As he was dying, Carolina knew that she probably would die of the disease, too. But she couldn't bear telling him that she was infected with the AIDS virus, and that he had been the cause. It would have meant confronting his infidelity after 27 years of marriage, and that would have been a "thing of fighting," she said in Spanish.
Today, Carolina, 60, also lives south of Fresno. She was smuggled across the border so that she could join her sons and take advantage of the medical treatment, which even for an undocumented immigrant is better than she would have received in rural Mexico.
Frail and weak, Carolina is among a growing number of Mexicans in the United States and Mexico who contracted HIV from their husbands or boyfriends who work in the Central Valley.
Almost nonexistent in the immigrant community a decade ago, AIDS has spread relatively quickly in recent years among California's farm workers, a trend that researchers and health officials attribute to migrants' high-risk behavior and constant movement.
As recently as 1994, more than 10 years after AIDS appeared in the United States, the California Office of AIDS found no migrant workers with HIV or AIDS when it conducted its first study of the community, said Director Juan Ruiz.
Now, based on a study of 600 migrant workers in Fresno and San Diego counties, up to 1 percent of the migrant population may be HIV-positive, according to a report published by the Universitywide AIDS Research division of the University of California. An estimated 1.3 million migrants work in California.
And even that may be underestimating the extent of the problem.
Migrants generally pass under the radar because their movement and, in many cases, undocumented status make it hard for researchers to count them or ask questions -- and for health officials to test them for the virus.
Migrant or mobile populations have played a major role in the spread of AIDS around the globe -- not just from the United States to Mexico.
Workers returning to South Asia from Africa spread the disease to the Indian subcontinent, where it threatens a population of more than a billion people. And truckers along the Kinshasa Highway helped spread HIV across the African continent, earning the route the moniker "the AIDS Highway."
In Mexico, where so many people "va y viene" (come and go), the first AIDS cases were reported in 1983 in six patients, all of whom had lived in the United States. Mexican government health records traced most HIV patients to a past in the United States until 1991.
Today, although the government has stopped collecting data regarding patients' travels, one third of AIDS cases occur in the six Mexican states that export the highest number of migrants to the United States. Michoacan, where Carolina is from, ranks No. 1.
Carolina doesn't know how her late husband got sick, and she considers it a moot point.
The possibilities aren't pretty. Whether her husband used intravenous drugs or had unprotected sex with another woman, maybe a prostitute -- or another man -- Carolina doesn't waste time thinking about it.
"What's done is done," she said, wearing a muumuu that failed to conceal her bone-thin limbs.
Looking for a better life
Migrants, like Carolina's husband, may come to the Central Valley to provide a better life for themselves and their families back home. But without those families, they are more likely to take risks, researchers and academics agree.
"Migrant people ... are in a different country, in a difficult (situation), away from their family and the group that provides them with the support that they need," said Ruiz, with the State Office of AIDS. "So they're more likely to engage in high-risk behavior in order to deal with loneliness and fear."
When migrants' families move with them, they tend to have fewer sexual partners, said Golden Valley Health Center's Dr. Salvador Sandoval.
"Probably most would prefer to have their families (with them)," he said.
But post-2001 border controls mean that more migrants now stay alone in the United States longer than in the past, Sandoval said. That gives them more exposure to HIV, which is twice as prevalent in adult populations in the United States as it is in Mexico.
During his 25 years as a migrant worker, Carolina's husband succeeded in furnishing his family -- him, his wife and four children -- with three houses: one in rural Mexico, another in a nearby mid-sized city where his children could study and one south of Fresno.
After her husband's funeral, her children sold their late father's two work vans to pay a smuggler to help her cross the border.
Carolina came because she thought she might qualify for government-funded widow's payments. Her kids wanted her here because they knew she'd get better medical care, even as an undocumented immigrant.
The first time she tried to flee, immigration officials apprehended the then-55-year-old. When she finally made it, all her husband had left was the house that their sons are still paying off and where Carolina spends her last days.
Carolina yearns for the home she left in 2000 beyond the border. But now that she's here, Carolina feels she can't leave.
"With what I went through to get here?" she said. "No way. I'm staying."
Carolina's two sons, who work at a canning factory to support her, won't go back, either.
"They don't have anything there to live off of," Carolina said.
The combination of the disease and talking about the economic realities that forced her family here caused her to excuse herself so she could vomit.
When she needs hospitalization, her sons pick up work in the fields to pay the bills.
Carolina's depressed about being stuck in Fresno County, but at least, her kids say, she's receiving medical treatment that is unavailable in rural Michoacan. Even though their father could have gotten help, too, he was in denial about his disease and never sought it.
Carolina visits a doctor in Fresno regularly and gets the medication she needs through the federally funded AIDS Drug Assistance Program.
Like everyone in California, Carolina is eligible regardless of her immigration status.
"There are probably some people who will be saying that we shouldn't be paying for (treating) the undocumented," said Sandoval. But from a public health perspective, immigration status is beside the point, he said.
"Diseases don't look into who's legal and who's illegal," Ruiz said. "There is a migrant population (that) at sometime or another is going to interact with the population at large. They're either going to have sex or they're going to share needles."
Carolina will never know if her husband infected anyone else.
"The thing is, really, now if someone is diagnosed with HIV, we end up paying for it," Sandoval said. "So it is in our benefit to prevent the disease in everybody."
Migrants a low priority
Migrants are last on the list for public health interventions.
Earlier this year, the Merced County Public Health Department came close to axing its program to educate hundreds of farm workers about the disease at the county's 18-plus ranches.
Facing $24,000 worth of budget cuts from the State Office of AIDS in September, Director John Volanti had to evaluate the county's at-risk groups and determine who would receive workshops and pamphlets describing infection and prevention measures.
He asked the Board of Supervisors to eliminate outreach to migrant workers.
"We just prioritized," Volanti said.
But shortly after, he received word that the state office would reallocate $56,000 to the county over two years for education and outreach.
It's the on-again, off-again attention that has left Merced County's migrants at increased risk.
"The loss of funding always impacts programs," said Cathy Bright, manager of Merced's Planned Parenthood, which relies on private donations and foundation grants to educate Merced's migrants about HIV/AIDS.
"Generally the result is that you have less time to spend with that population, and that always runs the risk of infection rates going back up."
Fluctuations in migrant outreach funding could prove especially painful when the very nature of the work requires steadiness and trust. Migrants, particularly those without work permits or other legal documents, can be very skeptical of strangers in the fields, educators agree.
"It takes a lot of time to develop the trust. You have to be very consistent," Bright said. "They have to see this is not a one-time shot in the dark."
And even though migrant HIV incidence estimates are lower than those of other at-risk groups, public health officials need to implement effective interventions now more than ever, Sandoval said.
Reports in the 1990s showed blacks practiced high-risk sexual or drug habits, he said, but, like migrants, had a lower incidence of HIV infection than other at-risk groups at the time.
Now, blacks account for more than half of the nation's new HIV infections, even though they account for only 13 percent of the population.
Health officials fear that something similar could happen in the migrant worker community, and that without a successful outreach effort to migrants, a big rise in incidence would have dire consequences for populations both north and south of the border.
"It's hard, very hard, but that doesn't really take away the responsibility of public health officials both in California and Mexico to come up with some interventions," Ruiz said.
For Carolina and her family, it's already too late. When she reflects on her life, Carolina misses the years she spent raising her four kids and dreaming about her husband's final return.
"I never imagined that it would come to this," Carolina said, holding a salted lime in her hand to stave off the bouts of nausea.
Reporter Liz Fox can be reached at 385-2472 or lfox@mercedsun-star.com.
