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The early years of AIDS in Tijuana

Emilio will take care of them

The funeral home declined to embalm the body, so all of Max's infected blood would enter the earth with him.  - Image by Paul Stachelek
The funeral home declined to embalm the body, so all of Max's infected blood would enter the earth with him.

A COLD RAIN STARTS TO FALL AS MAX'S DOVE-GRAY COFFIN IS UNLOADED FROM THE BACK OF A DARK HEARSE PARKED IN THE MUD. EMILIO VELASQUEZ, DR. CARLOS DIAZ, AND TWO OTHERS EASE THE COFFIN ONTO ROLLERS AND PUSH IT INTO THE SMALL CATHOLIC CHURCH THAT SERVES THE COMMUNITY OF El TECOLOTE, BACK IN THE HILLS SOUTH OF TIJUANA, ABOVE THE FREE ROAD TO ROSARITO BEACH. EMILIO HOPES THE FUNERAL AND BURILA WILL END IN TIME FOR HIM TO RACE BACK TO TlJUANA AND PAY. BUSINESS TAXES DUE THIS DAY ON

Emilio (left): "I need someplace to scream. Where can I go scream?"

Emilio's Cafe Musical, the small club he operates on Third Street. But Father Lorenzo, the gray-bearded priest conducting the service, is in no hurry, and when Emilio sees Max's mother sobbing on a front-row bench, death replaces taxes as his chief concern.

Dr. Carlos Diaz (center), Emilio (right)

Emilio rushes to her as the rain drums hard on the church's multicolored roof of salvaged plywood, drowning the sound of grief. Father Lorenzo begins his funeral Mass, while 20 people sit on the cold, hard benches. This is an unusually small number of mourners for rites for a community activist like Max.

Max's funeral. Father Lorenzo nearly shouts to be heard over the driving rain.

His brother Francisco has a good excuse for not being here; he's up the hill in the cemetery, helping to dig the grave next to that of Max's close friend Arturo, who died nine months ago. Like Arturo, Max died of AIDS.

Emilio and Carlos Diaz have made the trip to El Tecolote many times since last October, when Max, who was 29, became one of the first patients of Tijuana's only AIDS clinic.

Emilio holds Max's mother's hands, while Max's stepfather, a man with filmy eyes set in a deeply lined face, spends most of his time on his knees, praying.

In between his weekly visits to the clinic, Max would receive medications and other supplies from Carlos, the one medical doctor in Tijuana willing to devote most of his time to treating the city's growing population of AIDS patients, and from Emilio, the most visible activist in behalf of Tijuana's gay community. Most of those supplies were donated by families of San Diego AIDS patients who had died. Some of the donations, such as food, were purchased by Emilio with his own money.

Mary McCarthy, a nurse from San Diego, has informed Emilio that her boss will no longer allow her to work with AIDS patients.

But for Max, at least, all of that was ending today. Emilio and Carlos would continue visiting homes and hospitals where AIDS patients lay dying, and Emilio would still deliver food and necessities to the widows of Tijuana's AIDS victims. Emilio has no escape from the struggle with the confusion, ignorance, pain, and grief that AIDS has visited on Tijuana.

Father Lorenzo nearly shouts to be heard over the driving rain. He sticks to the liturgy, leaving the eulogies to the internal monologues of Max's friends and family. The casket is closed, as it was last night at the wake in the Martinez funeraria on Ninth Street, the one funeral home in Tijuana willing to handle the body of an AIDS patient.

Ernesto, a 36-year-old AIDS patient, who has been bedridden since November, looks much sicker now than Max did before he died.

Closed caskets are rare in Mexico, but the fear of AIDS overpowers tradition. The funeral home declined to embalm the body, so all of Max's infected blood would enter the earth with him. Nor was an autopsy performed, since most of Tijuana's forensic physicians refuse to touch the corpse of someone who has died of AIDS.

Most AIDS medical supplies and drugs are donated by families in the U.S. who no longer have need for them.

"Medical students, pathologists, doctors could have learned so much from Max's body," remarks Carlos Diaz, who signed the death certificate attributing Max's death to lung failure and lymphoma caused by AIDS. His eyes bulge in futile anger. When Carlos said this, he was sitting in the funeral home the night before the funeral, listening to Max's mother sob inconsolably and staring at the painting over Max's casket that depicted angels lifting Jesus Christ onto a cloud.

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In Fr. Lorenzo's drafty church, midway through the service, the large, bloody crucifix behind the altar suddenly brightens when the rainfall eases and winter sun shoots through the muddy windows. Emilio still holds Max's mother's hands, while Max's stepfather, a small man with filmy eyes set in a deeply lined face, spends most of his time on his knees, praying. By the time the casket is rolled out the door and loaded into the back of a red pickup truck, fleecy clouds fill the eastern sky, and the bright Mexican sun illuminates the mint-green stucco walls of the church. Max's mother and stepfather and several relatives climb into a four-wheel-drive vehicle for the precarious half-mile trip to the hilltop graveyard. The rest of the mourners, unable to drive the muddy roads, set out on foot for the burial. Emilio and Carlos both grab a corona of flowers and start walking.

El Tecolote's graveyard sits on a knoll with a spectacular view of the ocean and the Coronado Islands to the west and great rolling hills stretching away to mountains to the east. Northward, the top edge of Point Loma is just visible above a gray-brown ridge. By the time the mourners arrive, their shoes are caked with heavy layers of clay mud, and they're panting from the uphill climb. A stiff on-shore wind whines through the tilted wood and iron crosses. Emilio, dressed in fine, pointy-toed dress shoes, slacks, and necktie under a heavy peacoat, wonders again if he'll have time to pay his taxes on time and avoid the ten percent late fee.

Five men are still working hard on Max's grave, lining it with bricks and concrete to form a kind of sunken crypt, just like his friend Arturo's. The mourners will have to wait at least an hour for the grave to be completed. Meanwhile, clouds mass overhead once more, and rain begins to dapple Max's casket, which has been unloaded onto the flat top of another crypt. Max's mother collapses onto the coffin, crying, and Emilio once again tries to console her.

Ramona Lopez was one of Max's closest friends. She says that Max, who worked as a personnel manager for a large grocery chain, was an active member of the citizen's committee that successfully petitioned the state government for 200 adjoining lots to create the community of El Tecolote, now visible as a collection of small houses, shored up with stacks of worn tires, down the hill to the west. El Tecolote and a sister community, La Gloria, form the Delegation San Antonio de los Buenos, with a population of about 10,000. Arturo, Max's lover, was a doctor who often donated his services to the residents of the two colonias.

At the wake last night, Ramona had whispered to Emilio that she knew of one other man who had sex with both Max and Arturo. People frequently approach Emilio at these funerals with information about the dead man's sex partners. He used to try to track them down, but that became so time-consuming that nowadays he will simply tell the mourner to find that person and warn him. Emilio now urges Ramona to tell the man to be tested for HIV infection and to try to convince him that the earlier the infection is detected, the better it would be for him. Ramona, Emilio, and Carlos are probably the only people in the graveyard who truly understand the significance of the two brick crypts sitting side-by-side on a cold, windy hill, above a rural community in a third-world Catholic country. As rain starts to fall again, Carlos and Emilio head down the hill for the trip back to Tijuana. It's already too late to pay Emilio's taxes, but they don't want to wait in the cold and rain any longer. There are other patients who are still alive, and they will stop to visit one on the way back to town. They've paid their respects, and besides, they've seen plenty of burials already.

"I need someplace to scream. Where can I go scream?" Emilio's Castillian face is sagging as he enters the upstairs room of his Tijuana coffee house. It is six days before Max's death, and the doomed man is sitting in a booth with Dr. Diaz and Mary McCarthy, a nurse from San Diego, who are examining his grotesquely swollen lymph glands. Emilio has just gotten off the phone with an epidemiologist who works for the local federal health clinic. She has informed Emilio that her boss will no longer allow her to work with AIDS patients. Among the group of volunteers in the room, none is surprised. They are examining AIDS patients here at Emilio's cafe this Tuesday night because the epidemiologist's boss, Dr. Ismael Llamas Amaya, head of the federal health department in Tijuana, had shut down the AIDS treatment clinic the previous week. The weekly clinic, in operation since last October in the administrative offices of the federal health department, was branded by Llamas a threat to the lives of women and children who come to the health department for vaccinations and other health care. Llamas also downplayed the importance of the AIDS clinic, insofar as there were only 65 confirmed AIDS cases in all of Baja (55 of them in Tijuana), by official count. And if that weren't enough reason to banish the clinic, Llamas later told associates that he wanted nothing to do with treating that "puto's disease." Puto translates as "faggot."

Llamas's actions infuriated both the Mexican and American volunteers who have been trying to help AIDS sufferers in Tijuana. They were already struggling against a nearly implacable wall of fear, ignorance, and official indifference, analogous to the situation in the U.S. in the early 1980s, when AIDS was called the "gay cancer" and research money was slow to materialize. But for Mexico, with a primitive public health system that sees dozens of Tijuana babies die of simple diarrhea each year, the arrival of AIDS is potentially catastrophic. A Dr. Llamas was exactly what Tijuana's AIDS patients didn't need.

Contrary to Llamas's contention that AIDS isn't a significant problem in Tijuana, it's clear that it, like most other infectious diseases, is seriously underreported in Mexico. Reporting AIDS cases to the secretary of health in Mexico City wasn't even a legal requirement until 1986, a full five years after the virus had been identified. Today, Mexico claims to have only about 3000 AIDS cases, nationwide. The official number of 65 cases in Baja hasn't been updated since last July. But Emilio and Carlos Diaz and some of the American volunteers say that they hear informally from doctors at the Social Security Hospital that about seven new cases are diagnosed there each month. The AIDS workers figure that if you triple the official number of AIDS cases, you will be close to the actual number.

So where are all these AIDS patients? If there are over 150 in Tijuana, why is the clinic treating only about 20? Emilio offers several answers: some are misdiagnosed, some go elsewhere for treatment, and some are dying in seclusion at home.

According to Emilio and Dr. Diaz, there has been a sudden increase in the number of tuberculosis cases diagnosed in Tijuana. They believe many of these can be attributed to AIDS. "But the doctors don't know enough to put two and two together and figure out that the TB may be an opportunistic infection related to immune system suppression," says Emilio.

Then too, some well-off Mexicans with AIDS go north to the U.S. for treatment, because Mexican doctors have so little training, equipment, or experience with the disease. San Diego AIDS workers were shocked recently when one wealthy young man from Mexico City came to them for treatment, saying he had spent $30,000 on hospital care down there. Doctors in Mexico City performed major thoracic surgery on him just to obtain a piece of his lung for a biopsy. In the U.S., a lung biopsy can be performed on an outpatient basis, without cutting open the chest. In addition, Emilio offers, Mexican nurses are said to refuse to touch AIDS patients, who are routinely turned away from hospitals in Tijuana. When one is admitted, usually for some other malady like tuberculosis, once he or she is diagnosed with AIDS, the patient's care is left to volunteers from outside the hospital. Sheets and towels touched by the patient are burned, and after the victim dies, the body is often buried hastily, without autopsy or embalming.

Mary McCarthy, a nurse practitioner who specializes in AIDS care at UCSD's Owen Clinic, is an American volunteer who has helped establish the AIDS clinic in Tijuana. McCarthy says two illegal immigrants from Mexico are being treated at the Owen Clinic now, underscoring an emerging dilemma in the identification of Mexicans who are HIV-positive. It is believed by the medical community that illegal Mexican aliens who are diagnosed in the U.S. to be HIV-positive return to their homes in Mexico and never reveal their illness to Mexican medical authorities.

Emilio mentions a study that supports some of those fears. According to Miguel Angel Gonzalez-Block, a doctor of sociology and AIDS researcher at Mexico's Colegio de la Frontera Norte, "Migration is a risk factor itself. Studies point to a slowing in the rate of increase of the [HIV] infection overall, but in the lower-economic population, there's a higher rate of increase, and migration is the main factor." Gonzalez-Block points out that in Mexico, male prostitution is more widespread than in the U.S., and studies of Mexican sexual mores have shown that men can have sex with other men and not be considered homosexual, as long as they remain in the penetrator's role. For large groups of men isolated in U.S. migrant worker camps with almost no women, there are few options for exercising the need for sexual release. The problem of AIDS and migrant workers has caught the attention of the Mexican consulate in Los Angeles, which is cosponsoring (with the Colegio) a conference on AIDS and migration in Santa Monica at the end of May.

Emilio cites another academic study that underscores his concern about the devastating potential of the HIV virus in his city. In Mexico, where men tend to marry in their late 20s, the macho imperative requires sexual conquests prior to matrimony, and yet Mexican women are expected to remain chaste until marriage. According to a study conducted by anthropologist J.M. Carrier, published last year in the journal Medical Anthropology, this dilemma means that "at any given age, more sexually active single males in Mexico have had sexual intercourse with both genders than have Anglo-American males." When Emilio goes out to locate men to be tested for HIV infection, he doesn't ask a man if he's homosexual; he asks, "Have you ever had sex with a man?" Mexican men will deny being homosexual, Emilio says, but will admit having anal intercourse with another man. For AIDS workers in Mexico, this suggests that AIDS has the potential of spreading quickly through the heterosexual community as bisexual men who've contracted the disease spread it to their wives.

Emilio is also pessimistic because he knows that an AIDS patient in Mexico, for many good reasons, will continue to deny he has the disease until he's nearly dead. When he and his family do face the truth, they often ask that the information be kept quiet so no shame is brought to the family. This is another reason AIDS is underreported in Mexico and few men seek treatment.

Also, "There's a lot of violence against gays in Mexico," explains Emilio, and he believes the violence has escalated since AIDS arrived. This increases the difficulty of getting people in high-risk groups to come forward for testing. "We think a lot of people just hole up in their apartments to die alone," Emilio remarks.

Max didn't do that. As he watched Arturo die, he had a preview of his own fate. Max came to the clinic the first night it was open and almost every week thereafter, accompanied by his brother Francisco. He hoped to obtain the drug AZT through the clinic, "but Max was one of those poor souls with no money to find out what his blood counts were," explains Mary McCarthy. Baseline blood counts of certain types of cells need to be known before a patient is given AZT, an expensive drug and one that isn't available in Mexico. Clinic volunteers such as Fred) Scholl, a long-time gay activist in San Diego who has visited Tijuana regularly for years, are able to scrounge up various remedies, including AZT, but the drug is not administered indiscriminately because of its scarcity and potential side-effects. McCarthy and Dr. Diaz suspected Max's main problem was lymphoma, a fast-moving disease on which AZT would have been wasted.

Six days before his death, Max sat in a booth talking with Diaz, McCarthy, and another American volunteer nurse. He looked gaunt and said he couldn't walk much anymore. On both sides of his neck, huge masses bulged, and he had similarly large protrusions in his armpits. When the volunteers pressed these lymph nodes, Max winced.

"I wish we could lay him down so we could feel his stomach," McCarthy remarked. The donated examining table was back at the federal health department, from which they had been banished. A couple of volunteers spotted three long pads Emilio uses to cushion benches in the cafe, and these were placed on the floor in front of a large-screen television and covered with a donated plastic sheet. As Max was being eased onto this makeshift examining table, someone cursed Dr. Llamas for forcing them to work like this on mortally ill patients. Someone else asked why the volunteers couldn't pass Llamas some mordida and grease his palm. "With what? Oleo?" asks McCarthy. The clinic is chronically short of cash.

Emilio watches all this warily. His business has already suffered major declines since he started holding AIDS assistance meetings here in the mid-1980s, and then he nearly ended up going broke when he started using his upstairs room as a place to draw blood for HIV tests. "Customers weren't too excited seeing people carrying vials of blood downstairs," he recalls. Now, he's operating an AIDS clinic in a place where people buy food and drink. If Llamas wanted to, Emilio says, he could shut down the cafe for that.

Max is sprawled under a strong light bulb. He looks skeletal. He pulls up his shirt so McCarthy and Diaz can feel his stomach. An American social worker acts as translator. Max tells McCarthy he has dark urine, and his stools are yellow. He has a croupy cough; when he sits up and covers his mouth to collect the phlegm in a tissue, McCarthy insists on looking at it. "Oh my God, that looks like pus!" she exclaims. McCarthy proceeds to listen through his back with a stethoscope, and Max apologizes for not being able to take a bath for three days. "How do you say, 'You smell like perfume1 ?" McCarthy asks the translator. She tries to get Max to laugh.

Later, everyone was amazed at how fast Max went. Just a few days after that clinic visit, Max was brought back to the cafe. By now, his brother had to carry him upstairs so Carlos Diaz could examine him. Max's mother had also made the trip to town this time, and when Diaz told her Max had only a couple of days left, she broke into almost hysterical grief. Max told his brother he was ready to rest, and his brother also cried for the first time anyone could remember. Diaz gave Max some morphine, which is illegal in Mexico, as are most strong pain-killers. "That's all I could do," says Diaz. "Now, all there is to do is bury Max with a minimum of humiliation to the family," remarked a close associate of Emilio's. That night, Max died at home, about 10:30, after saying goodbye to his family and drifting off to sleep.

Why have you allowed yourself to become so consumed with this AIDS epidemic, up to your neck in death and suffering? Why don't you just say that's it, I quit? "I say that every day," Emilio replies, piloting his ancient Ford LTD in the bumpy blackness of night toward Tijuana General Hospital and another AIDS patient. "But who else would do what needs to be done? It's like a foreign army has invaded my country, and nobody's doing anything about it. I was just in the wrong place at the wrong time, but I'm trying to do the right thing."

Emilio Velasquez is 40, with the good looks and taut frame of a much younger man. His status as the son of a former Tijuana mayor would seem to equip him for a less arduous avocation, as would his education. Emilio came to Tijuana from Mexico City with his parents and three sisters in the mid-1950s, when his father, Ildefonso Velasquez Martinez, was appointed head of the Tijuana district attorney's office. While his father was mayor, between 1962 and 1965, the boy went to public schools and lived in a large house in the exclusive Cacho district, near downtown.

Emilio's leanings were always toward art and literature, and he wanted to go on to study music and enter the musical theater, but his parents decided he should go to law school at the University of Mexico City. He arrived there amid the social ferment and government repression of 1968. Middle-class people like Emilio had gotten caught up in the push for more political and personal freedom, which culminated in the infamous killing of 200 protesters by army troops at a political rally in the Plaza de Tlatelolco. Emilio was near the plaza that day but didn't get his personal taste of government repression until afterward. Frequent sweeps and harassment of young people in the Zona Rosa became part of the government's crackdown on those who had demanded more political and personal autonomy, and hundreds of people would be picked up each time. Emilio was among a group arrested during one of the sweeps. The government accused them of pimping selling drugs, or being gay — even though homosexuality is not a crime in Mexico.

Despite these experiences, Emilio remembers his years in Mexico City as a gilded time when he discovered coffeehouses, live music, poetry readings, and the company of like-minded friends. When he graduated from law school in 1973 (he never took the bar exam), he performed in the national touring company of the rock musical Jesus Christ, Superstar and later worked on other musicals. The tastes for political organizing and music that he carried with him from Mexico City were finally joined when he opened his cafe in Tijuana in 1978.

It would have been impossible for him to predict that 12 years later, he would find himself at Tijuana's General Hospital, in the eastern sector of the Rio district, carrying towels, a quart of milk, a radio, and other supplies to a stranger with an incurable disease. Emilio and another volunteer, Felix Castillo, walk past dumpsters overflowing with refuse on the way into the small, cold lobby, then trudge upstairs and past large hospital rooms where the bedridden are surrounded by family members.

To the left, off by itself, is the small, dark-yellow room where Jose lies alone. A clear plastic tube drains a creamy orange fluid from the left side of his chest into a large bottle on the floor. Jose smiles when Emilio and Felix enter the room, a weak smile filled with vulnerable uncertainty.

Jose was married, with four children, but now he's separated from his wife. He walked into the hospital a few days ago with fluid in his lungs, and he's being treated for tuberculosis. But a nurse at the hospital informed Emilio that the staff thinks Jose has AIDS, and that's how he's being treated. His bed sheets obviously haven't been changed in days, and he tells Emilio he gets only minimal attention from doctors. He has no money and no place to go when he's discharged. These days, much of Emilio's time is spent trying to arrange lodging and care for AIDS patients. He questions Jose about relatives. He has an aunt, he says, on a ranch near Ensenada who might put him up, but he hasn't seen her for a while. Nothing is decided this night, and after a few minutes, Emilio and Felix depart.

On the way back downtown, Emilio points out several solitary figures in the shadows beneath the bridges spanning the river road. "This is a very cruise-y area," he explains, using the gay term for a place where trolling for sex partners is fruitful. Emilio says he and other volunteers have drawn blood for HIV tests from people under the bridges, and he's distributed pamphlets and given safe-sex lectures here, too.

In the gloomy Tijuana night, death seems to surround Emilio like an aura. An unmistakable air of melancholy has settled onto him, and on the way back to the cafe, where he may have to sing tonight as a stand-in for the hired musicians who may or may not show up, Emilio offers an explanation. Last July his close friend Tomas, an artist, drowned in the ocean off Las Playas. He was 26. His body was found eight days later near the Silver Strand. "Tomas died partially because I'd neglected the relationship," Emilio explains. "There was a rocky period we went through in 1988, because I was always gone at all these meetings.” Gay-rights groups, such as Emilio's Organizacion SIDA, have taken on the job of educating the public about AIDS. The Mexican government, under pressure from powerful religious organizations, has been squeamish about using its official press to encourage the use of condoms. As AIDS started spreading in Tijuana, Emilio began working as many as 20 hours a day on AIDS-related tasks, including lecturing at local schools and colleges.

Tomas was involved too, at first; but "he got too depressed by all the pain and suffering," and he withdrew to concentrate on his art work. Tomas also became involved with another man, and both Emilio and the new man were pulling hard at Tomas. Tomas was with the other man that day at the beach. His death, it has been suggested, was a suicide.

Friends say Emilio hasn't been the same since. Emilio, who is wearing only black in the year following Tomas's death, acknowledges the possibility that his friend could have committed suicide, but he doubts it. "I've kept my wits about me, even though Tomas's death is the most devastating thing that ever happened in my life. If I've changed, it's just because I'm tired, burned out, I guess. All the pressure." He should have been with Tomas that day at the beach, Emilio insists to himself. "That would be the only thing I would do differently," he reflects. "I would have taken care of him first and the rest of the world later."

On the way back from Max's funeral, Emilio and Carlos Diaz stop in Colonia Davila, south of downtown, to check on Ernesto, a 36-year-old AIDS patient, who has been bedridden since November. Ernesto's mother, Armida Arizmemdiz, is caring for her son in her small apartment. She comes outside as Carlos Diaz and Emilio search for puddles to dissolve the mud off their shoes. "My mother's going to kill me when she sees these," Emilio cracks in mock terror. "I haven't had to scrape mud like this since I was five," says Dr. Diaz with a laugh. Senora Arizmemdiz joins the laughter, but then Emilio takes her aside and tells her where the mud came from. She hadn't heard that Max died two days ago. She takes the news hard, recoiling as if stabbed with a saber, and Emilio hugs her as she cries. She doesn't have to say what everyone is thinking: Ernesto looks much sicker now than Max did before he died.

Inside her apartment, Senora Arizmemdiz is more composed. She puts on a pot of coffee and goes into Ernesto's room to check on him. His condition hasn't changed for weeks. He's blind, effectively paralyzed, delirious sometimes, and only occasionally lucid. He lies on his back in a donated hospital bed, a near skeleton with severe bed sores. His mother is now his full-time nurse. Bags of pill bottles are nearby, an oxygen tank crowds one corner of the room, and boxes of diapers, gauze, and rubber gloves are in easy reach. For a while, Ernesto was being treated at the Owen Clinic in San Diego, but his father died last May, and the senora could no longer afford to pay for the American treatment. Here in Tijuana, she says, it's better that he's home rather than in a hospital because "hospitals are afraid. They're afraid to touch him. One nurse told me she thought I was contaminated from touching Ernesto." Now most of her medical supplies and drugs are donated by families in the U.S. who no longer have need for them. The names neatly typed on the prescription bottles are those of dead men making a final contribution to the living.

Volunteers are amazed that Ernesto is still alive. "He's been dying since November," reports one.

Unlike Max, who finally became resigned to his fate and seemed to will himself dead, Ernesto has struggled against it. "He's told me a lot of times, he wants to live," says his mother, who also refuses to give up. "If God wants it.... But I don't know what we're going to do about his walking, or about his eyes. And he has problems with his liver and one lung, and the incontinence. But if God wants it...."

Certainly his mother's careful treatment has something to do with Ernesto's longevity. He was on AZT for a time, but it was so toxic for him, it was discontinued. His mother feeds him 26 vitamins a day, dissolved in water. For nourishment he gets a liquified concoction of fruit, oatmeal, choyote, carrots, potatoes, squash, meat, and beans. She gives him 12 different medications every day, including KP, the mysterious "Korean AIDS treatment," available on the underground market.

This herbal medicine hasn't been approved for use by the Mexican government, but it still finds its way to AIDS patients. It comes in the form of a little black ball the size of a large marble, which is dissolved in water and drunk like a tea. Senora Arizmemdiz says Ernesto has improved since he started drinking the tea a few weeks ago. He's grown back some hair and put on weight. But no matter how much hair he grows or weight he gains, nothing can be done to repair his optic nerves, which were destroyed by the cytomegalovirus, a form of herpes linked to cancer.

The senora takes out Ernesto's passport and shows his picture around. The extraordinarily handsome face bears almost no resemblance to the half-dead man in the next room. But she has a need to exhibit the picture, a compulsion to remind herself and anyone else who will listen and look that her son once was beautiful.

Conversation turns to Dr. Llamas and the clinic. After a week of meetings and lobbying, the doctor has decided to let the clinic volunteers back into the health department offices, but he refuses to allow blood to be drawn there. Emilio worries that his cafe may still have to be used for that purpose, further eroding his business. Senora Arizmemdiz remarks that she heard Dr. Llamas on a radio talk show, denigrating the work of the volunteers and claiming that they were all profiting from its operation. Dr. Diaz, who has been neglecting his own private practice as he gets drawn deeper into volunteer AIDS treatment, shakes his head in disgust. Although Llamas would be fired a week later, his actions had reflected the deep and reflexive rejection of gays by many Mexican men.

Mexico has a long history of intolerance toward homosexuals. A slang term, "41s," used to describe gay men, dates back to a raid of a gay dance party in the city of Merida in 1901. Half of the dancers were dressed in drag. There were 41 arrests, including some prominent citizens. Since then, raids at gay bars and parties have been common in Mexico, with the "suspects" held on morals charges until bail can be raised for their release.

As evidence of community reaction to gays in Tijuana, Emilio cites the example of Pro Vida, a conservative, pro-life group that has filed a civil lawsuit against Dr. Jaime Sepulveda. The doctor is an epidemiologist and former head of the federal health department who is now Mexico's leading expert on AIDS. Pro Vida alleges that Sepulveda promoted immoral activities because he was recommending the use of condoms as a form of safe sex.

Emilio believes the new national government of President Carlos Salinas de Gortari, too, is extremely homophobic, and he cites Dr. Llamas (a federal appointee) and recent raids on gay bars and discos in Merida and Guadalajara as examples. Gay organizations such as FIGHT have helped reduce such raids in Tijuana, he says, but harassment is still common here. Apart from trouble with police, effeminatelooking men also suffer at the hands of macho civilians, some of whom consider gay-bashing a blood sport. Emilio sees "a kind of genocide underway against gays in Mexico. There have been some ghastly serial murders of gay men, and once in a while there is a 'guilt' murder that takes place when a man realizes he's had sex with another man." A friend of Emilio's from law school was murdered that way a couple of years ago. And the city's most famous recent homicide, that of Hector "Gato" Felix Miranda, the acerbic columnist for Zeta, might also have been a gay murder, Emilio claims. He and Diaz say that Felix was definitely gay, a fact that was reported in passing at the time of the murder in April 1987. One theory holds that Felix was executed because he was beginning to drop hints in his column alleging that an important Tijuana businessman was bisexual.

Emilio is convinced that violence against gays has escalated since AIDS claimed its first victim locally, a newspaper reporter for El Mexicano, in Tijuana in 1983. One effect of this violence, he speculates, will be an influx of "young effeminate runaways" who will make their way to Tijuana and join the burgeoning population of street kids. Typically, they're kicked out by their fathers, who do not want to live with the shame of having a gay son. Tourists see them elbowing their way through traffic at stop lights, trying to wash windshields in return for quarters. American gay men see them selling their bodies outside the gay bars or in the cruising areas. Although gays who frequent Tijuana say that most male prostitutes now insist that their customers use condoms, these new arrivals probably aren't educated in the ways of safe sex, and they're desperate for money. Emilio believes this group is a dangerous new breeding ground for AIDS.

Jesus, a 15-year-old who could be mistaken for a girl, just hit town a few weeks ago. Emilio first saw him near the bus station, when he was, as Emilio describes it, "swishing toward a bus" in a vain attempt to catch it. Emilio believes the bus driver would have stopped for anyone else but that Jesus's effeminate manner caused the driver to leave him in the dust. A few days later, Jesus found his way to Emilio, who has taken it upon himself to try to locate a place for the boy to live. In mid-January he visited MESA, a government boarding house that has beds for 40 street kids. The director didn't turn him away but explained that chances were good that Jesus would be roughed up there because of his clearly effeminate mannerisms. "But as you can see, he'll have problems living on the street too," says Emilio, gesturing to Jesus, standing on the stairs of the cafe, looking like a fawn in the cool morning. Emilio gazes at him with sad eyes, knowing too well the ugliness Jesus could be in for. Jesus smiles back coquettishly, secure in his childish faith that Emilio will take care of him.

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The funeral home declined to embalm the body, so all of Max's infected blood would enter the earth with him.  - Image by Paul Stachelek
The funeral home declined to embalm the body, so all of Max's infected blood would enter the earth with him.

A COLD RAIN STARTS TO FALL AS MAX'S DOVE-GRAY COFFIN IS UNLOADED FROM THE BACK OF A DARK HEARSE PARKED IN THE MUD. EMILIO VELASQUEZ, DR. CARLOS DIAZ, AND TWO OTHERS EASE THE COFFIN ONTO ROLLERS AND PUSH IT INTO THE SMALL CATHOLIC CHURCH THAT SERVES THE COMMUNITY OF El TECOLOTE, BACK IN THE HILLS SOUTH OF TIJUANA, ABOVE THE FREE ROAD TO ROSARITO BEACH. EMILIO HOPES THE FUNERAL AND BURILA WILL END IN TIME FOR HIM TO RACE BACK TO TlJUANA AND PAY. BUSINESS TAXES DUE THIS DAY ON

Emilio (left): "I need someplace to scream. Where can I go scream?"

Emilio's Cafe Musical, the small club he operates on Third Street. But Father Lorenzo, the gray-bearded priest conducting the service, is in no hurry, and when Emilio sees Max's mother sobbing on a front-row bench, death replaces taxes as his chief concern.

Dr. Carlos Diaz (center), Emilio (right)

Emilio rushes to her as the rain drums hard on the church's multicolored roof of salvaged plywood, drowning the sound of grief. Father Lorenzo begins his funeral Mass, while 20 people sit on the cold, hard benches. This is an unusually small number of mourners for rites for a community activist like Max.

Max's funeral. Father Lorenzo nearly shouts to be heard over the driving rain.

His brother Francisco has a good excuse for not being here; he's up the hill in the cemetery, helping to dig the grave next to that of Max's close friend Arturo, who died nine months ago. Like Arturo, Max died of AIDS.

Emilio and Carlos Diaz have made the trip to El Tecolote many times since last October, when Max, who was 29, became one of the first patients of Tijuana's only AIDS clinic.

Emilio holds Max's mother's hands, while Max's stepfather, a man with filmy eyes set in a deeply lined face, spends most of his time on his knees, praying.

In between his weekly visits to the clinic, Max would receive medications and other supplies from Carlos, the one medical doctor in Tijuana willing to devote most of his time to treating the city's growing population of AIDS patients, and from Emilio, the most visible activist in behalf of Tijuana's gay community. Most of those supplies were donated by families of San Diego AIDS patients who had died. Some of the donations, such as food, were purchased by Emilio with his own money.

Mary McCarthy, a nurse from San Diego, has informed Emilio that her boss will no longer allow her to work with AIDS patients.

But for Max, at least, all of that was ending today. Emilio and Carlos would continue visiting homes and hospitals where AIDS patients lay dying, and Emilio would still deliver food and necessities to the widows of Tijuana's AIDS victims. Emilio has no escape from the struggle with the confusion, ignorance, pain, and grief that AIDS has visited on Tijuana.

Father Lorenzo nearly shouts to be heard over the driving rain. He sticks to the liturgy, leaving the eulogies to the internal monologues of Max's friends and family. The casket is closed, as it was last night at the wake in the Martinez funeraria on Ninth Street, the one funeral home in Tijuana willing to handle the body of an AIDS patient.

Ernesto, a 36-year-old AIDS patient, who has been bedridden since November, looks much sicker now than Max did before he died.

Closed caskets are rare in Mexico, but the fear of AIDS overpowers tradition. The funeral home declined to embalm the body, so all of Max's infected blood would enter the earth with him. Nor was an autopsy performed, since most of Tijuana's forensic physicians refuse to touch the corpse of someone who has died of AIDS.

Most AIDS medical supplies and drugs are donated by families in the U.S. who no longer have need for them.

"Medical students, pathologists, doctors could have learned so much from Max's body," remarks Carlos Diaz, who signed the death certificate attributing Max's death to lung failure and lymphoma caused by AIDS. His eyes bulge in futile anger. When Carlos said this, he was sitting in the funeral home the night before the funeral, listening to Max's mother sob inconsolably and staring at the painting over Max's casket that depicted angels lifting Jesus Christ onto a cloud.

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In Fr. Lorenzo's drafty church, midway through the service, the large, bloody crucifix behind the altar suddenly brightens when the rainfall eases and winter sun shoots through the muddy windows. Emilio still holds Max's mother's hands, while Max's stepfather, a small man with filmy eyes set in a deeply lined face, spends most of his time on his knees, praying. By the time the casket is rolled out the door and loaded into the back of a red pickup truck, fleecy clouds fill the eastern sky, and the bright Mexican sun illuminates the mint-green stucco walls of the church. Max's mother and stepfather and several relatives climb into a four-wheel-drive vehicle for the precarious half-mile trip to the hilltop graveyard. The rest of the mourners, unable to drive the muddy roads, set out on foot for the burial. Emilio and Carlos both grab a corona of flowers and start walking.

El Tecolote's graveyard sits on a knoll with a spectacular view of the ocean and the Coronado Islands to the west and great rolling hills stretching away to mountains to the east. Northward, the top edge of Point Loma is just visible above a gray-brown ridge. By the time the mourners arrive, their shoes are caked with heavy layers of clay mud, and they're panting from the uphill climb. A stiff on-shore wind whines through the tilted wood and iron crosses. Emilio, dressed in fine, pointy-toed dress shoes, slacks, and necktie under a heavy peacoat, wonders again if he'll have time to pay his taxes on time and avoid the ten percent late fee.

Five men are still working hard on Max's grave, lining it with bricks and concrete to form a kind of sunken crypt, just like his friend Arturo's. The mourners will have to wait at least an hour for the grave to be completed. Meanwhile, clouds mass overhead once more, and rain begins to dapple Max's casket, which has been unloaded onto the flat top of another crypt. Max's mother collapses onto the coffin, crying, and Emilio once again tries to console her.

Ramona Lopez was one of Max's closest friends. She says that Max, who worked as a personnel manager for a large grocery chain, was an active member of the citizen's committee that successfully petitioned the state government for 200 adjoining lots to create the community of El Tecolote, now visible as a collection of small houses, shored up with stacks of worn tires, down the hill to the west. El Tecolote and a sister community, La Gloria, form the Delegation San Antonio de los Buenos, with a population of about 10,000. Arturo, Max's lover, was a doctor who often donated his services to the residents of the two colonias.

At the wake last night, Ramona had whispered to Emilio that she knew of one other man who had sex with both Max and Arturo. People frequently approach Emilio at these funerals with information about the dead man's sex partners. He used to try to track them down, but that became so time-consuming that nowadays he will simply tell the mourner to find that person and warn him. Emilio now urges Ramona to tell the man to be tested for HIV infection and to try to convince him that the earlier the infection is detected, the better it would be for him. Ramona, Emilio, and Carlos are probably the only people in the graveyard who truly understand the significance of the two brick crypts sitting side-by-side on a cold, windy hill, above a rural community in a third-world Catholic country. As rain starts to fall again, Carlos and Emilio head down the hill for the trip back to Tijuana. It's already too late to pay Emilio's taxes, but they don't want to wait in the cold and rain any longer. There are other patients who are still alive, and they will stop to visit one on the way back to town. They've paid their respects, and besides, they've seen plenty of burials already.

"I need someplace to scream. Where can I go scream?" Emilio's Castillian face is sagging as he enters the upstairs room of his Tijuana coffee house. It is six days before Max's death, and the doomed man is sitting in a booth with Dr. Diaz and Mary McCarthy, a nurse from San Diego, who are examining his grotesquely swollen lymph glands. Emilio has just gotten off the phone with an epidemiologist who works for the local federal health clinic. She has informed Emilio that her boss will no longer allow her to work with AIDS patients. Among the group of volunteers in the room, none is surprised. They are examining AIDS patients here at Emilio's cafe this Tuesday night because the epidemiologist's boss, Dr. Ismael Llamas Amaya, head of the federal health department in Tijuana, had shut down the AIDS treatment clinic the previous week. The weekly clinic, in operation since last October in the administrative offices of the federal health department, was branded by Llamas a threat to the lives of women and children who come to the health department for vaccinations and other health care. Llamas also downplayed the importance of the AIDS clinic, insofar as there were only 65 confirmed AIDS cases in all of Baja (55 of them in Tijuana), by official count. And if that weren't enough reason to banish the clinic, Llamas later told associates that he wanted nothing to do with treating that "puto's disease." Puto translates as "faggot."

Llamas's actions infuriated both the Mexican and American volunteers who have been trying to help AIDS sufferers in Tijuana. They were already struggling against a nearly implacable wall of fear, ignorance, and official indifference, analogous to the situation in the U.S. in the early 1980s, when AIDS was called the "gay cancer" and research money was slow to materialize. But for Mexico, with a primitive public health system that sees dozens of Tijuana babies die of simple diarrhea each year, the arrival of AIDS is potentially catastrophic. A Dr. Llamas was exactly what Tijuana's AIDS patients didn't need.

Contrary to Llamas's contention that AIDS isn't a significant problem in Tijuana, it's clear that it, like most other infectious diseases, is seriously underreported in Mexico. Reporting AIDS cases to the secretary of health in Mexico City wasn't even a legal requirement until 1986, a full five years after the virus had been identified. Today, Mexico claims to have only about 3000 AIDS cases, nationwide. The official number of 65 cases in Baja hasn't been updated since last July. But Emilio and Carlos Diaz and some of the American volunteers say that they hear informally from doctors at the Social Security Hospital that about seven new cases are diagnosed there each month. The AIDS workers figure that if you triple the official number of AIDS cases, you will be close to the actual number.

So where are all these AIDS patients? If there are over 150 in Tijuana, why is the clinic treating only about 20? Emilio offers several answers: some are misdiagnosed, some go elsewhere for treatment, and some are dying in seclusion at home.

According to Emilio and Dr. Diaz, there has been a sudden increase in the number of tuberculosis cases diagnosed in Tijuana. They believe many of these can be attributed to AIDS. "But the doctors don't know enough to put two and two together and figure out that the TB may be an opportunistic infection related to immune system suppression," says Emilio.

Then too, some well-off Mexicans with AIDS go north to the U.S. for treatment, because Mexican doctors have so little training, equipment, or experience with the disease. San Diego AIDS workers were shocked recently when one wealthy young man from Mexico City came to them for treatment, saying he had spent $30,000 on hospital care down there. Doctors in Mexico City performed major thoracic surgery on him just to obtain a piece of his lung for a biopsy. In the U.S., a lung biopsy can be performed on an outpatient basis, without cutting open the chest. In addition, Emilio offers, Mexican nurses are said to refuse to touch AIDS patients, who are routinely turned away from hospitals in Tijuana. When one is admitted, usually for some other malady like tuberculosis, once he or she is diagnosed with AIDS, the patient's care is left to volunteers from outside the hospital. Sheets and towels touched by the patient are burned, and after the victim dies, the body is often buried hastily, without autopsy or embalming.

Mary McCarthy, a nurse practitioner who specializes in AIDS care at UCSD's Owen Clinic, is an American volunteer who has helped establish the AIDS clinic in Tijuana. McCarthy says two illegal immigrants from Mexico are being treated at the Owen Clinic now, underscoring an emerging dilemma in the identification of Mexicans who are HIV-positive. It is believed by the medical community that illegal Mexican aliens who are diagnosed in the U.S. to be HIV-positive return to their homes in Mexico and never reveal their illness to Mexican medical authorities.

Emilio mentions a study that supports some of those fears. According to Miguel Angel Gonzalez-Block, a doctor of sociology and AIDS researcher at Mexico's Colegio de la Frontera Norte, "Migration is a risk factor itself. Studies point to a slowing in the rate of increase of the [HIV] infection overall, but in the lower-economic population, there's a higher rate of increase, and migration is the main factor." Gonzalez-Block points out that in Mexico, male prostitution is more widespread than in the U.S., and studies of Mexican sexual mores have shown that men can have sex with other men and not be considered homosexual, as long as they remain in the penetrator's role. For large groups of men isolated in U.S. migrant worker camps with almost no women, there are few options for exercising the need for sexual release. The problem of AIDS and migrant workers has caught the attention of the Mexican consulate in Los Angeles, which is cosponsoring (with the Colegio) a conference on AIDS and migration in Santa Monica at the end of May.

Emilio cites another academic study that underscores his concern about the devastating potential of the HIV virus in his city. In Mexico, where men tend to marry in their late 20s, the macho imperative requires sexual conquests prior to matrimony, and yet Mexican women are expected to remain chaste until marriage. According to a study conducted by anthropologist J.M. Carrier, published last year in the journal Medical Anthropology, this dilemma means that "at any given age, more sexually active single males in Mexico have had sexual intercourse with both genders than have Anglo-American males." When Emilio goes out to locate men to be tested for HIV infection, he doesn't ask a man if he's homosexual; he asks, "Have you ever had sex with a man?" Mexican men will deny being homosexual, Emilio says, but will admit having anal intercourse with another man. For AIDS workers in Mexico, this suggests that AIDS has the potential of spreading quickly through the heterosexual community as bisexual men who've contracted the disease spread it to their wives.

Emilio is also pessimistic because he knows that an AIDS patient in Mexico, for many good reasons, will continue to deny he has the disease until he's nearly dead. When he and his family do face the truth, they often ask that the information be kept quiet so no shame is brought to the family. This is another reason AIDS is underreported in Mexico and few men seek treatment.

Also, "There's a lot of violence against gays in Mexico," explains Emilio, and he believes the violence has escalated since AIDS arrived. This increases the difficulty of getting people in high-risk groups to come forward for testing. "We think a lot of people just hole up in their apartments to die alone," Emilio remarks.

Max didn't do that. As he watched Arturo die, he had a preview of his own fate. Max came to the clinic the first night it was open and almost every week thereafter, accompanied by his brother Francisco. He hoped to obtain the drug AZT through the clinic, "but Max was one of those poor souls with no money to find out what his blood counts were," explains Mary McCarthy. Baseline blood counts of certain types of cells need to be known before a patient is given AZT, an expensive drug and one that isn't available in Mexico. Clinic volunteers such as Fred) Scholl, a long-time gay activist in San Diego who has visited Tijuana regularly for years, are able to scrounge up various remedies, including AZT, but the drug is not administered indiscriminately because of its scarcity and potential side-effects. McCarthy and Dr. Diaz suspected Max's main problem was lymphoma, a fast-moving disease on which AZT would have been wasted.

Six days before his death, Max sat in a booth talking with Diaz, McCarthy, and another American volunteer nurse. He looked gaunt and said he couldn't walk much anymore. On both sides of his neck, huge masses bulged, and he had similarly large protrusions in his armpits. When the volunteers pressed these lymph nodes, Max winced.

"I wish we could lay him down so we could feel his stomach," McCarthy remarked. The donated examining table was back at the federal health department, from which they had been banished. A couple of volunteers spotted three long pads Emilio uses to cushion benches in the cafe, and these were placed on the floor in front of a large-screen television and covered with a donated plastic sheet. As Max was being eased onto this makeshift examining table, someone cursed Dr. Llamas for forcing them to work like this on mortally ill patients. Someone else asked why the volunteers couldn't pass Llamas some mordida and grease his palm. "With what? Oleo?" asks McCarthy. The clinic is chronically short of cash.

Emilio watches all this warily. His business has already suffered major declines since he started holding AIDS assistance meetings here in the mid-1980s, and then he nearly ended up going broke when he started using his upstairs room as a place to draw blood for HIV tests. "Customers weren't too excited seeing people carrying vials of blood downstairs," he recalls. Now, he's operating an AIDS clinic in a place where people buy food and drink. If Llamas wanted to, Emilio says, he could shut down the cafe for that.

Max is sprawled under a strong light bulb. He looks skeletal. He pulls up his shirt so McCarthy and Diaz can feel his stomach. An American social worker acts as translator. Max tells McCarthy he has dark urine, and his stools are yellow. He has a croupy cough; when he sits up and covers his mouth to collect the phlegm in a tissue, McCarthy insists on looking at it. "Oh my God, that looks like pus!" she exclaims. McCarthy proceeds to listen through his back with a stethoscope, and Max apologizes for not being able to take a bath for three days. "How do you say, 'You smell like perfume1 ?" McCarthy asks the translator. She tries to get Max to laugh.

Later, everyone was amazed at how fast Max went. Just a few days after that clinic visit, Max was brought back to the cafe. By now, his brother had to carry him upstairs so Carlos Diaz could examine him. Max's mother had also made the trip to town this time, and when Diaz told her Max had only a couple of days left, she broke into almost hysterical grief. Max told his brother he was ready to rest, and his brother also cried for the first time anyone could remember. Diaz gave Max some morphine, which is illegal in Mexico, as are most strong pain-killers. "That's all I could do," says Diaz. "Now, all there is to do is bury Max with a minimum of humiliation to the family," remarked a close associate of Emilio's. That night, Max died at home, about 10:30, after saying goodbye to his family and drifting off to sleep.

Why have you allowed yourself to become so consumed with this AIDS epidemic, up to your neck in death and suffering? Why don't you just say that's it, I quit? "I say that every day," Emilio replies, piloting his ancient Ford LTD in the bumpy blackness of night toward Tijuana General Hospital and another AIDS patient. "But who else would do what needs to be done? It's like a foreign army has invaded my country, and nobody's doing anything about it. I was just in the wrong place at the wrong time, but I'm trying to do the right thing."

Emilio Velasquez is 40, with the good looks and taut frame of a much younger man. His status as the son of a former Tijuana mayor would seem to equip him for a less arduous avocation, as would his education. Emilio came to Tijuana from Mexico City with his parents and three sisters in the mid-1950s, when his father, Ildefonso Velasquez Martinez, was appointed head of the Tijuana district attorney's office. While his father was mayor, between 1962 and 1965, the boy went to public schools and lived in a large house in the exclusive Cacho district, near downtown.

Emilio's leanings were always toward art and literature, and he wanted to go on to study music and enter the musical theater, but his parents decided he should go to law school at the University of Mexico City. He arrived there amid the social ferment and government repression of 1968. Middle-class people like Emilio had gotten caught up in the push for more political and personal freedom, which culminated in the infamous killing of 200 protesters by army troops at a political rally in the Plaza de Tlatelolco. Emilio was near the plaza that day but didn't get his personal taste of government repression until afterward. Frequent sweeps and harassment of young people in the Zona Rosa became part of the government's crackdown on those who had demanded more political and personal autonomy, and hundreds of people would be picked up each time. Emilio was among a group arrested during one of the sweeps. The government accused them of pimping selling drugs, or being gay — even though homosexuality is not a crime in Mexico.

Despite these experiences, Emilio remembers his years in Mexico City as a gilded time when he discovered coffeehouses, live music, poetry readings, and the company of like-minded friends. When he graduated from law school in 1973 (he never took the bar exam), he performed in the national touring company of the rock musical Jesus Christ, Superstar and later worked on other musicals. The tastes for political organizing and music that he carried with him from Mexico City were finally joined when he opened his cafe in Tijuana in 1978.

It would have been impossible for him to predict that 12 years later, he would find himself at Tijuana's General Hospital, in the eastern sector of the Rio district, carrying towels, a quart of milk, a radio, and other supplies to a stranger with an incurable disease. Emilio and another volunteer, Felix Castillo, walk past dumpsters overflowing with refuse on the way into the small, cold lobby, then trudge upstairs and past large hospital rooms where the bedridden are surrounded by family members.

To the left, off by itself, is the small, dark-yellow room where Jose lies alone. A clear plastic tube drains a creamy orange fluid from the left side of his chest into a large bottle on the floor. Jose smiles when Emilio and Felix enter the room, a weak smile filled with vulnerable uncertainty.

Jose was married, with four children, but now he's separated from his wife. He walked into the hospital a few days ago with fluid in his lungs, and he's being treated for tuberculosis. But a nurse at the hospital informed Emilio that the staff thinks Jose has AIDS, and that's how he's being treated. His bed sheets obviously haven't been changed in days, and he tells Emilio he gets only minimal attention from doctors. He has no money and no place to go when he's discharged. These days, much of Emilio's time is spent trying to arrange lodging and care for AIDS patients. He questions Jose about relatives. He has an aunt, he says, on a ranch near Ensenada who might put him up, but he hasn't seen her for a while. Nothing is decided this night, and after a few minutes, Emilio and Felix depart.

On the way back downtown, Emilio points out several solitary figures in the shadows beneath the bridges spanning the river road. "This is a very cruise-y area," he explains, using the gay term for a place where trolling for sex partners is fruitful. Emilio says he and other volunteers have drawn blood for HIV tests from people under the bridges, and he's distributed pamphlets and given safe-sex lectures here, too.

In the gloomy Tijuana night, death seems to surround Emilio like an aura. An unmistakable air of melancholy has settled onto him, and on the way back to the cafe, where he may have to sing tonight as a stand-in for the hired musicians who may or may not show up, Emilio offers an explanation. Last July his close friend Tomas, an artist, drowned in the ocean off Las Playas. He was 26. His body was found eight days later near the Silver Strand. "Tomas died partially because I'd neglected the relationship," Emilio explains. "There was a rocky period we went through in 1988, because I was always gone at all these meetings.” Gay-rights groups, such as Emilio's Organizacion SIDA, have taken on the job of educating the public about AIDS. The Mexican government, under pressure from powerful religious organizations, has been squeamish about using its official press to encourage the use of condoms. As AIDS started spreading in Tijuana, Emilio began working as many as 20 hours a day on AIDS-related tasks, including lecturing at local schools and colleges.

Tomas was involved too, at first; but "he got too depressed by all the pain and suffering," and he withdrew to concentrate on his art work. Tomas also became involved with another man, and both Emilio and the new man were pulling hard at Tomas. Tomas was with the other man that day at the beach. His death, it has been suggested, was a suicide.

Friends say Emilio hasn't been the same since. Emilio, who is wearing only black in the year following Tomas's death, acknowledges the possibility that his friend could have committed suicide, but he doubts it. "I've kept my wits about me, even though Tomas's death is the most devastating thing that ever happened in my life. If I've changed, it's just because I'm tired, burned out, I guess. All the pressure." He should have been with Tomas that day at the beach, Emilio insists to himself. "That would be the only thing I would do differently," he reflects. "I would have taken care of him first and the rest of the world later."

On the way back from Max's funeral, Emilio and Carlos Diaz stop in Colonia Davila, south of downtown, to check on Ernesto, a 36-year-old AIDS patient, who has been bedridden since November. Ernesto's mother, Armida Arizmemdiz, is caring for her son in her small apartment. She comes outside as Carlos Diaz and Emilio search for puddles to dissolve the mud off their shoes. "My mother's going to kill me when she sees these," Emilio cracks in mock terror. "I haven't had to scrape mud like this since I was five," says Dr. Diaz with a laugh. Senora Arizmemdiz joins the laughter, but then Emilio takes her aside and tells her where the mud came from. She hadn't heard that Max died two days ago. She takes the news hard, recoiling as if stabbed with a saber, and Emilio hugs her as she cries. She doesn't have to say what everyone is thinking: Ernesto looks much sicker now than Max did before he died.

Inside her apartment, Senora Arizmemdiz is more composed. She puts on a pot of coffee and goes into Ernesto's room to check on him. His condition hasn't changed for weeks. He's blind, effectively paralyzed, delirious sometimes, and only occasionally lucid. He lies on his back in a donated hospital bed, a near skeleton with severe bed sores. His mother is now his full-time nurse. Bags of pill bottles are nearby, an oxygen tank crowds one corner of the room, and boxes of diapers, gauze, and rubber gloves are in easy reach. For a while, Ernesto was being treated at the Owen Clinic in San Diego, but his father died last May, and the senora could no longer afford to pay for the American treatment. Here in Tijuana, she says, it's better that he's home rather than in a hospital because "hospitals are afraid. They're afraid to touch him. One nurse told me she thought I was contaminated from touching Ernesto." Now most of her medical supplies and drugs are donated by families in the U.S. who no longer have need for them. The names neatly typed on the prescription bottles are those of dead men making a final contribution to the living.

Volunteers are amazed that Ernesto is still alive. "He's been dying since November," reports one.

Unlike Max, who finally became resigned to his fate and seemed to will himself dead, Ernesto has struggled against it. "He's told me a lot of times, he wants to live," says his mother, who also refuses to give up. "If God wants it.... But I don't know what we're going to do about his walking, or about his eyes. And he has problems with his liver and one lung, and the incontinence. But if God wants it...."

Certainly his mother's careful treatment has something to do with Ernesto's longevity. He was on AZT for a time, but it was so toxic for him, it was discontinued. His mother feeds him 26 vitamins a day, dissolved in water. For nourishment he gets a liquified concoction of fruit, oatmeal, choyote, carrots, potatoes, squash, meat, and beans. She gives him 12 different medications every day, including KP, the mysterious "Korean AIDS treatment," available on the underground market.

This herbal medicine hasn't been approved for use by the Mexican government, but it still finds its way to AIDS patients. It comes in the form of a little black ball the size of a large marble, which is dissolved in water and drunk like a tea. Senora Arizmemdiz says Ernesto has improved since he started drinking the tea a few weeks ago. He's grown back some hair and put on weight. But no matter how much hair he grows or weight he gains, nothing can be done to repair his optic nerves, which were destroyed by the cytomegalovirus, a form of herpes linked to cancer.

The senora takes out Ernesto's passport and shows his picture around. The extraordinarily handsome face bears almost no resemblance to the half-dead man in the next room. But she has a need to exhibit the picture, a compulsion to remind herself and anyone else who will listen and look that her son once was beautiful.

Conversation turns to Dr. Llamas and the clinic. After a week of meetings and lobbying, the doctor has decided to let the clinic volunteers back into the health department offices, but he refuses to allow blood to be drawn there. Emilio worries that his cafe may still have to be used for that purpose, further eroding his business. Senora Arizmemdiz remarks that she heard Dr. Llamas on a radio talk show, denigrating the work of the volunteers and claiming that they were all profiting from its operation. Dr. Diaz, who has been neglecting his own private practice as he gets drawn deeper into volunteer AIDS treatment, shakes his head in disgust. Although Llamas would be fired a week later, his actions had reflected the deep and reflexive rejection of gays by many Mexican men.

Mexico has a long history of intolerance toward homosexuals. A slang term, "41s," used to describe gay men, dates back to a raid of a gay dance party in the city of Merida in 1901. Half of the dancers were dressed in drag. There were 41 arrests, including some prominent citizens. Since then, raids at gay bars and parties have been common in Mexico, with the "suspects" held on morals charges until bail can be raised for their release.

As evidence of community reaction to gays in Tijuana, Emilio cites the example of Pro Vida, a conservative, pro-life group that has filed a civil lawsuit against Dr. Jaime Sepulveda. The doctor is an epidemiologist and former head of the federal health department who is now Mexico's leading expert on AIDS. Pro Vida alleges that Sepulveda promoted immoral activities because he was recommending the use of condoms as a form of safe sex.

Emilio believes the new national government of President Carlos Salinas de Gortari, too, is extremely homophobic, and he cites Dr. Llamas (a federal appointee) and recent raids on gay bars and discos in Merida and Guadalajara as examples. Gay organizations such as FIGHT have helped reduce such raids in Tijuana, he says, but harassment is still common here. Apart from trouble with police, effeminatelooking men also suffer at the hands of macho civilians, some of whom consider gay-bashing a blood sport. Emilio sees "a kind of genocide underway against gays in Mexico. There have been some ghastly serial murders of gay men, and once in a while there is a 'guilt' murder that takes place when a man realizes he's had sex with another man." A friend of Emilio's from law school was murdered that way a couple of years ago. And the city's most famous recent homicide, that of Hector "Gato" Felix Miranda, the acerbic columnist for Zeta, might also have been a gay murder, Emilio claims. He and Diaz say that Felix was definitely gay, a fact that was reported in passing at the time of the murder in April 1987. One theory holds that Felix was executed because he was beginning to drop hints in his column alleging that an important Tijuana businessman was bisexual.

Emilio is convinced that violence against gays has escalated since AIDS claimed its first victim locally, a newspaper reporter for El Mexicano, in Tijuana in 1983. One effect of this violence, he speculates, will be an influx of "young effeminate runaways" who will make their way to Tijuana and join the burgeoning population of street kids. Typically, they're kicked out by their fathers, who do not want to live with the shame of having a gay son. Tourists see them elbowing their way through traffic at stop lights, trying to wash windshields in return for quarters. American gay men see them selling their bodies outside the gay bars or in the cruising areas. Although gays who frequent Tijuana say that most male prostitutes now insist that their customers use condoms, these new arrivals probably aren't educated in the ways of safe sex, and they're desperate for money. Emilio believes this group is a dangerous new breeding ground for AIDS.

Jesus, a 15-year-old who could be mistaken for a girl, just hit town a few weeks ago. Emilio first saw him near the bus station, when he was, as Emilio describes it, "swishing toward a bus" in a vain attempt to catch it. Emilio believes the bus driver would have stopped for anyone else but that Jesus's effeminate manner caused the driver to leave him in the dust. A few days later, Jesus found his way to Emilio, who has taken it upon himself to try to locate a place for the boy to live. In mid-January he visited MESA, a government boarding house that has beds for 40 street kids. The director didn't turn him away but explained that chances were good that Jesus would be roughed up there because of his clearly effeminate mannerisms. "But as you can see, he'll have problems living on the street too," says Emilio, gesturing to Jesus, standing on the stairs of the cafe, looking like a fawn in the cool morning. Emilio gazes at him with sad eyes, knowing too well the ugliness Jesus could be in for. Jesus smiles back coquettishly, secure in his childish faith that Emilio will take care of him.

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