. “Because of the dynamics on the border, the dynamics between Mexico and California, we have to understand some of those dynamics and how they affect behavior and increase risk.”
A main goal of Entre Fronteras is to develop culturally appropriate and effective methods for preventing the spread of HIV among border Latinos. That is, HIV prevention strategies which work for middle-class American Anglos may not work for migrant farm workers from Mexico who have no more than middle-school educations. From a research standpoint, you cannot help a group of people until you discover what ways of helping will be most effective.
In its three years of existence, Entre Fronteras has completed three main research studies: an intervention targeting HIV risk behaviors in Tijuana high-school students, a study of HIV risk behaviors in female maquiladora workers in Mexicali and a study of male Latino immigrants in North County who have sex with other men.
Fernando Sañudo, director of health promotions at Vista Community Clinic, helped Entre Fronteras implement the North County study. “Our charge was to go out into the community and basically assess the community and find out who these people are,” he said. One of the clinic's missions is to halt the spread of HIV and AIDS, and the Entre Fronteras project provided valuable funds to help accomplish that goal. “It's money to research this population and try to get a better feel of who these individuals are, where they are hanging out, what type of risk behaviors that they engage in,” Sañudo said.
The project was sorely needed, Sañudo said, because the prevalence of HIV among Latinos is “most definitely” a concern. Many of the Latinos at risk for contracting HIV are migrant farm workers who may have little education and even less awareness of the dangers of HIV and its methods of transmission. (Through 2001, of all the San Diego County AIDS cases diagnosed in Latinos, 53 percent of those were in people born outside the U.S.) On top of that, the workers' poverty, lack of English language skills and seasonal migration place them in a netherworld into which social-service organizations have difficulty reaching.
“There are multiple challenges,” said Sañudo. “Part of what we're trying to do is to not only provide AIDS information and AIDS education, preventive education, so that they're better able to protect themselves; but you're also dealing with individuals who have faced poverty their entire lives, homelessness for some, racism for others-so we're dealing with kids and young people who have a lot of challenges throughout their entire life.”
Entre Fronteras is a project of the Center for Behavioral Epidemiology and Community Health (C-BEACH), which is run by Dr. Melbourne Hovell, a professor in SDSU's Graduate School of Public Health. C-BEACH brings in about $2 million a year in grant funding, and its approximately 100 researchers, students and collaborators study a variety of community health issues.
“We've been working in HIV prevention with Latinos since 1988, when we had our first study funded,” said Sipan, who in addition to being a C-BEACH research associate has been on San Diego County's HIV Prevention Community Planning Board since 1997 and helped write the County's first HIV prevention plan in 1995. She said that although C-BEACH studies a number of different health risks in the Latino community-environmental tobacco exposure, asthma, exercise and nutrition, among others-the researchers saw a need for a center devoted to studying prevention of HIV/AIDS in the Latino community. Thus, Entre Fronteras was born.
“We feel a tremendous responsibility, being here in San Diego, to address one of the larger populations that has a lot of health risks,” Sipan said. “It's a matching of our expertise with the need in the community.”
Sipan said Entre Fronteras hopes to use the UC grant funding as seed money to get other, larger grants. The UC funding ensures that Entre Fronteras will have money for offices, personnel, student assistantships and other infrastructure-related needs. This will support the group's efforts to apply for funding at the federal level, mainly from the National Institutes for Health-where the big money is. Entre Fronteras hopes to use grant money to recruit a new research faculty member to SDSU.
“What we're hoping to do is to obtain pilot data that could then support grant proposals of a larger scope,” Sipan said. One of the project's goals is to obtain enough funding to be self-sustaining, independent of any one funding source. The UC grant will ensure the survival of Entre Fronteras for at least three more years.
The group is about to begin a study of HIV risk factors in Mixtec Indians, a Oaxacan indigenous group that constitutes one of the larger migrant agricultural worker populations in San Diego County. In another study, Entre Fronteras plans to collect data from migrant farm workers as far north as Merced, in California's Central Valley, following the workers' seasonal path. Another study in Mexico will attempt to discover which interviewing styles best encourage Latinos to talk about the risk behaviors they engage in.
It may be years before any tangible benefits from Entre Fronteras' efforts are seen in the border Latino community, but such is the nature of community research. Entre Fronteras is doing its best to plan for the long term.
Sipan stresses that one of the project's main goals is to promote the careers of junior researchers. Several students in SDSU's Graduate School of Public Health work on different aspects of Entre Fronteras, helping to collect data, recruit and interview participants and run studies. Many are Latinos themselves. One of the studies already completed was actually a student's master's thesis. Sipan hopes some of these students will go on to become researchers in the field and make their own contributions. “That's one of the objectives of this as well,” she said. “To grow research capacity and not only a body of knowledge, but also researchers who are capable of continuing in this work.”