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"NAFTA is making the border area more visible to the two countries’ central
governments, and the health impact of problems such as the question of what’s more
important transmission of tuberculosis and HIV/AIDS is just starting to be felt. The
potential for future problems is dramatic if something isn’t done now," said Dr.
Blanca Lomeli, director of PCI’s Border Health Initiative.
Lomeli said border areas are attracting business and industry without providing
well-planned strategies for growth. "Tijuana has become a major Mexican industrial
city, with its maquiladores (foreign-owned assembly plants in Mexico) and its proximity to
the U.S.," she said. "A growth rate of 5.2 percent a year brings huge problems
of air and water pollution, sewage disposal, chemical exposure and disease transmission.
The question of ‘what’s more important — healthful environment or access to
jobs — hasn’t been answered yet."
   Tackling Tuberculosis, HIV/AIDS and Substance Abuse
Tuberculosis (TB) is one of the most prevalent diseases in the border region. Lomeli
said the people who are most vulnerable to TB are those with inadequate immune systems
— often due to malnourishment or HIV — and that those who contract TB often do
not recognize its symptoms.
"TB is a highly contagious disease that is especially dangerous along our active
border because of the high transiency rate," Lomeli said. Almost 2.3 million people
cross the Mexicali-Calexico border every month, and about 6 million cross between San
Diego and Tijuana.
"When [people with TB] are diagnosed, they must complete their course of treatment
or the disease will recur and be resistant to medication. The key is early detection and
control," she said. "With a population that lives and works on both sides of the
border, it’s vital that the health providers working with them have very good
communication and cooperation."
PCI is working with health departments in Imperial and San Diego counties to facilitate
collaborations with Mexican health agencies — along with nonprofit organizations and
medical personnel in both countries — to combat not only TB, but also another major
problem: HIV/AIDS.
"It’s common knowledge along the border that TB travels south to north and
HIV/AIDS from north to south," Lomeli said.
While Tijuana has the second highest urban rate of HIV/AIDS infection in Mexico with
800 reported cases last year, San Diego reported more than 8,000 cases. The BHI is raising
awareness of the disease by providing technical assistance and support to binational
committees in San Diego, Tijuana, Imperial and Mexicali. In October, a Binational HIV
Reality Tour, organized by the Binational HIV/STD Committee, brought a group of San Diego
health providers and politicians to Tijuana to foster collaboration. A Tijuana-to-San
Diego exchange is also on the agenda.
 The BHI also supports vital substance abuse education
programs by promoting collaborations, making minigrants for prevention efforts and
encouraging a web-based communications network among agencies.
"We’re putting a special emphasis on the Imperial County/Mexicali Municipio
needs, because the resources [for substance abuse prevention] in that more rural area are
the most limited," Lomeli explained. "Interestingly, collaborative efforts are
often more difficult between counties on the same side of the border, because of
geographical barriers, so we’re working on those too."
Strengthening Border Agencies
 Although TB, HIV/AIDS and substance abuse are the
region’s major health threats, they are part of a larger pattern of declining health
on the border. A primary focus of the BHI is to increase the capacity of community-based
organizations (CBOs) and public health agencies to design, implement, manage and evaluate
binational health programs to institute change on a broad scale.
PCI has refined much of the know-how for setting up and administering health and
community development programs during its more than 35 years in the U.S.-Mexican border
region. Lomeli and her staff use this expertise to marshal agencies into collaborations
and help them acquire the skills needed to be effective health service providers.
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