Tijuana’s Low AIDS Tally Called Unreliable : Health: Mexican city records only 215 cases, compared to 3,400 for San Diego. Medical officials say the social stigma attached to the disease leads to an inaccurate count.

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

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

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

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

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

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

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

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

Local health officials deny that the statistics are intentionally underreported.

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

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

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

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

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

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

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

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

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

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

“You cannot be walking around five days with a ruptured appendix and survive,” said Lepe angrily.

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

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