In late 2010, Haitian immigrants began to arrive at remote river border crossings in the western Brazilian Amazon. Attracted by the prospect of work in Brazil's burgeoning economy, thousands of Haitians paid large sums to people traffickers, known as “coyotes,” to arrange their journey to Brazil. They entered Brazil through the border towns of Tabatinga (Amazonas state) and Brasileia (Acre state). Their journeys from Haiti were complex and involved travel by air, road, river boat, and on foot. Between four and six thousand Haitians have arrived in Brazil since 2010. Most have made their way to Manaus, a city of 1.8 million inhabitants in the western Amazon. Manaus itself presents considerable challenges for infectious disease control because of its dynamic mix of urban and forest environments and its fringe of shanty towns.