Tracking a Killer in Tijuana : Health: Poor record-keeping and patient fear make it hard to compile accurate figures of AIDS cases. Some say they could be three to five times greater than the official figure.

San Diego, with 2.5 million residents, has more than 3,400 AIDS cases. But across the border in Tijuana, with its 1.5 million people, only 215 AIDS cases have been reported.

All along the U.S.-Mexico border, health officials say, fewer cases of AIDS are reported in the developing country.

The Tijuana doctors who treat many of the city’s AIDS patients say they know the government’s numbers are in error. The underreported numbers, they say, show the tremendous stigma attached to the disease and a fear that runs so deep that infected patients are sometimes left to die untreated in hospitals.

“There’s rejection of the idea that we have a problem, because that translates to less tourism,” said Dr. Jose Lepe, medical director of a free clinic for AIDS patients in Tijuana.

‘The numbers are a big lie,” said Dr. Carlos Diaz, who also treats AIDS patients. “The authorities are in denial that we have a problem.”

Lepe and others say that Mexico may indeed have fewer cases than the United States because of differing cultural views toward homosexuality, but that the official numbers still underrepresent the true picture. Doctors and activists say the actual number of AIDS cases in Tijuana is probably three to five times greater than the official figure.

Local Mexican health officials say AIDS has not swept into their country as vigorously as it has in the United States, but acknowledge that the problem is more widespread than their statistics indicate.

“There probably are more cases,” said Dr. Jose Medina, coordinator of epidemiology monitoring for the federal health department in Tijuana. “These are the cases we have confirmed.”

Local health officials deny the statistics are intentionally underreported.

Instead, budget constraints, lack of resources and testing centers, and insufficient public awareness of the disease in Tijuana are all obstacles to compiling accurate data, Medina said. In addition, the border city has a large transient population of migrants from elsewhere in Mexico that is particularly hard to monitor.

“There is more consciousness of AIDS in San Diego,” he said.

Efforts are under way to improve record keeping, said Dr. Eduardo Valdez of the City Medical Services, a government agency that tests and registers Tijuana prostitutes for AIDS.

A group of doctors and health officials in the city is working to create a central data bank that would receive AIDS test results from private doctors, hospitals, laboratories and the health department, Valdez said. “It . . . (would) gather all the information in the same place and get the statistics closer to reality.”

Medical experts are quick to point out that in Mexico, diseases considered simple to treat--such as diarrhea--can be life-threatening. And tests, like the ones for HIV that are readily available in the United States, are not free in Mexico.

All along the border, fewer AIDS cases are reported in Mexico. In El Paso, Texas, for instance, which has a population of 516,000, there have been 160 AIDS cases. Yet in neighboring Juarez, which is twice as big as El Paso, only 200 AIDS cases have been reported.

“It’s a poor country. Whether proportionately they have neglected AIDS is a real question,” said Dr. J. Allen McCutchan, a professor of medicine at UC San Diego and director of the California Collaborative Treatment Group, which runs statewide AIDS research trials. “Think about tuberculosis and other diseases.”

Today in Tijuana, there are more reasons to stay mum about AIDS, some say, than to come forward and seek help.

The recent death of Patricia Zaragoza, who had AIDS, served as a painful reminder to activists that the battle to educate about the disease has only just begun.

Zaragoza, a 22-year-old prostitute who worked for two years in Tijuana, died in June after being repeatedly denied admission to the public hospital. She arrived at the hospital with a note from her doctor saying she was infected with AIDS and urging the staff to treat her promptly for what appeared to be appendicitis.

When she was finally admitted to the hospital after four days, the doctors did not operate. Zaragoza, who told her doctor that she catered mostly to American clients, died on a gurney June 14.

No autopsy was conducted. Lepe, the doctor who sent her to the hospital, believes she died of a ruptured appendix.

“You cannot be walking around five days with a ruptured appendix and survive,” said Lepe angrily. “It was maybe a German-like solution to kill the sick. It was a quick solution to her problem.”

Lepe and others say there are numerous social, cultural and economic hurdles that ensure that AIDS sufferers never step forward or, like Zaragoza, only seek help when they are desperate. With no cure for AIDS, some afflicted see little point in enduring the stigma that inevitably accompanies diagnosis of the disease.

In the United States, many people believe it is in their best interest to know early that they are infected. Armed with this knowledge, they can seek treatment designed to stave off the advances of the disease. But this approach often includes expensive drugs, like AZT, that are not widely available in Tijuana.

“If you are positive (for HIV), it doesn’t help you to know. It becomes a nightmare in all respects,” Lepe said. “You won’t have access to treatment. The society will reject you. There is no incentive for being tested. There is no incentive to really know the reality.”

Because the government asks physicians to submit names of their infected patients, some people request that their true names not be used and others will simply stay away from doctors. In hopes of maintaining their privacy, an unknown number of wealthy patients cross the border seeking treatment.

Still others will persuade their doctor not to report their status.

“That exists but I can’t say in what quantity--we think it’s minimal,” said Dr. Ernesto Macareno, coordinator of health services for the health department.

(In the United States, health agencies monitor the epidemic but do not record names.)

In part, the low number of recorded AIDS cases reflects the country’s poverty and the fact that so few Mexicans can afford medical treatment.

“You have to have money, you have to be rich,” said Alberto Hugo Garcia, a 41-year-old AIDS patient. “If you don’t have money, you are on the street.”

But, the low number of reported AIDS cases also reveals a different attitude toward treatment and medicine. Sometimes, an ailing patient will simply go to the local pharmacy, describe a particular symptom and request relief. Injections of vitamin B-12, for instance, are popular.

“When people in the Hispanic culture seek health care, it’s for the final solution,” said Mary McCarthy, a UC San Diego nurse who helped found Tijuana’s first AIDS clinic. “You can buy anything over the counter in a pharmacy and that’s how a lot of people treat illness.”

The Latino culture, some patients said, is more fatalistic about death.

“People say if they are going to die, they don’t want to know,” said Juan Manuel Lasso, a 36-year-old taxi driver found to be HIV positive three weeks ago.

To Lasso, a former heroin user, the diagnosis was no surprise because he had shared so many needles during his 20-year heroin addiction. But the irony wasn’t lost on him: Lasso kicked his habit four years ago.

Almost proudly, he rolls up his sleeves to show the scars on his arms from repeated punctures by years of needle use. The veins in his legs, too, bear the legacy of needles.

Today, Lasso has told few people outside his family that he is infected with the AIDS virus. “I am,” he said, “a little afraid.” His wife has not yet been tested.

Patients and doctors say the discrimination that automatically follows disclosure of the disease is a major reason why more people don’t seek medical attention and therefore are not reported.

In the case of Alberto Hugo Garcia, the diagnosis of AIDS destroyed his life. Two years ago, Garcia worked as a salesman in a Los Angeles clothing store. When he started feeling ill, he came home to Tijuana, where he learned he had AIDS.

Garcia first lived with his sister but when her 2-year-old son was diagnosed with leukemia, the family asked him to leave.

Today, Garcia lives in a wood shack several miles outside Tijuana. It has no electricity or running water. Every week, his sister brings him rice, beans and eggs. At the medical clinic, he can sometimes pick up donated food; last week, he got five grapefruits.

“People say, ‘Don’t come near me,’ ” said Garcia, his voice flat.

His other sister and brother have also asked him to stay away from their homes. Friends avoid him and when they do run into one another, they will not shake hands.

“I understand,” he said. “They treat you like they are going to get infected.”

Garcia says he knows other people who are infected, or even ill, and just do not seek medical help.

“There are a lot of people infected. They don’t want to come to the clinic. They just want to live like they always have,” Garcia said. “They don’t want to live with the pain of knowing they are infected with AIDS. Some just come for a test and then they don’t come again. They are afraid of the discrimination.”

For those who do learn they have AIDS, and their doctor does report it, there is still no guarantee that the information will actually get passed along to the appropriate government authority. Data collection and communication between medical facilities and the government has been erratic, medical experts said. Somehow information seems to tumble into a void. This problem is not limited to AIDS--it also happens with other diseases, such as tuberculosis.

“There’s poor case reporting between Tijuana hospitals and the federal health center,” McCarthy said. “Getting information from federal, state, and local authorities? There’s poor communication--forget it!”

In the case of Zaragoza, the young prostitute, the government office charged with monitoring and testing prostitutes had no record of her, Jose Rubio, director of City Medical Services, told local newspapers.

Luz Robles, a registered nurse, accompanied Zaragoza as she sought treatment from Hospital General de Tijuana. On the first day, the doctor told Robles and Zaragoza that there were no beds, Robles said through an interpreter. Zaragoza, pale and sweating, clutched her stomach and fainted, Robles said.

Over the next several days, Luz accompanied the young woman as she again and again sought help from the hospital. One time, they were told there still were no available beds, Luz said. Another time, they were told to seek help at a private facility.

It was clear to Luz that Zaragoza was suffering more and more pain. She fainted frequently.

“I could not believe it,” Luz said. “The hospital is supposed to be open to the general public. I thought ‘what am I supposed to do now?’ ”

Luz said she went to a municipal judge and obtained a court order.

Zaragoza “didn’t understand why she wasn’t being admitted,” Luz recalled. “She was in a lot of pain, she couldn’t understand what was going on.”

Although the hospital finally admitted Zaragoza, the doctors did not operate. At 5 a.m., only hours after being admitted, Zaragoza died.

“It was a life wasted, it couldn’t even serve to raise awareness,” Lepe said. “It was buried as all her problems were.”

Staff writers Sebastian Rotella and Lee Romney contributed to this story.