'Mercy Smugglers' Help Alleviate AIDS in Mexico

TIMES STAFF WRITER

Francisco Ortega packs $30,000 in AIDS medications into the battered 1982 Chrysler LeBaron parked outside a Huntington Beach garage, secures the trunk with a rope and heads south to Mexico.

It's an inauspicious start to a mission of mercy.

Ortega secretly exports American AIDS drugs and other supplies to barracks-like clinics in Tijuana and other Mexican cities where bony men without health insurance or family resources live out their last days.

From cities throughout the United States, "mercy smugglers" such as Ortega move millions of dollars in AIDS drugs--specifically the so-called triple cocktail variety that is extending the lives of AIDS patients across the U.S. and Europe.

These smugglers come from all walks of life and include American gay activists, relatives of AIDS victims, even a Mexican nun named Sorberta Lopez who travels to Santa Ana and Los Angeles every few months to collect drugs for shelters in Guadalajara and Cancun.

Some stash the drugs--obtained from patients who have died or switched to other medications--in glove compartments and trunks as they drive across the border. Others stuff suitcases and fly south using donated frequent flier miles.

The transfer of medicine without a prescription is illegal in both Mexico and the United States. But neither country is making a concerted effort to stop the flow.

Mexico has 42,000 registered AIDS cases--and more than a third of the patients don't have access to health insurance and the top drugs, according to research compiled for the Mexican government by Dr. Jorge Saavedra, an expert in the country's health care system.

Many of these patients are migrant workers who contracted HIV, the AIDS virus, in the United States and now turn to the clinics for medication and treatment not available in their rural Mexican hometowns.

"There are many, many people in Mexico who don't have these medications," Saavedra said. "That is what fuels the work of [others] to help."

For many Mexican patients, drugs and other supplies brought in illegally from the United States represent one of the few ways to treat their disease.

Patricia, a 33-year-old mother of two living in a tiny Michoacan village, said she contracted HIV from her husband after he returned from work in the United States. He died, leaving her to raise the children by harvesting corn and lentils.

Patient Relies on Others' Goodwill

Patricia, who asked that her last name not be used, spent the family's entire savings--$2,500--purchasing AIDS medications for herself. When the money ran out, a friend's son who lives in California offered to bring her unused medication from clinics near his home. Patricia believes that she would be gravely ill--if not dead--without his help.

"It's only because of the goodwill of others that I can make it," she said.

Such stories of need drive smugglers to keep their operations going--even though they know that they are breaking the law.

"I may go to prison, but that's OK, because I know God is watching me and he knows what I am doing and why," said Mercedes Castaneda, a smuggler who works as a nurse in Michoacan.

Four years ago, Castaneda started transporting drugs to AIDS patients in Mexico from Nashville, Atlanta and Chicago after discovering that her cousin was infected with the virus.

With help from relatives in the United States, Castaneda, 37, found several AIDS clinics willing to donate surplus drugs. She packs the medicine in her suitcase and travels by plane to Morelia, the capital of Michoacan state, several times a year.

Authorities have stopped her only once--at an airport checkpoint. A customs agent in Mexico opened her suitcase and saw boxes and boxes of medicines, along with other hospital supplies including soaps and towelettes, she said.

"I told him I had AIDS and that I needed these medicines to survive," she recalls. "He immediately closed the suitcase and threw it down. He didn't even want to touch it."

Group Hopes to Regulate Transport

AIDS clinic doctors and managers credit the "mercy smugglers" with helping to improve the health--and brighten the lives--of hundreds of patients who either cannot afford or don't have access to the most advanced medication.

The smuggling has become so prevalent that the Pan American Health Organization is trying to work with nonprofit groups to better understand how smuggled drugs make their way into Mexico and how they are stored and administered.

Officials for the organization, which coordinates public health policy throughout Latin America, say they hope to eventually create some regulations for drug recycling to ensure that the treatments are safe.

"This cunningness must be combined with great organization and knowledge," said Rafael Mazin, regional advisor for the group.

Vials of smuggled medicines often are mixed together in plastic shoe boxes and later administered by volunteers with limited medical training. Mazin and other health professionals fear that drugs with different expiration dates are being combined or mislabeled, making it difficult to know whether patients are getting proper treatment or even if they are being harmed.

"It's wonderful to have donations," said Rebeca Ramos, technical director for the U.S. Mexico Border Health Assn. "But there must be medical follow-up to the donations and continual access to the drugs."

Smugglers reject these concerns, saying the alternative to the aid they provide is a death sentence for patients.

"I started doing this because I saw people in need," Ortega said. "After seeing that there is more than enough [drugs and supplies] . . . in the United States, there was no other moral choice for me."

Ortega, 42, who makes a living selling watches at swap meets, got involved in smuggling four years ago. Several of his close friends, both in Orange County and Mexico, suffered from AIDS and, on a trip to his native Guadalajara, he saw firsthand how few resources clinics in Mexico had compared with those in the United States.

He started by collecting medicine for an HIV-positive couple he knew in Guadalajara. But eventually, his smuggling expanded to a clinic in Tijuana.

"When you see what these people are going through, what they suffer because of what they do not have, there is no other option," said Ortega, who said he is not infected with the AIDS virus.

Ortega says what keeps him going are the little triumphs he sees in AIDS patients who receive his medicine.

On a recent Friday, his destination was Las Memorias, an AIDS hospice hidden behind an olive orchard and a swath of factories 15 miles from downtown Tijuana.

When his car arrived amid a cloud of dust from the unpaved road in front of Las Memorias, the patients peered out of the door to see what he had brought.

While they sifted through the used jeans, shirts, canned foods and hotel soaps he had hauled, Ortega was busy checking out the water tanks. He worries, because there's not enough money to pay for water so that patients can wash their clothes regularly.

Inside the hospice, he hugged the patients. He talked with 24-year-old Carla about getting her a stove for an apartment she will share with her boyfriend when she leaves Las Memorias soon.

"I began to get to know the patients. They became people. These were not statistics, and for me this was not another country. We are all in this together," he said.

He sat on the beds of the men with withered limbs. He held patients' hands as they groaned in pain. Two were blind from AIDS-related diseases; some had tuberculosis.

As he left the clinic, he kept with him his own handwritten list of 200 HIV-positive patients in Tijuana, the type of medicines they take and other items they need.

On the way home, Ortega said the visit discouraged him because it underlined how much more there is to do. He planned to ask friends in Orange County to help.

"They need to raise more money, selling tacos or doing whatever," he said. "No one can live this way."

At Las Memorias, Ortega is nothing less than a lifeline.

Jose Luis Aguirre, 31, weighed 154 pounds before he found out that he was infected with HIV. He was visiting his mother in Tijuana at the time, on vacation from his job as a factory worker in Los Angeles. He weighed 92 pounds when he got the diagnosis. Even then, there were no HIV medicines available, even if he had the money.

Through friends, he found out about Las Memorias.

Aguirre gained 30 pounds with the help of HIV drugs donated by Ortega and others. Still frail, he watches television at the shelter and worries about whether the donations will be there tomorrow.

Aguirre says he wouldn't know where to turn without Ortega's help. He believes that he got AIDS in Los Angeles, where he hit the bars of West Hollywood and Van Nuys after work. Though he goes by the name "Jose," he had a sex-change operation while in the United States and wears women's clothing.

He feels at home at Las Memorias but worries what would happen to him if Ortega's Chrysler broke down.

"The medications do run out. Then we just wait and pray. It really frightens me," he said.

The smuggling makes such a difference because most impoverished Mexican AIDS patients cannot afford--or can't gain access to--the most effective treatments for the disease--the so-called triple cocktail.

The mix consists of two medications that slow the AIDS virus' copying of itself and a third, newer drug called a protease inhibitor. The drug stops a later stage of reproduction, when an enzyme, HIV protease, makes material that will become copies of the virus.

The drugs must be taken every day at precise times, otherwise a patient can become ill or develop a resistance to the therapy.

Most of the AIDS patients in the United States who cannot afford the drugs can receive them free through a federal program.

But in many developing countries, including Mexico, the government doesn't subsidize such treatment.

Instead, only AIDS patients whose employers make health insurance contributions are eligible for low-cost drugs. That leaves thousands of impoverished Mexicans without access to the triple cocktail therapy, which costs about $1,000 a month.

And even for those who can afford the best AIDS drugs, the medications are not always available. Doctors give these patients prescriptions, but pharmacies cannot always fill them, leading to gaps between doses.

Even worse is the fact that many impoverished patients go for long periods without necessary testing. In July, for example, the National Institute of Diagnosis and Epidemiological Reference suddenly announced that it had run out of the materials necessary to conduct tests that determine AIDS patients' viral loads. The load determines which drugs patients should take.

The institute is the only public facility that could do such a test for $80. Private clinics charge $300.

Both government officials and AIDS activists acknowledge that there are no easy answers to the problem.

If the government gave the triple cocktail to all of the estimated 90,000 uninsured people believed by the Pan American Health Organization to be HIV-positive, it would need $591 million a year, according to research compiled for the Mexican government. That's about 50% of the total budget for the Ministry of Health.

It is the disparity between two neighboring countries--the lack of money and medicine in Mexico and the advanced care and bountiful supplies in the United States--that motivates many smugglers.

Said Skip Rosenthal, founder of El Paso-based International AIDS Empowerment: "When you are so close to the border, I find it morally repugnant that on one side, people have access to everything, and on the other side, people [are] dying."

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