Epidemic in the Borderland

On 19th of August, 1773, Francisco Palou, a Franciscan friar, placed a cross on a rock close to Tijuana, Mexico, to establish the line of authority between the Franciscan Fathers of Alta California and the Dominican Fathers of Baja California.

Both Californias were owned by Spain, then by the recently independent Mexico. Tijuana was part of a merged urban zone with its main settlement to the North of it.

In the Mexican-American War of 1848, the US took control of the land to the South of California, and the humble cross then became the sign of an international border with the Spanish-speaking settlements to its north becoming politically separated from Tijuana.

For many years, the Mexican central government had done very little to strengthen Tijuana’s position. The city’s proximity to the United States made it seem unreliable, and so it turned to alcohol, gambling, sex, and drugs to make its economic recovery.

A Nation correspondent described the situation in 1889, saying that there were more saloons in Tijuana than buildings. The Mexican Revolution of 1910 was even advertised by the city’s revolutionaries as an opportunity for American tourists to view battles up close.

Spectators were charged 25 cents for the privilege.

This form of entertainment became increasingly popular as America’s temperance movement increased, and the American Board of Temperance, Prohibition, and Public Morals of the Methodist Church wrote in 1920 that “everything goes at Tia Juana”.

It was a mecca for “prostitutes, booze sellers, gamblers and other American vermin.”

Tijuana has long been known for its economic dependence on the United States and its distance from the rest of Mexico.

The city’s rougher areas border the U.S. border fence, and the local highway is often congested and is infamous for fatal car accidents involving drug users escaping police brutality.

One of these areas, the Zona Norte, is the location of Tijuana’s quasi-legal red-light district, which is home to the majority of the city’s estimated nine thousand sex workers. On a visit to the city, a local doctor took me on a walk through the area in the morning.

The streets were filled with female sex workers, and a chorus of hisses followed us as we went. During later visits, I saw a heavy police presence with squad cars often blocking intersections and police pickups carrying drug users, presumably on their way to city remand facilities.

The Tijuana Arch, a rather lackluster monument located in the city’s tourist district, is just a short three-block walk away from the red-light district. This is the site of the sex trade, stronghold of cartel power, and the epicenter of Tijuana’s HIV epidemic.

It is estimated that 10,000 people inject drugs in the city, with the rate among men being 4 percent and 10 percent for women. Zona Norte and El Bordo, a part of the contaminated Tijuana River canal, are other areas where drug injectors live.

Additionally, 25 percent of sex workers in Tijuana also inject drugs and are at greater risk of HIV infection, estimated at a minimum of 12 percent.

Dr. Thomas Patterson, a scientist of San Diego’s origin, has been busy in the same region for much of his life. He is a tall, affable person, similar to the renowned Richard Branson with a nearly-identical silvery mane, acute intelligence and a laid-back atmosphere of authority.

These attributes are well-deserved, as Patterson is regarded as one of the most renowned HIV specialists in the world and has spent more than a decade on the mission to impede the transmission of HIV among sex workers near the US-Mexico border.

As a behavioral psychologist, he has been exploring what drives choice and how a person’s conditions determine his/her involvement in precarious activities (like unprotected sex and shared syringes).

He has devoted a large amount of his time to understanding the way power is exercised in close situations, and how vulnerability among people makes diseases spread swiftly through a population.

In the 80s and 90s, many scientists were driven to action after seeing the devastating effects of HIV firsthand.

Dr. Steffanie Strathdee, Patterson’s wife and the associate dean of Global Health Sciences at the University of California, San Diego (of which I am a part of a project on how police activity influences HIV risk in Tijuana), was one such person.

After losing her best friend and PhD supervisor during the early years of the epidemic, she felt that working to end HIV was her only option.

Patterson, however, was originally interested in animals; he wanted to understand their movements and behavior, and potentially their capacity for thinking and social organization.

This led him to do research on the memories of gorillas, orangutans and chimpanzees as an undergraduate. But he wanted to work in the field so he moved on to the University of California, Riverside, where he spent 7 years studying white-crowned sparrows in San Francisco.

His findings were published in prestigious journals like Science. His early studies contained visuals of the sparrow-song dialects in San Francisco that were comparable to Russian futurist paintings.

Patterson’s early studies gave him an understanding of how to utilize statistical methods in analyzing behavior.

Nevertheless, the 1981 US recession caused government grants to prioritize science with a practical purpose, leaving his work to suffer from a lack of financial support.

As a result, he changed his career and accepted a job in San Diego to research how to protect families from heart issues.

This job made him consider approaches to not just study behavior but also attempt to modify it. Furthermore, he collaborated with the Department of Psychiatry at UCSD on the impacts of stress on the immune system. Finally, Patterson notes, “HIV came on the scene.”

Patterson was quickly recruited into the battle against HIV due to his fame as an excellent scientific methodologist in the United States.

He remembered, “HIV was a death sentence; some individuals would die within three years, while others could live for up to ten.

We had no idea what to expect. So we questioned: does stress have any influence on the situation?”

Everyone was trying to find a way to make a difference, and Patterson thought that the only way to make any progress, apart from curing the disease, was to view those who were infected as members of the fight rather than as people who were already defeated.

He hypothesized that if people with HIV changed their behaviors so that they would not pass on the illness, it would potentially slow down the epidemic.

Patterson proposed to concentrate the efforts of researchers on those who already had HIV instead of those who could be exposed to the virus.

When he proposed this to the National Institutes of Health, they objected as they were afraid of being contaminated by touching a doorknob which had been touched by an infected person.

Patterson argued that the government was ready to compromise effectiveness in order to hold onto the current state of affairs, which was impractical.

After two years of controversy, Patterson finally succeeded in persuading the NIH to concentrate their risk-reduction efforts on HIV-positive people. This is now the standard of care. Patterson was among the pioneers to make this happen.

For a while, Patterson was happy with his work in the US, where there were plenty of HIV-related and human behavior issues to keep him busy, and plentiful research funding to fund his career.

But it was soon clear that the disease had a more far-reaching impact than just human lives. He remembers, “It was just over 10 years ago that the NIH noticed that HIV was causing instability in governments, especially in Africa.

The military, law enforcement, and aid structures were all affected. Before, they saw it as just a US problem, but now they saw it as something that could really disrupt foreign relations and a government’s ability to govern itself.” Speaking to me from his office at UCSD, he reflects on this.

In the early 2000s, HIV soon became an issue of national security, prompting officials to search for experienced individuals capable of dealing with the complexities of international work. Patterson, with an established career in HIV prevention, was the perfect candidate.

He had no desire to move to Africa, but Tijuana, just a twenty-minute drive from San Diego, was the ideal laboratory. Patterson had fond memories of the area from his youth, where the border was much more lax and people went to party.

However, the current security perimeter and paranoia about illegal immigrants had changed the scene significantly. Nonetheless, it still felt safe. Tourists of all ethnicities would come to certain bars and it was very lively, colorful, and bustling day and night.

When Patterson began his work in Tijuana in 2000, Mexico was just beginning to experience a drug war. Little did he know that it was the start of an explosion of violence that would hit Tijuana especially hard. Among the locations affected was the city’s main sex trade district, Zona Norte.

This area was now less profitable and more dangerous for customers, causing a decrease in the sex trade’s power to negotiate safe sex.

In 2006, the HIV rate among female sex workers in Tijuana had risen from 1 percent to 6 percent, fulfilling the United States’ fear of a destabilized southern border.

Patterson would certainly emphasize that safety is largely based on one’s social role, particularly in Tijuana. Tourists from America who are spending money generally won’t encounter any trouble, so long as they don’t wander away from the Avenido Revolucion (“La Revo”) or the main sex clubs in the Zona Norte. But the women employed in Tijuana’s sex trade have a contrasting experience.

Ana (whose name and details have been altered at her request), a twenty-six year old woman with the face of a child, shares a similar story to many in the Zona Norte, as she was recruited into the sex trade at the age of fourteen.

She was taken in by a “mister”, a pimp, with seven other girls. Ana states that they were all kept in a rented house, in which they were expected to pay rent and were constantly monitored.

When they weren’t at this house, Ana and the other minors were taken to private gatherings, where they would mostly provide services to narcos – cartel members.

Ana remembers these episodes as “pure violence”, recalling that in the remote locations they would be taken to, the danger of sexual attack was apparent. The girls were expected to do whatever their customers wanted, and if they refused, they could be killed.

During this time, in the early 2000s, cartel ranches were a frequent target. Ana noted that she and the other underage sex workers were sometimes caught in the middle of the chaos.

Furthermore, the pimp would decide whether or not the girls could use a condom during their services, making the prevention of disease additionally difficult. Ana recounts having pills placed into her drinks by cartel clients, which left her with an unclear memory of the night.

Ana’s routine customers, apart from the narcos, were the police who came for a monthly visit to the cramped abode where she and the other girls were held. “It was apparent to them that we all were underage,” she remembers. “It felt like the mister was paying them with our bodies.”

Knowing the police had been bought, Ana’s likelihood of getting away was nonexistent; she recollects that the time two of the girls attempted to leave, they were severely beaten.

Eventually, though, a patron took a liking to Ana and she managed to be set free. She believes money likely was exchanged for her freedom, but wasn’t sure. At a young age, she left the house to live with her new husband, and shortly after they got married and had a boy.

If things would have gone according to plan, her life in the sex trade would have been over when she was still a teen.

However, her husband was part of the cartel, as proved by the drugs and money that filled their home. “I was secure with him,” she states, “but I was also scared because I thought, They will take me as soon as they have him.”

Her assumption was right: after two years together, one day the police came to their door.

“They came and took him out, and I assumed they would take him to jail, but a few blocks away they killed him.” She uses the word levantarlo which implies that her spouse was “disappeared” by the authorities, a common practice of the cartel.

Ana is sure that while the police carried out her husband’s murder, it was ordered by the cartel. With no other options, Ana subsequently went back to the sex business.

Suzy, a former drug user with a formidable appearance, has had a long association with the Zona Norte. She was never a sex worker, however, acted as a “hit doctor” in the red-light district–someone with considerable expertise in injecting drugs into others.

Hit doctors are common in drug injection scenes. Over time, injections can cause veins to collapse, necessitating injections in other places like the neck, groin, armpits, or between the toes.

In Tijuana, black tar heroin is the drug of choice and its consistency makes it hard to break down, thus increasing the odds of vein damage. Injecting into armpits or necks is not straight forward, which is why hit doctors are employed to do the job for a fee or in return for drugs.

Beyond collapsed veins, social power dynamics also play a role in people needing hit doctors, as women are less likely to have been taught to inject themselves and thus rely on men, usually the older ones, to do it for them.

The unfavorable conditions in Tijuana ensure hit doctors have plenty of work to do and research has demonstrated that those who need help injecting are usually women, from other places and more likely to use shared needles.

Increasing their chances of getting HIV (60 percent of drug injectors report sharing needles in Tijuana, but the figure is higher for those requiring assistance, at 70 percent).

Suzy, at a Zona Norte taco stand, tells me her story using a slightly difficult Tijuanensis slang. Her life, in a sense, was similar to the one Patterson described in his research.

She recalls with a smile that her friend Angie worked as a sex worker for nine years and they used to rob Americans together. When Suzy was tested in 2001 and found out she was HIV positive, none of her friends believed her warnings.

She had no one to turn to and despite wanting to leave, had no idea how to. Methadone was not as accessible as it is now in Tijuana, and the addiction centers weren’t the most reliable.

People would try to quit with pills, but that would only make them higher, in a sort of self-deception. Thus, without the help of treatment, Suzy continued to use drugs and shared needles.

Suzy moves her arm onto the table and traces her finger along a mass of scarring that extends from her wrist to her elbow, which was caused by years of injecting with whatever makeshift syringes she could find.

She explains that syringes were not freely given, so she had to scavenge for thrown away, dirty ones, which she then washed or burned with a lighter to construct her own.

Even when they were sold, it was only in veterinary clinics, and they were used syringes intended for chickens or other animals, which she purchased for a low cost of five pesos or two fifty.

Suzy was very protective of Angie, viewing her as a child; the close relationship between them was only heightened by the risks in the Zona Norte. An act of intimate support between them was to share drugs in order to stave off the effects of la malilla –heroin withdrawal.

Suzy recounts, “I had to search for her every time she changed hotels.

When I finally found her, I would ask, ‘Do you have any R [heroin]? I’m feeling withdrawal symptoms.’

People often visited the room, and Angie would usually have already injected herself, but she would still lend me the syringe when I was suffering from withdrawal chills, so that we could get high together.”

HIV researchers describe sex workers as a “hidden” population, because they often try to hide from authorities, including health officials. This is true for the women of the Zona Norte in Tijuana, but there is another group that is even more hidden: their clients.

Patterson was fascinated by this group, as he believed they were the key to understanding the risk of HIV that the women were facing. He felt that these clients had been ignored and were desperate for information.

His research revealed that 4 percent of the clients tested positive for HIV, with those that reported crystal meth use being even more likely to be positive.

This showed that the clients were a major factor in HIV transmission, and could also spread HIV to their families in Mexico and the US.

Patterson’s collected writings on HIV risk, sex, drugs, and despair offer a multifaceted representation. Clients who had been sent away from the US were aware of their distress and isolation, and their words were evident in the scientific records.

One individual declared, “Loneliness… immense loneliness. That this city cannot fulfill,” after being deported to Tijuana. Another spoke of the “fast life” of hustling to survive and declared, “Having sex without a condom is part of that. If you don’t want to have risks in your life, you need to go somewhere else.” The sentiment of fatalism was echoed in another statement: “Normally I try to keep safe, but if I’m drunk or high, I don’t care in the moment.

Then later I think, What if the girl has an infection? Especially in this part of Tijuana…”

Patterson’s study included Salvador, a vendor of second-hand clothes in the Zona Norte. Salvador is likely in his late forties and he explains that he pays for sex as a result of living in the area.

He states, “I sell things here, you know… so that’s how I get to know [sex workers]… They buy my things, they ask for money, I give them money, and that’s how we start having relations.

Sometimes they don’t have money, and I can offer them a place to stay for two or three days and that’s how I interact with them.” Salvador moved to the Zona Norte in 1991 and he has noticed the decline of the neighborhood and the risks of disease for women in the sex trade.

He believes that many women take the risk of not using a condom in exchange for more money. He also worries about the risks of sharing a pipe when using crystal meth.

This motivated him to join Patterson’s study. He says, “I was really interested in [HIV risk], and also to be able to explain all this to my kids and also to be able to tell my friends, to have an opinion.

Now I can explain to someone what this is all about, and it’s not only [about putting a condom on or taking something] to cure yourself… The point is to be careful… to avoid all these diseases, right? And then know what to do if you get it.”

At the core of the HIV epidemic in Tijuana is the complex web of behaviors, gender roles, and economic activities in the red-light district, which Patterson attempted to unravel and find a way to alter in order to allow sex workers to find some kind of footing in countering the economics that put them in danger.

In Tijuana, it is easy to observe the many facets through which people interact.

The taxi drivers are well-known for their attempts to direct people to the region’s sex clubs, like Hong Kong and Las Chavelas. Moreover, they are also able to link up customers to polleros, the smugglers who help people cross the border.

It is not seen as a form of corruption, but as a way to help people get what they desire. This duality is a common phenomenon across the northern Mexico border area, as Patterson explains.

He once heard of a doctor working for a research team in a small town on the border, who was also employed by the local cartel to treat gunshot wounds. This duality and secret identities can be found all over the northern Mexican social and political scenes.

Victor Alaniz, the head statistician at the Tijuana police department and a 31-year veteran of the force, including 15 years on the street, acknowledges the presence of a local problem.

“When family members are involved in corrupt activities, it becomes commonplace in the city until it reaches a breaking point,” he states. The headquarters of the Tijuana police department have a parking lot-like atmosphere, complete with concrete walls and pillars.

On the day I visit, various levels of security are in place, including armed military police and a distracted security clerk, making the atmosphere slightly daunting. Once inside, officers are friendly and welcoming, offering smiles and nods as I pass by.

In his office, full of tidy stacks of paper and a poster of Tijuana on the wall, Bañuelos goes through a PowerPoint presentation with his finger.

Alaniz and Bañuelos were there when the cartels became powerful in Tijuana, and Bañuelos pulls up a graph of violent crimes over the years. The number rose greatly after 2006, when Felipe Calderon, then president of Mexico, began a war on drugs.

This drug war was meant to weaken the cartels, but it was unsuccessful in the northern border towns of Tijuana and Ciudad Juarez, where the cartels had a stronghold.

When asked about how Tijuana was during the drug war, Bañuelos replied that kidnappings had dropped from one hundred sixty in 2006 to around thirty or thirty-two in 2014, which he said was going to be a bad year.

Bañuelos brings up a slide of mug shots on the PowerPoint. “That was the criminal activity taking place without any consequence,” he explains. He then switches to another slide, which shows a number of men in press shots, being apprehended by the police.

I inquire who the people in the bottom row are, and he pauses before responding. “The leaders of the police institution.” Starting in 2000, the typical Tijuana police corruption had become unrecognizably worse.

“You would observe the director bringing in ten people one day, and then seeing them in uniform and with weapons the next day,” he adds. Some of them had even penetrated the police command structure.

Bañuelos and Alaniz were just witnesses to their department becoming a unit of mercenaries.

During the 2004-07 mayoralty of Jorge Hank Rhon, Tijuana’s flamboyant casino magnate and long-time political operator, corrupt recruits were infiltrating the department with impunity. “In Hank’s administration, it was when the conflict between cops began,” explains Alaniz.

“The bad cops were killing the good cops, right?” The violence was just the most obvious consequence of the transformation of the old order and the excessive power of Tijuana’s corrupting forces.

Before the cartel’s 2006 killing spree (El Pozolero boasted to prosecutors that he had personally dissolved three hundred bodies in vats of acid), Tijuanenses were starting to question the corruption that had set in the city.

For many years, there had only been a few people who challenged the status quo, with the most remarkable being Zeta , a harsh and sensationalistic weekly magazine that made a living by giving out biographical information about gang members, sometimes even with photos

A dangerous task considering the climate of dread brought by the Mexican cartels’ warnings to journalists.

Targeting Hank Rhon was a favorite pastime of Zeta. Hank is the proprietor of Grupo Caliente, the largest sports-betting company in Mexico, and he also has the Agua Caliente racetrack and Club Tijuana Xoloitzcuintles de Caliente in Tijuana.

Hank once proudly wore a vest of Xolo skin, a type of Mexican hairless dog, and supposedly had a jacket made from donkey penises. Accusations of criminal behavior have shadowed him since the 1980s.

A US diplomatic cable from the Tijuana consulate labeled him as “widely believed to have been a corrupt mayor and to be still involved in narco-trafficking”.

The cable was sent after an incident in which local police failed to arrest a drug trafficker at the consulate while bodyguards in a black Crown Victoria drove away with him. The police refused to follow the car into Hank’s compound.

This was in response to the murder of Hector Felix Miranda, a Zeta cofounder and critic of Hank’s, in 1988. Zeta published a full-page ad each week in the aftermath of the killing, directly addressing Hank and continuously asking why Miranda had been killed.

Two years into Hank’s mayoral term, the cartels had infiltrated Tijuana’s power structure to the point that no one knew how far their reach extended.

To discover who could be trusted, the department was placed under the leadership of Alberto Capella, a civil-rights advocate, and Julian Leyzaola, a tough military officer. While Capella lacked police experience, he was bold enough to stage protests against the cartels, while Leyzaola was known as a detached yet demanding commander. Through the capture of cartel figures and research into their agents’ documents, it became clear how much the police had been infiltrated.

According to Alaniz, “Previously, the law enforcement was bought, now the criminals are within the force. Yet, it was not a public confrontation.”

In 2008, the Tijuana municipal police made an unheard of decision when they chose to arrest twenty-one of their own officers on suspicion of having connections to the local drug cartels and fired another one hundred.

To further their efforts, an additional five hundred officers were sent back to the police academy for training and background check processes. All in all, roughly a quarter of the two-thousand-two-hundred-strong police force was dealt with in this manner.

It was a remarkable move, given the extent to which cartels had infiltrated the police, making it seem like a near-impossible task to break the cycle of corruption.

The mission was proclaimed a success; however, when the arrests were broadcast on Mexican television, the Tijuana Cartel (then one of the three major cartels managing drug trafficking in Mexico) communicated a clear directive: “Kill any cop you come across.”

That night, seven law enforcement officers were killed, and in the following weeks, forty-six more would be assassinated by the cartel in retaliation for the bust — twice the amount of corrupted police who were initially taken into custody.

Officers started wearing balaclavas during press conferences; a senior officer was assassinated in his sleep, along with his wife and their eleven-year-old daughter.

Bañuelos maintains that the fatalities and firings were worth it, as it enabled the police to weaken Tijuana’s cartels in a few years, mainly by capturing the top management. However, this action threw the city into a civil war.

In the six years after the war on cartels was initiated, it is estimated that more than one hundred thousand Mexicans were killed in drug-related violence, with the methods becoming increasingly cruel as time went on.

Mexico’s federal government stopped releasing information concerning drug-related homicides in a weird attempt to make the problem vanish.

The strain of the drug war led to the Tijuana Cartel and Los Teos (among the other factions competing for control) to initiate open confrontations with the police, the Mexican military, and one another.

Moreover, smaller factions and outside syndicates emerged, then realigned and divided again, with brutality. Corpses were hung from a bridge close to Tijuana’s airport.

The head of a victim was discovered under a bridge near the Zona Norte, while the headless body was later discovered on a tranquil stretch of highway connecting Tijuana to Ensenada, one hundred kilometers to the south.

Bodies were used to send messages between cartels–some forewarning violence, others urging rivals to abstain from killing minors.

During the war, stories of beheadings, hangings, and kidnappings dominated the news, yet the killing of women in border regions hardly registered any reaction.

Suzy, shaking her head, said: “Many people died in those years.

La Paloma, La Paniqueada, La Osa, La Lobita–those were my friends… Men would take them away and they never returned.” Angie, who was Suzy’s companion in thievery and syringe sharing, was found dead near a Tijuana highway–another casualty of a disastrous date.

According to reports, within the first two years of Mexico’s drug war, 105 female fatalities occurred in Baja California, a lot of them being sex workers.

Women in the sex trade are aware that working in a club is generally safer than taking their chances on the streets, due to potential dangers they may face when alone.

However, for those addicted to drugs, in whom getting money can mean avoiding unbearable withdrawals, their choices are limited. Suzy has experienced this first hand when she said, “It’s more hazardous for a sex worker who uses injectable drugs than for those who don’t.

Men come to the clubs but the women don’t leave with them. But for those struggling with addiction, it’s a different story… They just go, they get into the cars, like that.”

Rosa, now in her 50s, has been a sex worker in the Zona Norte for two decades. She is unsmiling and her words are fast; her language is full of Tijuana street slang.

According to her, the early 2000s were chaotic and full of violence–she remembers who the offenders were. “I was scared because people would threaten me, take me to a place away from everyone–not only customers but the police too.

They would make me have sex with them or give them oral sex. Or when taken to la veinte [jail], we had to perform oral sex on the judge to be let go.” For Rosa, the police were the biggest threat. “They would take us to secluded places and do whatever they wanted to us.

The policemen were awful to us, and you could tell they were high.” Officers would often search the Hotel Michoacan, Rosa’s home and workplace. “Policemen wearing hoods would enter the hotel room… One time I was able to hide, but a policeman went to my friend’s room and raped her.

It was very scary.” When asked if there is less corruption now, Rosa does not know. “Maybe it’s still the same chingadera [the same old shit] but before, it was much more blatant.” She believes that the most extreme forms of violence have declined.

“Yes, [the cartel members] used to come to the brothel with guns, and no one–not even the police–did anything, and they would do whatever they wanted to us. I feel that has decreased a lot. Before, you would hear gunshots and see killings everywhere.

You would witness the violence all around.”

Tom Patterson’s aim was to develop an intervention that could assist female sex workers, especially those who use drugs, to evade the everyday threats of HIV.

The initial step was to recruit these women. However, when his group started doing field outreach in the closely watched Zona Norte, their progress was halted.

It turns out that the Tijuana Bar Owners’ Association, which regulates the Zona Norte, was not satisfied with the unauthorized presence in their area.

It is not possible to discuss the bar owners’ association without sensing a certain unease.

On the one hand, Tijuana has a large agglomeration of maquiladoras (manufacturing plants), and despite its recent dip in business, the Zona Norte district is still a major financial contributor to the city.

On the other hand, the relationship between the police, the narcos and the brothels in the district is so close, it is hard to discern where the boundaries between legitimate commerce and prohibited activity lie (as is the case for many of the powers in the city).

It is common knowledge that police are hired by the clubs for ‘protection’, as stated by Victor Alaniz: “it is not protection for illegal actions, but rather to guarantee security and control the zone”. Nonetheless, the cartel’s presence in Zona Norte is still apparent.

The exact coordination between the sex clubs and the drug cartels is unknown, but it is clear that all of them benefit economically from the alliance.

Suzy, having spent nearly three decades here, firmly believes that the cartel’s leaders and the owners of the district’s most important brothels are the same individuals.

When Patterson heard of the suspension of his field recruitment and the bar owners’ association requesting to see him, he was well aware of the gravity of the situation.

This was not his first experience doing HIV prevention work on Mexico’s border, and he knew that having his services officially sanctioned was of utmost importance.

His research coordinator’s husband in Ciudad Juarez, who was a lawyer, had been shot dead at his doorstep, possibly due to him representing some cartel members that were going to be imprisoned. He went to the meeting, feeling apprehensive.

The restaurant had been emptied and a cluster of tables was situated in the middle. Additionally, Mexican police were patrolling outside.

I was seated at the table with the bar owners and the two people who had accompanied me, and a large number of gentlemen in trench coats had Uzis and other weapons visibly displayed.

After I gave my usual academic presentation of the study, they all nodded in agreement. Then, the leader of the bar owners’ association asked me, “But Dr. Patterson, what would be the benefit for us if we participated in this study?”

Since his early days studying primates through a glass enclosure and pursuing white-crowned sparrows in the Bay Area, Patterson has had to explain his research into animal and human behavior to several different people.

This period of his career has revolved around attempting to gain insight into the motivations of individuals, so as to help them to reduce the risks that they face.

It was this capacity for professional empathy which enabled him to put aside his own interests in that particular instance and comprehend the nature of the game. He said to himself, “I figured out that these are businessmen and women, and that their commodity was sex workers.

Thus, I realised that the reason they wanted me was because I would teach the women how to stay healthy, which would result in them making more money.”

The response they gave was, “That’s great! You can be employed in Tijuana.”

The bar owners’ association provided Patterson with the chance he needed, and he immediately began to use the special knowledge of sex workers to develop a strategy to battle the HIV epidemic.

Since that starting point (“Which is etched in my mind,” Patterson remembers), he and his group have implemented an influential HIV-prevention program in Tijuana, notwithstanding the continuous danger of violence and addiction faced by women in the industry.

“Our investigation has kept on despite the drug war,” Patterson said, “and I think it’s because we have partners who are there and because… we don’t want to shut down the whole sex-work sector; we’re attempting to execute damage-control strategies. We are not a menace.”

Patterson’s first program, Mujer Segura (Secure Woman), concentrated on assisting females with the formation of strategies to persuade clients to take on condom use, which is still a major cause of the HIV outbreak near Mexico’s northern border.

After two years, she saw an impressive 40 percent decrease in new cases of sexually transmitted diseases – including HIV – among the women who took part in the program, when compared to a control group.

Patterson and Strathdee found that women in the sex trade who also injected drugs, those with the highest risk of transmitting HIV, had poor results.

Thus, they conducted a two-year randomized clinical trial in the Zona Norte and Ciudad Juarez in 2008-2010 to test the effectiveness of a program to increase condom use and access to clean needles.

The women in the trial created a video, Contamination, to show scenarios and teach strategies to avoid HIV.

After two years, the experimental arm of the Mujer Mas Sugura (“Safer Women”) intervention saw more than 50% fewer new cases of HIV and other sexually transmitted infections than the control group. The proportion of needle sharing also fell from 100% to 5%.

These results are remarkable given the drug war.

The Mujer Segura program, which was created following the publication of Patterson’s research team’s findings, has now been extended to thirteen cities in Mexico, the majority of which are along the northern border.

Patterson attributes this successful project to the assistance he has gotten from his Mexican partners. He remarks, “Many people have gained from this work and have gone the extra mile to help us succeed.”

Suzy is an example of one of these individuals, having leveraged her substantial understanding of the Zona Norte to serve as an outreach worker for the Global Public Health Division at UCSD where Patterson works.

Nowadays, instead of administering injections, Suzy visits her former haunts in the Zona Norte and El Bordo to identify drug users, recruit them for health studies, and link them with medical care.

Patterson’s research on the risks of HIV at UCSD has triggered a surge in condom and clean-needle distribution in areas of Tijuana with high drug use, such as Zona Norte.

According to Salvador, who sells in the aforementioned district, he has become much more aware of the importance of condom use due to the increased availability of them and what he learned from the study. “It’s now much simpler to get condoms, they’re everywhere.

Before, they were only available if you had money. I used to not use them, but now I do, and because I know the risks, I’m much more conscious of using them.”

Ana attests to the efficacy of the improved access to condoms and HIV testing in Zona Norte for its sex workers. “It’s been a great help because I’m aware of my health status,” she states.

Before being part of Patterson’s research, the last time she was tested was during her son’s birth around ten years ago, despite engaging in the sex industry for nearly the same amount of time.

In the Patterson’s field offices of Zona Norte, Rosa, a drug user, spoke about the ways that the Mujer Segura project has helped her. She mentioned that she had been diagnosed with human papilloma and that the project members paid for her surgery that cost two thousand dollars.

Rosa also mentioned that the project provides free condoms to prevent HIV risk and that she has learned a lot from the talks. She added that she used to share and sell used needles, but no longer does that due to the high risk of contracting diseases such as TB and hepatitis.

At the end of our interview, Suzy took me to the research field office she works in, located in the Zona Norte. As we arrived at the door, two uniformed police officers walked past, giving courteous nods to both Suzy and the Mexican physician studying with us.

The two of them chuckled without much joy, informing me that the officers were notorious for their blackmailing of drug users in Tijuana. Although the violence has decreased from the drug wars of the 2000s, the effects are still visible in the sex industry.

Most of the American customers have disappeared, making it difficult for sex workers like Ana and Rosa. Ana used to have up to ten customers a day, but now she only gets one.

Rosa is down from twenty-five to three. With such low numbers, it is hard to stay away from unsavory customers.

Bañuelos and Alaniz know that the drug war never fully vanishes. In 2013, there were 492 homicides, a surge of 54 percent from the previous year, and new cartel factions were sending out increasingly bold warnings to police who interfered with them.

Things calmed down to some degree in 2014, when homicides lessened by 40 percent, though no one is really celebrating yet. The police force is still recovering from the removal of corrupt officers and the implementation of stricter enrollment requirements.

Despite it all, Bañuelos appears to be hopeful. Sitting back in his chair, he remarks, “Even though we are fewer, we are now more reliable and effective.”

Before concluding the interview at the police station, Alaniz wanted to emphasize that “Tijuana is not an isolated event.”

He declined to clarify when I asked him what he meant, and instead he commented that “Americans are generally afraid of almost everything and this is not my opinion only… we all know that.

Because of these fears, they perceive it differently than what we’ve experienced in Tijuana during that time. There were less-than-ideal circumstances, but they tend to exaggerate it even more. I’ve been to places such as New York, Tennessee, and New Jersey, which also have areas similar to the Zona Norte.”

I questioned Alaniz if he ever felt frightened, due to the continuing corruption and the persistent danger of aggression. He shook his head. “You’re familiar with your job place, you’re acquainted with your history, and you can carry out your duties with contentment.”

According to him, when there’s faith in the state organizations, “you can cooperate with the administrators that have been there, because of the trust that has been established.

When there’s no trust, well… you can only withdraw and work on the more mundane things, no? You remain. That’s why I’m capable of narrating the tale that I’m sharing. You don’t converse much. ”

The interviews and translations were aided by Teresita Rocha Jimenez, Iv an Gonzalez, and Jaime Arredondo.

Additionally, You Could Enjoy

Using an alternative structure, this text could be written as follows: It is possible to avoid plagiarism by altering the structure of the text without altering the context and meaning. This is done by preserving the markdown formatting.

The use of technology has drastically altered the way we communicate and interact with one another. It has revolutionized the way we communicate and share information, and it has made it easier to stay connected with people no matter the distance.

Technology has enabled us to bridge the gap of physical separation, allowing us to establish and maintain relationships with individuals who may be far away.

Rather than simply copying and pasting, one way to avoid plagiarism is to restructure the text while maintaining the same context and meaning. This can be done by altering the order of the words, phrases, and sentences while still expressing the same message.

Endeavoring to avoid chasms, various

lesions and openings, boils.

In their teenage years they acted foolishly with things like drugs and acid, and suffered through heartache in their love life.

Abigail, who could be seen as having acted in an unpredictable manner, crafted a lament that was not well-received.

I constantly chase after Abigail, yet I’m filled with fear – is it an ailment?

Wildlife can predict a landslide. Creatures

have a fear of slaughterhouses. I, as an animal,

Nervousness runs rampant. My limbs are in a constant state of motion. I can’t help but marvel at my chance of being alive.

Dressed like a novice tightrope walker,

speaking to crowds with a fear of heights.

Adulthood drew a captivated creator to the ambition of a novice.

A foolish relationship ended in an abortion.

Subsequently, a belief in no deity was declared.

Going up to the altar in an abbey, the individual seeks to inquire of the supposed All-Powerful about what lies beyond life.

Going at a leisurely pace, one could be seen strolling around a stadium. Taking in the sights of a centuries-old aqueduct, they also sampled a dish of aspic.

Heaped affection on many creatures, devouring them in the process. Climb a mountain peak. Spoke with a particular inflection.

Hired a bookkeeper, a counting frame, and other possessions.

Tried out discordant broken chords.

The impact of the internet on our everyday lives has been immense, with it becoming an integral part of how we communicate and interact with one another. Our reliance on the web has made it a cornerstone of our society, with its influence being felt in almost every aspect of our lives.

It has allowed us to access a wide range of information, services, and products, as well as facilitating communication on a global scale.

It has also been a major driving force behind the development of numerous technologies and innovations that have made our lives easier and more convenient. In short, the internet has revolutionized the way we live.