4/8 Guest Lecture by Dr. Hirsch

Yesterday, we had a guest lecturer, Dr. Jennifer S. Hirsch, Associate Professor of Sociomedical Sciences at Columbia University Mailman School of Public Health. She spoke about sex, love, and marriage in Mexican transnational families.

Dr. Hirsch has most recently been working in Western Mexican rural villages to study health issues (HIV in particular) among transnational families. When she first began exploring these issues, through conversations with migrants in Atlanta, it became clear that the notion of marriage and love has changed in the last few decades. One important change has been the idea that marriage is based on love and intimacy, rather than on obligation. This conflicts with migration patterns that force the men away from their families and thus put a strain on the intimacy component of a marriage.

Another important change that she realized quickly was that for Mexican women, the biggest risk of HIV comes from having sex with their husbands. Mexico currently has a very low prevalence of HIV – significantly lower than that of the U.S. Thus, male Mexican migrant workers have a much higher risk of contracting HIV in the U.S. than at home in Mexico.

Dr. Hirsch’s most recent book, The Secret: Love, Marriage, and HIV, focuses on the risks of HIV for married women. She explained three main points:

1. extra-marital opportunity structures – elements of society that shape choices; i.e. if I grew up with 2 parents who are doctors, I will likely make different choices than if I grew up with a single, unemployed parent. Such structures include:

- gendered patterns of mobility: for Mexican migrant workers, these are important because the male migrant is likely unable to return to Mexico regularly while his wife and family is unable to move to the U.S. with him

- male socialization: cantinas in Mexico and dollar dance halls in the U.S. form male groups that encourage extra-marital sexual relations

- family pattern: marriage in Mexico is nonoptional and actually create opportunities for extra-marital relations by creating extra leisure time for men

2. Sexual geographies – Mexicans see the U.S. as a place of moral decay, no reputational cost for pre-marital sex. Mexican entry into the U.S. comes with an assumption of lowered moral expectations

3. Social Risk – engaging in extra-marital relations provide an opportunity for social gain for men; i.e. validity from other men, feeling of financial worth, etc. This conflicts with the health risk of HIV and other infections, but the social gain generally wins out.

Dr. Hirsch then explained that through her findings, and through a conversation with Dr. Paul Farmer, she realized that the U.S. consumption patterns are actually a chief reason for increased HIV prevalence in Mexico. The U.S. consumer wants cheap products, so we require cheap labor, which Mexicans (often male) provide, which leads to split up Mexican families and the result is men who end up with HIV and return to Mexico and infect their wives. As Dr. Hirsch put it, we’re all ordering our “cheeseburgers with a side of HIV.”

The problem, according to Dr. Hirsch, is the labor system and the solution is labor and migration reform. With our current system, we offload health burdens onto the most vulnerable. The solution is not telling Mexicans to use condoms or be faithful, because we’ve learned that this probably will not be completely successful. If we’re going to change someone’s behavior, let’s change our own by being more responsible consumers and by demanding reform from our representatives.