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Rammohan I, Jain S, Sun S, Marks C, Milloy MJ, Hayashi K, DeBeck K, González-Zúñiga P, Strathdee S, Werb D. Latent polydrug use patterns and the provision of injection initiation assistance among people who inject drugs in three North American settings. Drug Alcohol Rev 2023; 42:1504-1516. [PMID: 37321850 PMCID: PMC10524861 DOI: 10.1111/dar.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/17/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION We sought to identify latent profiles of polysubstance use patterns among people who inject drugs in three distinct North American settings, and then determine whether profile membership was associated with providing injection initiation assistance to injection-naïve persons. METHODS Cross-sectional data from three linked cohorts in Vancouver, Canada; Tijuana, Mexico; and San Diego, USA were used to conduct separate latent profile analyses based on recent (i.e., past 6 months) injection and non-injection drug use frequency. We then assessed the association between polysubstance use patterns and recent injection initiation assistance provision using logistic regression analyses. RESULTS A 6-class model for Vancouver participants, a 4-class model for Tijuana participants and a 4-class model for San Diego participants were selected based on statistical indices of fit and interpretability. In all settings, at least one profile included high-frequency polysubstance use of crystal methamphetamine and heroin. In Vancouver, several profiles were associated with a greater likelihood of providing recent injection initiation assistance compared to the referent profile (low-frequency use of all drugs) in unadjusted and adjusted analyses, however, the inclusion of latent profile membership in the multivariable model did not significantly improve model fit. DISCUSSION AND CONCLUSIONS We identified commonalities and differences in polysubstance use patterns among people who inject drugs in three settings disproportionately impacted by injection drug use. Our results also suggest that other factors may be of greater priority when tailoring interventions to reduce the incidence of injection initiation. These findings can aid in efforts to identify and support specific higher-risk subpopulations of people who inject drugs.
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Affiliation(s)
- Indhu Rammohan
- Centre on Drug Policy and Evaluation, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, United States
| | - Shelly Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, United States
| | - Charles Marks
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
- School of Community Health Sciences, University of Reno, Reno, United States
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Patricia González-Zúñiga
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
| | - Dan Werb
- Centre on Drug Policy and Evaluation, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
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Zhang G, Zhong Q, Tan Y, Yang Q. Risky behavior analysis for cross-border drivers: A logit model and qualitative comparative analysis of odds of fault and injury vulnerability in Guangdong, Hong Kong and Macau. JOURNAL OF SAFETY RESEARCH 2022; 82:417-429. [PMID: 36031272 DOI: 10.1016/j.jsr.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/28/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Due to globalization and the acceleration of cross-border exchanges, cross-border risk behaviors have received widespread attention. Previous research has concluded that foreign cross-border drivers engage in relatively more risk-taking behavior patterns and are likely to experience a higher crash rate or be more inclined to cause severe crashes. However, there is little evidence on the comparison of drivers who belong to the same ethnic group driving across within-country borders. METHOD Based on the cross-border motor-vehicle crash reports in 2006-2010 from the Road Traffic Accident Database of the China Ministry of Public Security, this paper examines the risk factors of being at fault and getting killed or seriously injured in cross-border traffic crashes and casual paths toward crash liability and injury severity for Hong Kong and Macao drivers driving in the Chinese mainland. RESULTS There are extremely complex factors behind drivers from Hong Kong and Macao causing at-fault crashes or sustaining fatal and serious injuries in the Chinese mainland. Factors such as gender, age, illumination, and weather conditions do not individually affect the risk of driver at-fault crashes or severe casualties in the crashes among Hong Kong and Macao drivers driving in the Chinese mainland. Nonetheless, collectively, these factors influence them along with different vehicle types, roads, and environmental factors. CONCLUSIONS This paper provides more theoretical findings for understanding the compound effect of multiple risk factors involving cross-border at-fault crashes or serious casualties. The conclusions of this research are valuable as representative references for cross-border risk management policies. PRACTICAL APPLICATIONS To reduce the effects of different factors on cross-border risky driving behaviors and/or injurious crashes, various measures should be focused on, including specialized driver training, enhancement of the roads/environment, development of effective road safety campaigns, and directives facilitating cross-border cooperation in the field of road safety.
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Affiliation(s)
- Guangnan Zhang
- Center for Studies of Hong Kong, Macao and Pearl River Delta, Institute of Guangdong, Hong Kong and Macao Development Studies, Sun Yat-sen University, Guangzhou, China
| | - Qiaoting Zhong
- Center for Studies of Hong Kong, Macao and Pearl River Delta, Institute of Guangdong, Hong Kong and Macao Development Studies, Sun Yat-sen University, Guangzhou, China.
| | - Ying Tan
- Guangdong University of Finance, China
| | - Qingxuan Yang
- Center for Studies of Hong Kong, Macao and Pearl River Delta, Institute of Guangdong, Hong Kong and Macao Development Studies, Sun Yat-sen University, Guangzhou, China
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Stewart A, West BS, Rafful C, Lazos K, Jain J, Gonzalez-Zuniga P, Rocha-Jimenez T. "I would rather do it myself": injection initiation and current injection patterns among women who inject drugs in Tijuana, Mexico. Harm Reduct J 2021; 18:105. [PMID: 34645473 PMCID: PMC8513336 DOI: 10.1186/s12954-021-00554-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Women who inject drugs (WWID) experience unique risks and adverse health outcomes related to injection initiation and patterns of injection drug use. However, there is limited information on injection initiation experiences and injection patterns among women and the protective strategies employed to limit injection-related harms, especially in low- and middle-income settings. Therefore, this study sought to explore injection initiation and current injection patterns (e.g., relying on someone else to inject) among women who inject drugs and engage in sex work in Tijuana, Mexico. METHODS Semistructured in-depth interviews were conducted with 30 WWID on the following topics: injection initiation, current injection patterns, places where women inject, and protective strategies (i.e., risk reduction). All interviews were audio-recorded, transcribed, and de-identified. An inductive thematic analysis was conducted to identify and compare common themes and patterns across participants. RESULTS The interviews revealed that the vast majority of study participants were first initiated by another person who injects drugs (PWID), often a male sexual partner. However, the majority of the women transitioned to become self-injectors in order to avoid risks associated with relying on others for injection, including overdose, interpersonal violence, sexual abuse, and wounds. Those who relied on others indicated that they would prefer to inject themselves without assistance from others if they were able to. CONCLUSIONS The narratives uncovered in this study reveal the importance of multiple risk environments in shaping perceived risks associated with injection drug use among women in Tijuana, Mexico. Specifically, the interviews elucidate the connection between interpersonal relationships with other PWID and protective strategies used to minimize risk and harm. These findings highlight the need for women-centered harm reduction programs to facilitate the development of safer drug use environments among WWID in Tijuana, Mexico.
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Affiliation(s)
- Allison Stewart
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Claudia Rafful
- Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
- Center on Global Mental Health Research, National Institute of Psychiatry, Mexico City, Mexico
| | | | - Jennifer Jain
- Division of Infectious Diseases of Global Public Health, School of Medicine, University of California, La Jolla, CA, USA
| | - Patricia Gonzalez-Zuniga
- Wound Clinic Tijuana, Tijuana, Mexico
- Division of Infectious Diseases of Global Public Health, School of Medicine, University of California, La Jolla, CA, USA
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases of Global Public Health, School of Medicine, University of California, La Jolla, CA, USA.
- Society and Health Research Center, Faculty of Humanities, Universidad Mayor, Santiago de Chile, Chile.
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Caetano R, Vaeth PAC, Gruenewald PJ, Ponicki WR, Kaplan Z, Annechino R. Proximity to the U.S./Mexico border, alcohol outlet density and population-based sociodemographic correlates of spatially aggregated violent crimes in California. Ann Epidemiol 2021; 58:42-47. [PMID: 33640486 PMCID: PMC8164990 DOI: 10.1016/j.annepidem.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
This paper examines trends and population-level correlates of violent crime rates from 2005 to 2017 in California, including proximity to the U.S./Mexico border and alcohol outlet density. Crime data come from the Crimes and Clearances report compiled by the California Department of Justice. These and U.S. Census data were aggregated at the level of 499 Law Enforcement Reporting Areas (LERA) that contributed to the report. Reported crime rates were related to area characteristics using hierarchical Bayesian Poisson space-time models. Violent crime rates declined 16% from 2005 to 2017. Crime rates were positively related to distance to the border, total alcohol outlet density, percent outlets that are bars and pubs, percent population Black, percent population Hispanic, percent population 30-49 years of age, percent population U.S. born, percent 150% below federal poverty level, percent high school graduate, and percent houses vacant. Violent crimes were negatively related to percent total outlets that are off-premise, percent population male, percent with higher than 2017 adjusted median income, percent owner occupied houses, and lower population density. In conclusion, several population level characteristics including ethnic composition, community socioeconomic stability, and alcohol availability are associated with violent crime rates. Contrary to public perceptions, violent crime rates increase as distance to the Mexico border increases.
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Affiliation(s)
- Raul Caetano
- Pacific Institute for Research and Evaluation, Berkeley, CA.
| | | | | | | | - Zoe Kaplan
- Pacific Institute for Research and Evaluation, Berkeley, CA
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Morris MD, Yen IH, Shiboski S, Evans JL, Page K. Housing Stability and Hepatitis C Infection for Young Adults Who Inject Drugs: Examining the Relationship of Consistent and Intermittent Housing Status on HCV Infection Risk. J Urban Health 2020; 97:831-844. [PMID: 32901411 PMCID: PMC7704865 DOI: 10.1007/s11524-020-00445-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Housing status affects drug using behaviors, but less is known about the relationship between housing patterns and hepatitis C virus (HCV) infection. HCV-negative young people who inject drugs (PWID) were enrolled into a prospective cohort (2003-2019) with quarterly study visits. We used Cox regression to estimate the independent association of recent housing status (housed vs. unhoused, housing stability, and housing trajectory) on HCV incidence. Among 712 participants, 245 incident HCV infections occurred over 963.8 person-years (py) (cumulative incidence 24.4/100 py). An inverse relationship between time housed and HCV incidence was observed (always unhoused 45.0/100 py, 95% confidence interval (CI) 37.1, 54.5; variably housed 18.0/100 py, 95% CI 15.0, 21.3; and always housed 7.0/100 py, 95% CI 3.0, 17.3). In Cox regression models controlling for confounders, those unhoused versus housed at baseline had a 1.9-fold increased infection risk (95% CI 1.4, 2.6). Those always unhoused versus always housed had a 1.5 times greater risk of HCV (95% CI 1.0, 2.3), and those spending a portion of time in stable housing a lower risk (adjusted relative hazard 0.05, 95% CI 0.3, 0.9) with a similar trend for those being housed for less time. Young adult PWID experiencing both recent and chronic states of being unhoused are at elevated risk for HCV infection. Importantly for this group of PWID, our findings indicate that some frequency of residential housing significantly reduces HCV infection risk.
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Affiliation(s)
- Meghan D Morris
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94153-1224, USA.
| | - Irene H Yen
- Department of Public Health, School of Social Sciences, Humanities & Arts, University of California, Merced, Merced, CA, USA
| | - Steve Shiboski
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94153-1224, USA
| | - Jennifer L Evans
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94153-1224, USA
| | - Kimberly Page
- Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
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Meyers SA, Smith LR, Luisa Mittal M, Strathdee SA, Garfein RS, Guise A, Werb D, Rafful C. The role of gender and power dynamics in injection initiation events within intimate partnerships in the US-Mexico border region. CULTURE, HEALTH & SEXUALITY 2020; 22:1080-1095. [PMID: 31625809 PMCID: PMC7771651 DOI: 10.1080/13691058.2019.1651903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
Women's initiation into injection drug use often establishes a pattern of risk following first injection. This study explored sources of gendered power dynamics in injection initiation experiences for people who inject drugs. A qualitative subsample from two prospective community-recruited cohorts of people who inject drugs in San Diego and Tijuana provided data on the contexts surrounding injection initiation processes. Intimate partnerships were identified in initiation; sub-themes were identified drawing on three concepts within the theory of gender and power. With reference to sexual division of labour, men were often responsible for access to resources in partnerships across both contexts, although there were limited accounts of women obtaining those resources. Extending the structure of power, women in San Diego reported that initiation events involving an intimate partner occurred from a position of vulnerability but expressed greater agency when providing initiation assistance. With regard to structure of cathexis, social norms proscribing injection initiation among women exist, particularly in Tijuana. Gendered power dynamics are a multifaceted component of injection initiation events, especially for women in intimate partnerships. These results stress the need for nuance in understanding the intersection of risk, gender and harm reduction within injection initiation events across socio-cultural contexts.
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Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Facultad de Medicina, Universidad Xochicalco, Tijuana, Baja California, Mexico
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andy Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Addison House, Guy's Hospital, King's College London, London, UK
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Claudia Rafful
- Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Center for Global Mental Health Research, National Institute of Psychiatry, Mexico City, Mexico
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Beaulieu T, Hayashi K, Dong H, DeBeck K, Day A, McKendry R, Kaur G, Barrios R, Milloy MJ, Ti L. Impact of migration from an illicit drug scene on hospital outcomes among people who use illicit drugs in Vancouver, Canada. Drug Alcohol Rev 2020; 39:924-931. [PMID: 32485075 DOI: 10.1111/dar.13095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND AIMS People who use illicit drugs (PWUD) are vulnerable to an array of negative health outcomes, and increased hospital services utilisation. PWUD are also a transient population which poses challenges to the provision of optimal health care. The objective of this study was to identify out-migration patterns from Vancouver's Downtown Eastside (DTES), a neighbourhood where services for PWUD are concentrated, and to estimate the impact of these patterns on hospitalisation events among PWUD. DESIGN AND METHODS Data were collected through three prospective cohorts of PWUD in Vancouver, which were linked with health administrative data. Latent class growth analysis was used to define migration trajectory groups. Poisson regression was used to estimate the effect of migration patterns on hospitalisation events. RESULTS A total of 1180 participants were included in the study. Four latent classes were identified: early migration out (243, 20.6%); frequent revisit (112, 9.5%); late migration out (219, 18.6%); and consistently living in the DTES (606, 51.4%). Compared with those who consistently lived in the DTES, participants in the early migration out group had lower hospitalisation events (adjusted rate ratio = 0.65; 95% confidence interval: 0.48-0.90). DISCUSSION AND CONCLUSION We found that PWUD who migrated out of the DTES early had lower hospitalisation events compared to those who consistently lived in the DTES, which may be a function of lesser addiction severity among this trajectory group. These findings underscore a need to provide transitional health and social service supports for other trajectory groups in an effort to minimise hospitalisation for preventable causes.
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Affiliation(s)
- Tara Beaulieu
- British Columbia Centre on Substance Use, Vancouver, Canada.,Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Public Policy, Simon Fraser University, Vancouver, Canada
| | - Andrew Day
- Vancouver Coastal Health, Vancouver, Canada
| | | | | | - Rolando Barrios
- Vancouver Coastal Health, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Fleiz C, Villatoro J, Dominguez M, Bustos M, Medina-Mora ME. Opioid Crisis Along Mexico's Northern Border: Treatment Needs Mexican Opioid Crisis. Arch Med Res 2020; 50:527-534. [PMID: 32035369 DOI: 10.1016/j.arcmed.2019.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Heroin production for external markets and low rates of use in Mexico have had a long history. A recent shift toward an increase in use and related problems calls for the evaluation of treatment needs in order to draw recommendations for policies. METHODS The objectives were to identify predictors of choice of treatment and barriers to care among persons that had been with no treatment. The study included a convenience sample of 600 face-to-face interviews of people 18 years of age and older and a rapid HIV and HCV tests in three cities on Mexico's Northern Border: Ciudad Juárez, San Luis Río Colorado and Tijuana. The choice of treatment (methadone, other pubic or private treatments with no experience with methadone maintenance and only self-help or religious care), was analyzed though a multiple logistic multimodal regression analysis. Informed consents to be interviewed and for HIC and HIV were signed by interviewers. RESULTS The majority of persons interviewed were males (89.7%) with an average age of 40. Having emigrated to the United States and a greater length of heroin use predicted seeking methadone treatment versus public or private treatment or informal care. The most important barriers to care were lack of information and stigma. HIC, HIV and other infectious and chronic diseases including depression were often unattended. CONCLUSIONS There is a need to reform treatment policies in order to cover this w emerging and demanding problem.
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Affiliation(s)
- Clara Fleiz
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Jorge Villatoro
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Mario Dominguez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Marycarmen Bustos
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - María Elena Medina-Mora
- Departamento de Psiquiatría y Salud Mental, Escuela de Medicina, Universidad Autónoma de México, Ciudad de México, Mexico; Centro Global de Investigación en Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico.
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Abadie R, Habecker P, Gelpi-Acosta C, Dombrowski K. Migration to the US among rural Puerto Ricans who inject drugs: influential factors, sources of support, and challenges for harm reduction interventions. BMC Public Health 2019; 19:1710. [PMID: 31856774 PMCID: PMC6923839 DOI: 10.1186/s12889-019-8032-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While PWID of Puerto Rican origin have been migrating to the US for decades, the range of factors influencing their migration to the US and the resources they draw on to do so are not well understood. This is particularly true for rural Puerto Rican PWID, and the present study is the first empirical research to document migration patterns among this population. The specificities of their migration raise important challenges that need to be documented in order to implement more effective harm reduction policies at home (Puerto Rico) and abroad (US). METHODS This paper draws from data obtained employing a modified NHBS survey which was administered to (N =296) PWID in four rural municipalities of Puerto Rico with participants 18 years or older. The primary dependent variables for this paper are the number of times a person has lived in the continental US, and if they are planning on moving to the continental US in the future. RESULTS Findings suggest that 65% of the sample reported ever lived in the US and that 49% are planning on moving in the future. The number of times living in the US is associated with higher education and older age, but not with self-reported positive HIV or HCV statuses. Planning to move to the US is associated with knowing PWID who have moved or plan to move, negatively associated with age, and is not associated with HIV or HCV status. Around one third of those that lived in the US reported having some sort of support, with the majority receiving support from family sources. No participant received help to enter HIV/HCV treatment. CONCLUSIONS A multi-region approach to prevention is required to make a dent in curbing HIV/HCV transmission in this population. Understanding PWID migration patterns, risk behaviors, and health care needs in the US is now more important than ever as natural disasters prompted by human-made climate change will only increase in the future, raising demands not only for service providers but also harm reduction policies to cope with an increasing influx of "climate refugees" as PWID move across national borders.
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Affiliation(s)
- R Abadie
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA.
| | - P Habecker
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA
| | - C Gelpi-Acosta
- Social Science Department, LaGuardia Community College, 29-10 Thompson Avenue, Long Island City, NY, 11101, USA
| | - K Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA
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Bórquez A, Garfein RS, Abramovitz D, Liu L, Beletsky L, Werb D, Mehta SR, Rangel G, Magis-Rodríguez C, González-Zúñiga P, Strathdee SA. Prevalence and Correlates of Injecting with Visitors from the United States Among People Who Inject Drugs in Tijuana, Mexico. J Immigr Minor Health 2019; 21:1200-1207. [PMID: 30771144 PMCID: PMC6697237 DOI: 10.1007/s10903-019-00868-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cross-border infectious disease transmission is a concern related to drug tourism from the U.S. to Mexico. We assessed this risk among people who inject drugs (PWID) in Tijuana, Mexico. We measured the prevalence and identified correlates of injecting with PWID visiting from the U.S. among PWID in Tijuana using univariable and multivariable logistic regression. Of 727 participants, 18.5% injected during the past 6 months in Mexico with U.S. PWID described mostly as friends (63%) or acquaintances (26%). Injecting with U.S. PWID was independently associated with higher education [adjusted odds ratio (aOR) = 1.13/year], deportation from the U.S. (aOR = 1.70), younger age at first injection (aOR = 0.96/year), more lifetime overdoses (aOR = 1.08), and, in the past 6 months, backloading (aOR = 4.00), syringe confiscation by the police (aOR = 3.02) and paying for sex (aOR = 2.98; all p-values < 0.05). Nearly one-fifth of PWID in Tijuana recently injected with U.S. PWID, and their reported risk behaviors could facilitate cross-border disease transmission.
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Affiliation(s)
- A Bórquez
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA
| | - R S Garfein
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA.
| | - D Abramovitz
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA
| | - L Liu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - L Beletsky
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - D Werb
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - S R Mehta
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA
| | - G Rangel
- Comisión de Salud Fronteriza México-Estados Unidos, Tijuana, Mexico
- El Colegio de la Frontera Norte, Tijuana, Mexico
| | | | - P González-Zúñiga
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA
| | - S A Strathdee
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0725, La Jolla, CA, 92093-0725, USA
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11
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Wise A, Finlayson T, Sionean C, Paz-Bailey G. Incarceration, HIV Risk-Related Behaviors, and Partner Characteristics Among Heterosexual Men at Increased Risk of HIV Infection, 20 US Cities. Public Health Rep 2019; 134:63S-70S. [PMID: 31059417 DOI: 10.1177/0033354919833435] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The effect of incarceration on HIV risk-related behaviors among at-risk heterosexual men is understudied. The objective of our study was to examine the association between incarceration and HIV risk-related behaviors among a sample of predominantly non-Hispanic black and Hispanic heterosexual men residing in urban areas in the United States with a high prevalence of AIDS. METHODS We analyzed data from the 2013 National HIV Behavioral Surveillance system on 5321 at-risk heterosexual men using log-linked Poisson regression models, adjusted for demographic characteristics and clustered on city. RESULTS Of 5321 men, 1417 (26.6%) had recently been incarcerated (in the past 12 months), 2781 (52.3%) had ever been incarcerated but not in the past 12 months, and 1123 (21.1%) had never been incarcerated. Recent incarceration was associated with multiple casual female sexual partners (adjusted prevalence ratio [aPR] = 1.23; 95% confidence interval [CI], 1.05-1.44), condomless sex with multiple female sexual partners (aPR = 1.32; 95% CI, 1.06-1.66), injection drug use (aPR = 3.75; 95% CI, 2.64-5.32), and having sexual partners who were more likely to have ever injected drugs (aPR = 1.84; 95% CI, 1.48-2.28), been incarcerated (aPR = 2.28; 95% CI, 2.01-2.59), or had a concurrent sexual partner (aPR = 1.08; 95% CI, 1.05-1.11), as compared with never-incarcerated men. CONCLUSIONS Incarceration history was associated with HIV risk-related behaviors among heterosexual men from urban areas in the United States. Correctional rehabilitation initiatives are needed to promote strategies that mitigate HIV risk-related behaviors and promote healthy reentry into communities among heterosexual men at high risk for HIV.
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Affiliation(s)
- Akilah Wise
- 1 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,2 Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa Finlayson
- 2 Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catlainn Sionean
- 2 Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- 2 Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Identification of a Syndemic of Blood-Borne Disease Transmission and Injection Drug Use Initiation at the US-Mexico Border. J Acquir Immune Defic Syndr 2019; 79:559-565. [PMID: 30222661 DOI: 10.1097/qai.0000000000001858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Efforts to prevent injection drug use (IDU) are increasingly focused on the role that people who inject drugs (PWID) play in the assistance with injection initiation. We studied the association between recent (ie, past 6 months) injection-related HIV risk behaviors and injection initiation assistance into IDU among PWID in the US-Mexico border region. SETTING Preventing Injecting by Modifying Existing Responses (PRIMER) is a multicohort study assessing social and structural factors related to injection initiation assistance. This analysis included data collected since 2014 from 2 participating cohorts in San Diego and Tijuana. METHODS Participants were 18 years and older and reported IDU within the month before study enrollment. Logistic regression analyses were conducted to assess the association between recent injection-related HIV risk behaviors (eg, distributive/receptive syringe sharing, dividing drugs in a syringe, and paraphernalia sharing) and recent injection initiation assistance. RESULTS Among 892 participants, 41 (4.6%) reported recently providing injection initiation assistance. In multivariable analysis adjusting for potential confounders, reporting a higher number of injection-related risk behaviors was associated with an increased odds of recently assisting others with injection initiation (adjusted odds ratio per risk behavior: 1.3; 95% confidence interval: 1.0 to 1.6, P = 0.04). CONCLUSIONS PWID who recently engaged in one or more injection-related HIV risk behavior were more likely to assist others in injection initiation. These results stress the syndemic of injection initiation and risk behaviors, which indicates that prevention of injection-related HIV risk behaviors might also reduce the incidence of injection initiation.
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13
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West BS. Social Networks of Substance-Using Populations: Key Issues and Promising New Approaches for HIV. Curr HIV/AIDS Rep 2019; 16:48-56. [PMID: 30659477 PMCID: PMC6420834 DOI: 10.1007/s11904-019-00425-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This paper presents recent literature on substance using networks and HIV, highlighting renewed and emerging themes in the field. The goal is to draw attention to research that holds considerable promise for advancing our understanding of the role of networks in shaping behaviors, while also providing critical information for the development of interventions, programs, and policies to reduce HIV and other drug-related harms. RECENT FINDINGS Recent research advances our understanding of networks and HIV, including among understudied populations, and provides new insight into how risk environments shape the networks and health of substance-using populations. In particular, the integration of network approaches with molecular epidemiology, research on space and place, and intervention methods provides exciting new avenues of investigation. Continued advances in network research are critical to supporting the health and rights of substance-using populations and ensuring the development of high-impact HIV programs and policies.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
- Division of Infectious Diseases and Global Public Health in the School of Medicine, University of California San Diego, San Diego, CA, USA.
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14
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Zlotorzynska M, Weidle PJ, Paz-Bailey G, Broz D. Factors associated with obtaining sterile syringes from pharmacies among persons who inject drugs in 20 US cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:51-58. [PMID: 30359873 DOI: 10.1016/j.drugpo.2018.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Increased access to sterile syringes has been shown to reduce HIV risk among people who inject drugs (PWID). Where syringe services programs (SSPs) are limited, pharmacies are an important sterile syringe source. We assessed factors associated with using pharmacies as the primary source of syringes among PWID from 20 US cities. METHODS PWID ages ≥18 years were recruited for the 2015 National HIV Behavioral Surveillance using respondent-driven sampling. Using generalized estimating equation (GEE) models, we assessed demographic characteristics independently associated with participant-reported primary syringe source: pharmacies vs. SSPs. We calculated associations between primary syringe source and various behavioural outcomes, adjusted for participant characteristics. RESULTS PWID who were <30 years old, female, white, and less frequent injectors were more likely have used pharmacies as their primary syringe source. Accessing syringes primarily from pharmacies, as compared to SSPs, was associated with receptive syringe sharing and unsafe syringe disposal; using sterile syringes, recent HIV testing and participation in an HIV behavioural intervention were negatively associated with primary pharmacy use. CONCLUSIONS Pharmacies can play an important role in comprehensive HIV prevention among PWID. Linkage to HIV interventions and syringe disposal services at pharmacies could strengthen prevention efforts for PWID who cannot access or choose not to utilize SSPs.
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Affiliation(s)
- Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Paul J Weidle
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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15
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Walters SM, Rivera AV, Reilly KH, Anderson BJ, Bolden B, Wogayehu A, Neaigus A, Braunstein S. Exchange Sex Among Persons Who Inject Drugs in the New York Metropolitan Area: The Importance of Local Context, Gender and Sexual Identity. AIDS Behav 2018; 22:2773-2787. [PMID: 29468492 DOI: 10.1007/s10461-018-2039-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exchanging sex for money or drugs is known to increase risk for HIV among persons who inject drugs (PWID). To better understand determinants of exchange sex among PWID we examined factors associated with exchange sex in the New York metropolitan area-defined as New York City (NYC), NY; Newark, NJ; and Long Island, NY-using data from the 2012 National HIV Behavioral Surveillance system cycle on injection drug use. Of the 1160 PWID in this analysis, 24% reported exchange sex, with differences in gender and sexual identity by location. In multivariable analysis gay/bisexual men, heterosexual women, and lesbian, gay, or bisexual (LGB) women were more likely to exchange sex compared to heterosexual men. Exchange sex was also associated with race/ethnicity, homelessness, incarceration, location, and non-injection crack and cocaine use. We find that heterosexual women and LGB women who injected drugs residing in Newark were more likely to report exchange sex compared to NYC. This study highlights how local conditions impact exchange sex.
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Affiliation(s)
- Suzan M Walters
- Department of Sociology, State University of New York at Stony Brook, 152-11 Union Turnpike Apt 3A, Flushing, Stony Brook, NY, 11367, USA.
| | - Alexis V Rivera
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, NY, USA
| | - Kathleen H Reilly
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, NY, USA
| | - Bridget J Anderson
- New York State Department of Health, Office of Public Health, Albany, NY, USA
| | - Barbara Bolden
- Division of HIV, STD and TB Services, New Jersey Department of Health, Trenton, NJ, USA
| | - Afework Wogayehu
- Division of HIV, STD and TB Services, New Jersey Department of Health, Trenton, NJ, USA
| | - Alan Neaigus
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York, NY, USA
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16
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Nerlander LMC, Hoots BE, Bradley H, Broz D, Thorson A, Paz-Bailey G. HIV infection among MSM who inject methamphetamine in 8 US cities. Drug Alcohol Depend 2018; 190:216-223. [PMID: 30055426 DOI: 10.1016/j.drugalcdep.2018.06.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Men who have sex with men (MSM) and inject drugs are at risk for HIV infection. Although research exists on non-injection methamphetamine (meth) use and sexual risk among MSM, less is known about meth injection and its association with HIV infection among MSM who inject drugs. METHODS We analyzed data from men aged ≥18 years who reported injecting drugs and male-to-male sexual contact. Men were recruited using respondent-driven sampling, interviewed, and tested for HIV during the 2012 and 2015 cycles of National HIV Behavioral Surveillance among persons who inject drugs. We included data from 8 cities where ≥10 MSM reported meth as the primary drug injected. We assessed differences in demographic characteristics, past 12 months risk behaviors, and HIV infection between MSM who primarily injected meth and those who primarily injected another drug. RESULTS Among 961 MSM, 33.7% reported meth as the drug they injected most often. Compared to MSM who primarily injected other drugs, MSM who primarily injected meth were more likely to have had ≥5 condomless anal sex partners, have been diagnosed with syphilis, and were less likely to report sharing syringes. In multivariable analysis, injecting meth was associated with being HIV-positive (adjusted prevalence ratio 1.48; 95% confidence interval 1.08-2.03). Including number of condomless anal sex partners in mediation analysis rendered this association no longer significant. CONCLUSIONS HIV prevalence among MSM who primarily injected meth was almost 50% higher than among MSM who primarily injected other drugs, and this association was mediated by sexual risk.
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Affiliation(s)
- Lina M C Nerlander
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA; Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Brooke E Hoots
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Heather Bradley
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Dita Broz
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
| | - Anna Thorson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Gabriela Paz-Bailey
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, MS E-46, 1600 Clifton Road, 30329, Atlanta, GA, USA.
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17
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Melo JS, Mittal ML, Horyniak D, Strathdee SA, Werb D. Injection Drug Use Trajectories among Migrant Populations: A Narrative Review. Subst Use Misuse 2018; 53:1558-1570. [PMID: 29364762 PMCID: PMC6033671 DOI: 10.1080/10826084.2017.1416404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dual epidemics of injection drug use and blood-borne disease, characterized as "syndemics," are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. OBJECTIVES This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego-Tijuana border region as the most dynamic example of these phenomena. METHODS Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. RESULTS Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. CONCLUSION Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.
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Affiliation(s)
- Jason S Melo
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Maria Luisa Mittal
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,b School of Medicine, Universidad Xochicalco , Tijuana , Baja California , Mexico
| | - Danielle Horyniak
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,c Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,d School of Public Health and Preventive Medicine, Monash University , Melbourne , Victoria , Australia
| | - Steffanie A Strathdee
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Dan Werb
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,e Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada
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Pinedo M, Burgos JL, Zúñiga ML, Perez R, Macera CA, Ojeda VD. Deportation and mental health among migrants who inject drugs along the US-Mexico border. Glob Public Health 2018; 13:211-226. [PMID: 27132880 PMCID: PMC5191974 DOI: 10.1080/17441692.2016.1170183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) screening instrument. Eligible participants were ≥18 years old, injected drugs in the past month, spoke English or Spanish, and resided in Tijuana. Multivariate analyses identified factors associated with depressive symptoms. Among deported PWID, 45% reported current symptoms of depression. Deported PWID who were initially detained in the US for a crime-related reason before being deported (adjusted odds ratio (AOR): 5.27; 95% CI: 1.79-15.52) and who perceived needing help with their drug use (AOR: 2.15; 95% 1.01-4.61) had higher odds of reporting depressive symptoms. Our findings highlight the need for effective strategies targeting deported migrants who inject drugs to treat mental health and drug abuse in Tijuana. Investing in the mental health of deported PWID may also be a viable HIV prevention strategy.
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Affiliation(s)
- Miguel Pinedo
- Alcohol Research Group, 6475 Christie Avenue Suite 400, Emeryville, CA 94608
| | - José Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, Hepner Hall 203D, San Diego, CA 92182
| | - Ramona Perez
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-6022
| | - Caroline A. Macera
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162
| | - Victoria D. Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093
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Exchange Sex and HIV Infection Among Women Who Inject Drugs-20 US Cities, 2009. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S333-S340. [PMID: 28604435 DOI: 10.1097/qai.0000000000001408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women who inject drugs and who also exchange sex are at increased risk for HIV infection, but data on this population in the United States remain sparse. METHODS This study assessed the prevalence of exchanging sex for money or drugs among women who inject drugs using data from the 2009 US National HIV Behavioral Surveillance (NHBS) system. Prevalence of being HIV-positive (testing positive in NHBS), HIV-positive-unaware (reporting being HIV-negative or unknown status but testing positive in NHBS), and risk behaviors and use of services were compared between women who did and did not exchange sex. The association between exchange sex and being HIV-positive-unaware of the infection was examined using multivariate Poisson models with robust standard errors. RESULTS Among 2305 women who inject drugs, 39% reported receiving things like money or drugs from ≥1 male partners in exchange for oral, vaginal, or anal sex in the previous 12 months. Women who exchanged sex were more likely to be unemployed, homeless, lack health insurance, have multiple condomless vaginal or anal sex partners, and receptively share syringes. In multivariate analysis, exchange sex was associated with being HIV-positive-unaware (adjusted prevalence ratio 1.97, 95% confidence intervals: 1.31 to 2.97). CONCLUSIONS Prevalence of exchange sex was high in this population. Women who exchange sex were more likely to be socially disadvantaged, report sexual and injection risk, and be HIV-positive-unaware. They represent an important group to reach with HIV prevention, testing, and care services.
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20
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Health-damaging policing practices among persons who inject drugs in Mexico: Are deported migrants at greater risk? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:41-46. [PMID: 28601020 DOI: 10.1016/j.drugpo.2017.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/12/2017] [Accepted: 05/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence-based public health and criminal justice policies aimed at addressing the structurally vulnerable population of persons who inject drugs (PWID) and who are involved in the immigrant enforcement and deportation system are lacking. Policing practices are critical structural determinants of HIV among PWID. PWID in Mexico who have been deported from the US are at elevated risk of HIV. METHODS From 2011 to 2013, 733 PWID were recruited to complete structured questionnaires, including past 6-month experiences with police. Eligible PWID were 18 years or older, had injected in the past month, and resided in Tijuana, Mexico with no intentions of moving. To determine if deportation status was associated with experiences of arrests and problematic policing practices, we conducted separate multivariate logistic regression models for independent policing variables. RESULTS In multivariate analyses, deportation status was independently associated with higher odds of being arrested (Adjusted Odds Ratio (AOR): 1.45; 95% Confidence Interval (CI): 1.02-2.05), being asked for a bribe (AOR: 1.39; 95% CI: 1.05-2.04), and being forced to leave a place of residence (AOR: 2.00; 95% CI: 1.08-3.70) in the past 6 months. CONCLUSION Results highlight a previously poorly understood elements of the US-deportation experience: migrants' experiences with law enforcement post-deportation and the role of deportation policies and practices as structural drivers of public health risk in destination countries. We provide policy recommendations for Mexico and the US based on our findings, which have potential application in other countries seeking to improve enforcement and related policing practices from a public health perspective.
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21
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Borges G, Zemore S, Orozco R, Cherpitel CJ, Ye Y, Bond J, Maxwell JC, Wallisch L. Co-occurrence of alcohol, drug use, DSM-5 alcohol use disorder, and symptoms of drug use disorder on both sides of the U.S.-Mexico border. Alcohol Clin Exp Res 2016; 39:679-87. [PMID: 25833029 DOI: 10.1111/acer.12672] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 01/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The U.S.-Mexico border displays elevated rates of hazardous alcohol and drug use. Whether the co-occurrence of alcohol and drug use and disorders is also high in the border area is unknown. METHODS Data are from the U.S.-Mexico Study on Alcohol and Related Conditions, a cross-sectional survey of randomly selected respondents interviewed from 2011 to 2013. Participants included 1,690 Mexican Americans from Texas (572 in an off-border city and 1,118 from 3 border cities) and 1,293 Mexicans from Nuevo Leon and Tamaulipas (415 in an off-border city and 878 from 3 Mexican cities bordering Texas) who reported drinking in the last 12 months. Participants were interviewed regarding the prevalence of and risk factors for: (i) co-occurring hazardous alcohol use (5+/4+ at least monthly) and drug use (medical and illicit) and (ii) co-occurring presence of a DSM-5 alcohol use disorder (AUD) and 2 symptoms (hazardous use and quit/control) of drug use disorder (DUD symptoms). RESULTS Co-occurring hazardous alcohol and drug use was more common in the U.S. border cities (14.7%) than off-border (7.2%), but similar for Mexican border (1.2%) and off-border (1.4%) cities. Co-occurrence of AUD and DUD symptoms was likewise more common at the U.S. border (6.8%) than off-border (3.3%), as well as at the Mexican border (1.3%), compared to off-border (0.6%), but not statistically significant for Mexico. In models adjusting for demographics, mobility factors and exposure to the U.S. culture, border residence in both countries related to a nearly twofold increase in prevalence ratios (PRs) of co-occurring AUD and DUD symptoms (PR = 1.97, 95% CI = 1.36 to 2.85). CONCLUSIONS Increased rates of co-occurring AUDs and DUDs suggest an added negative impact on already difficult conditions of the border population.
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Affiliation(s)
- Guilherme Borges
- Dirección de Investigaciones Epidemiológicas y Psicosociales and Universidad Autónoma Metropolitana , Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
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22
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Armenta RF, Roth AM, Wagner KD, Strathdee SA, Brodine SK, Cuevas-Mota J, Munoz FA, Garfein RS. Prevalence and Correlates of the Use of Prefilled Syringes Among Persons Who Inject Drugs in San Diego, CA. J Urban Health 2015; 92:1081-91. [PMID: 26382653 PMCID: PMC4675744 DOI: 10.1007/s11524-015-9988-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Persons who inject drugs (PWID) are at increased risk for blood-borne virus (BBV) infections and overdose resulting from high-risk injecting practices. Studies of prefilled syringe use ([PFSU] using a syringe that already contained drug solution when it was obtained by the user), an injection practice previously described in Eastern Europe, suggest that it increases susceptibility to BBV. However, little is known about this practice in the USA. Data were obtained from an ongoing cohort study of PWID to determine the prevalence and assess correlates of PFSU in San Diego, CA. Baseline interviews assessed socio-demographics and drug use behaviors. Logistic regression was used to identify factors independently associated with ever using a prefilled syringe (yes/no). Participants (n = 574) were predominately males (73.9%) and white (50.9%) with a mean age of 43.4 years (range 18-80); 33.3% reported ever using prefilled syringes, although only 4.9% reported use in the past 6 months. In multivariable analyses, PFSU was independently associated with ever having a rushed injection due to police presence [adjusted odds ratio (AOR) = 2.51, 95% CI 1.66, 3.79], ever being in prison (AOR = 1.80, 95% CI 1.23, 2.63), injecting most often in public versus private places in the past 6 months (AOR = 1.66, 95% CI 1.11, 2.48), and injecting drugs in Mexico (AOR = 1.70, 95% CI 1.16, 2.49). Results indicate that a history of PFSU is common and associated with environmental factors that may also increase risk for adverse health outcomes. Studies are needed to better understand PFSU in order to develop interventions to prevent adverse outcomes associated with their use.
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Affiliation(s)
- Richard F Armenta
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA.,Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Alexis M Roth
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA
| | - Stephanie K Brodine
- Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jazmine Cuevas-Mota
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA
| | - Fatima A Munoz
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA
| | - Richard S Garfein
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA, 92093-0507, USA.
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Wagner KD, Pitpitan EV, Valente TW, Strathdee SA, Rusch M, Magis-Rodriguez C, Chavarin CV, Patterson TL. Place of Residence Moderates the Relationship Between Emotional Closeness and Syringe Sharing Among Injection Drug Using Clients of Sex Workers in the US-Mexico Border Region. AIDS Behav 2015; 19:987-95. [PMID: 25613593 DOI: 10.1007/s10461-015-1001-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Injection drug-using men from the US and Mexico who purchase sex in Tijuana, Mexico are at risk for transmitting HIV to their contacts in both countries via syringe sharing. We used social network methods to understand whether place of residence (US vs. Mexico) moderated the effect of emotional closeness on syringe sharing. We interviewed 199 drug-using men who reported paying/trading for sex in Tijuana, Mexico using an epidemiological and social network survey and collected samples for HIV/STI testing. Seventy-two men reported using injection drugs with 272 network contacts. Emotional closeness was strongly associated with syringe sharing in relationship where the partner lives in the US, while the relationship between emotional closeness and syringe sharing was considerably less strong in dyads where the partner lives in Mexico. Efforts to reduce HIV risk behaviors in emotionally close relationships are needed, and could benefit from tailoring to the environmental context of the relationship.
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Affiliation(s)
- Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia Street, MS 0274, Reno, NV, 89557-0274, USA,
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Guerrero EG, Villatoro JA, Kong Y, Fleiz C, Vega WA, Strathdee SA, Medina-Mora ME. Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:30. [PMID: 25074067 PMCID: PMC4118628 DOI: 10.1186/1747-597x-9-30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Abstract
Background We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender. Methods This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. Results Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. Conclusions Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA.
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Correlates of HIV infection among African American women from 20 cities in the United States. AIDS Behav 2014; 18 Suppl 3:266-75. [PMID: 24077972 DOI: 10.1007/s10461-013-0614-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little research has been conducted to investigate multiple levels of HIV risk-individual risk factors, sex partner characteristics, and socioeconomic factors-among African American women, who, in 2010, comprised 64 % of the estimated 9,500 new infections in women. Respondent-driven sampling was used to recruit and interview women in 20 cities with high AIDS prevalence in the United States through the National HIV Behavioral Surveillance System. We assessed individual risk factors, sex partner characteristics, and socioeconomic characteristics associated with being HIV-positive but unaware of the infection among African American women. Among 3,868 women with no previous diagnosis of HIV, 68 % had high school education or more and 84 % lived at or below the poverty line. In multivariable analysis, women who were 35 years or older, homeless, received Medicaid, whose last sex partner ever used crack cocaine or was an exchange sex partner were more likely to be HIV-positive-unaware. Developing and implementing strategies that address socioeconomic factors, such as homelessness and living in poverty, as well as individual risk factors, can help to maximize the effectiveness of the public health response to the HIV epidemic.
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Broz D, Pham H, Spiller M, Wejnert C, Le B, Neaigus A, Paz-Bailey G. Prevalence of HIV infection and risk behaviors among younger and older injecting drug users in the United States, 2009. AIDS Behav 2014; 18 Suppl 3:284-96. [PMID: 24242754 DOI: 10.1007/s10461-013-0660-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study compared HIV sero-prevalence and risk behaviors between younger and older injecting drug users (IDUs). IDUs aged ≥18 years were interviewed for the 2009 National HIV Behavioral Surveillance System. Using GEE regression, we assessed characteristics of younger (18-29 years) and older (≥30 years) IDUs, and factors associated with past 12-month receptive syringe sharing and unprotected sex (vaginal/anal). Of 10,090 participants, 10 % were younger. HIV sero-prevalence was lower among younger than older IDUs (4 vs. 10 %, p = 0.001). Younger IDUs were more likely (p ≤ 0.002) to be non-black race/ethnicity, report higher household income, homelessness, being arrested and to engage in receptive syringe sharing and unprotected sex. In multivariable models, age remained associated (p < 0.001) with receptive syringe sharing (aPR = 1.14, 95 % CI1.07-1.22) and unprotected sex (aPR = 1.10, 95 % CI1.06-1.14). Although younger IDUs had lower HIV prevalence, their behaviors place them at increased risk of HIV infection and could lead to a rapid spread in this susceptible population.
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Affiliation(s)
- Dita Broz
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-E46, Atlanta, GA, 30333, USA,
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Pinedo M, Burgos JL, Ojeda VD. A critical review of social and structural conditions that influence HIV risk among Mexican deportees. Microbes Infect 2014; 16:379-90. [PMID: 24583278 DOI: 10.1016/j.micinf.2014.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/17/2014] [Indexed: 11/27/2022]
Abstract
Mexican migrants who are deported from the US may be at elevated risk for HIV infection. Deportations of Mexican migrants by the US have reached record numbers. We critically reviewed existing literature to assess how social and structural conditions in post-deportation settings can influence Mexican deported migrants' HIV risk. We also identify critical research gaps and make research recommendations.
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Affiliation(s)
- Miguel Pinedo
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093, USA; Joint Doctoral Program in Public Health, San Diego State University and University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - José Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093, USA
| | - Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093, USA.
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Robertson AM, Garfein RS, Wagner KD, Mehta SR, Magis-Rodriguez C, Cuevas-Mota J, Moreno-Zuniga PG, Strathdee SA. Evaluating the impact of Mexico's drug policy reforms on people who inject drugs in Tijuana, B.C., Mexico, and San Diego, CA, United States: a binational mixed methods research agenda. Harm Reduct J 2014; 11:4. [PMID: 24520885 PMCID: PMC3944401 DOI: 10.1186/1477-7517-11-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/10/2014] [Indexed: 11/23/2022] Open
Abstract
Background Policymakers and researchers seek answers to how liberalized drug policies affect people who inject drugs (PWID). In response to concerns about the failing “war on drugs,” Mexico recently implemented drug policy reforms that partially decriminalized possession of small amounts of drugs for personal use while promoting drug treatment. Recognizing important epidemiologic, policy, and socioeconomic differences between the United States—where possession of any psychoactive drugs without a prescription remains illegal—and Mexico—where possession of small quantities for personal use was partially decriminalized, we sought to assess changes over time in knowledge, attitudes, behaviors, and infectious disease profiles among PWID in the adjacent border cities of San Diego, CA, USA, and Tijuana, Baja California, Mexico. Methods Based on extensive binational experience and collaboration, from 2012–2014 we initiated two parallel, prospective, mixed methods studies: Proyecto El Cuete IV in Tijuana (n = 785) and the STAHR II Study in San Diego (n = 575). Methods for sampling, recruitment, and data collection were designed to be compatible in both studies. All participants completed quantitative behavioral and geographic assessments and serological testing (HIV in both studies; hepatitis C virus and tuberculosis in STAHR II) at baseline and four semi-annual follow-up visits. Between follow-up assessment visits, subsets of participants completed qualitative interviews to explore contextual factors relating to study aims and other emergent phenomena. Planned analyses include descriptive and inferential statistics for quantitative data, content analysis and other mixed-methods approaches for qualitative data, and phylogenetic analysis of HIV-positive samples to understand cross-border transmission dynamics. Results Investigators and research staff shared preliminary findings across studies to provide feedback on instruments and insights regarding local phenomena. As a result, recruitment and data collection procedures have been implemented successfully, demonstrating the importance of binational collaboration in evaluating the impact of structural-level drug policy reforms on the behaviors, health, and wellbeing of PWID across an international border. Conclusions Our prospective, mixed methods approach allows each study to be responsive to emerging phenomena within local contexts while regular collaboration promotes sharing insights across studies. The strengths and limitations of this approach may serve as a guide for other evaluations of harm reduction policies internationally.
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Affiliation(s)
| | | | | | | | | | | | | | - Steffanie A Strathdee
- Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA.
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Gaines TL, Rudolph AE, Brouwer KC, Strathdee SA, Lozada R, Martinez G, Goldenberg SM, Rusch MLA. The longitudinal association of venue stability with consistent condom use among female sex workers in two Mexico-USA border cities. Int J STD AIDS 2013; 24:523-9. [PMID: 23970766 DOI: 10.1177/0956462412473890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined the relationship between venue stability and consistent condom use (CCU) among female sex workers who inject drugs (FSW-IDUs; n = 584) and were enrolled in a behavioural intervention in two Mexico-USA border cities. Using a generalized estimating equation approach stratified by client type and city, we found venue stability affected CCU. In Tijuana, operating primarily indoors was significantly associated with a four-fold increase in the odds of CCU among regular clients (odds ratio [OR]: 3.77, 95% confidence interval [CI]: 1.44, 9.89), and a seven-fold increase among casual clients (OR: 7.18, 95% CI: 2.32, 22.21), relative to FSW-IDUs spending equal time between indoor and outdoor sex work venues. In Ciudad Juarez, the trajectory of CCU increased over time and was highest among those operating primarily indoors. Results from this analysis highlight the importance of considering local mobility, including venue type and venue stability, as these characteristics jointly influence HIV risk behaviours.
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Affiliation(s)
- T L Gaines
- Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA.
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Wagner KD, Moynihan MJ, Strathdee SA, Cuevas-Mota J, Clark M, Zúñiga ML, Volkmann TA, Teshale E, Garfein RS. The social and environmental context of cross-border drug use in Mexico: findings from a mixed methods study of young injection drug users living in San Diego, CA. J Ethn Subst Abuse 2013; 11:362-78. [PMID: 23216441 DOI: 10.1080/15332640.2012.735182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors report the results of qualitative (n = 19) and quantitative (n = 545) interviews with young injection drug users (IDUs) in San Diego, California about their experiences using drugs in Tijuana, Mexico, and associated risks for HIV infection. Young IDUs who have ever traveled to Mexico (n = 365) used a variety of injection (54%) and noninjection (30%) drugs there and appear to be heavier users than those who have never traveled to Mexico. Sociocultural themes influencing drug use in Mexico included interactions among the purpose of travel, drug preference, and route of administration; familiarity with the border region; evolving relationships with the United States and Mexican drug markets; and the experience of crossing the U.S.-Mexico border. Interventions for IDUs in border regions need to be sensitive to the ethnicity, familiarity with the border region, and life history of participants, as well as differences in national policies that could influence drug use and risk for HIV on both sides of the border.
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Affiliation(s)
- Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego, 92093, USA.
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Ojeda VD, Burgos JL, Rangel AG, Lozada R, Vera A. U.S. drug use and migration experiences of Mexican female sex workers who are injection drug users. J Health Care Poor Underserved 2012; 23:1733-49. [PMID: 23698687 PMCID: PMC4232365 DOI: 10.1353/hpu.2012.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe U.S.-based drug/sex behaviors and correlates of lifetime U.S. drug use by Mexican female sex workers who inject drugs (FSW-IDUs). METHODS Between 2008-2010, 315 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. RESULTS Twenty-seven percent (n=85) of FSW-IDUs were U.S. migrants; of these, 46% (n=39) were deportees. One-half of U.S.-migrant FSW-IDUs consumed illicit drugs in the U.S., and two-thirds of these injected drugs in the U.S. Among U.S. injectors, over 75% ever received or shared used injection equipment. The majority (92%) of U.S.-migrant FSW-IDUs never obtained U.S. drug treatment services. HIV prevalence was 4% among U.S.-migrant and 5% among non-U.S. migrant FSW-IDUs; 100% of U.S.-migrant and 75% of non-U.S. migrant FSW-IDUs were unaware of their HIV status. CONCLUSIONS Binational coordination to improve access to substance use treatment and HIV testing services in Mexico and the U.S. among marginalized binational migrants may be critical to containing HIV transmission.
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Affiliation(s)
- Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, UCSD School of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA.
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Border crossing to inject drugs in Mexico among injection drug users in San Diego, California. J Immigr Minor Health 2012; 14:281-6. [PMID: 21442300 PMCID: PMC3163238 DOI: 10.1007/s10903-011-9462-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
We examined correlates of ever injecting drugs in Mexico among residents of San Diego, California. From 2007 to 2010, injecting drug users (IDUs) in San Diego underwent an interviewer-administered survey. Logistic regression identified correlates of injection drug use in Mexico. Of 302 IDUs, 38% were Hispanic, 72% male and median age was 37; 27% ever injected in Mexico; 43% reported distributive syringe sharing there. Factors independently associated with ever injecting drugs in Mexico included being younger at first injection, injecting heroin, distributive syringe sharing at least half of the time, and transporting drugs over the last 6 months. One-quarter of IDUs reported ever injecting drugs in Mexico, among whom syringe sharing was common, suggesting possible mixing between IDUs in the Mexico-US border region. Prospective studies should monitor trends in cross-border drug use in light of recent Mexican drug policy reforms partially decriminalizing drug possession.
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Campollo O, Roman S, Panduro A, Hernandez G, Diaz-Barriga L, Balanzario MC, Cunningham JK. Non-injection drug use and hepatitis C among drug treatment clients in west central Mexico. Drug Alcohol Depend 2012; 123:269-72. [PMID: 22138538 DOI: 10.1016/j.drugalcdep.2011.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/02/2011] [Accepted: 11/10/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Research on hepatitis C virus (HCV) prevalence among non-injecting drug treatment clients in the United States, Europe and Asia indicate substantial differences by place. To date, little or no research on HCV and non-injection drug use (NIDU) has been conducted in Mexico. METHODS We examined the prevalence of HCV, hepatitis B virus (HBV), and HIV among non-injecting drug users (NIDUs) in community-based drug treatment (N=122) and NIDUs in a prison-based drug treatment program (N=30), both located in west central Mexico. RESULTS Among the community clients, prevalence was 4.1% (95% confidence interval [CI]: 1.8-9.2) for HCV, 5.7% for HBV (95% CI: 2.8-11.4), and 1.6% for HIV (95% CI: 0.4-5.8). Among the in-prison clients, prevalence was 40.0% (95% CI: 24.6-57.7) for HCV, 20.0% for HBV (95% CI: 9.5-37.3), and 6.7% for HIV (95% CI: 1.9-21.3). None of the clients were aware of being infected. CONCLUSION The HCV prevalence found for the NIDU community treatment clients ranks among the lower HCV estimates published for NIDUs in treatment to date. The prevalence found for the in-prison clients ranks among the higher, raising a concern of possible elevated HCV infection among NIDUs in the west central Mexico prison--one compounded by the finding that none of this study's clients knew they were HCV positive.
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Affiliation(s)
- Octavio Campollo
- Center of Studies on Alcohol and Addictions, CUCS, Universidad de Guadalajara, Hospital Civil de Guadalajara, Hospital 278, Guadalajara, Jal. 44280, Mexico. renaceboy@hotmail
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Robertson AM, Rangel MG, Lozada R, Vera A, Ojeda VD. Male injection drug users try new drugs following U.S. deportation to Tijuana, Mexico. Drug Alcohol Depend 2012; 120:142-8. [PMID: 21835559 PMCID: PMC3245754 DOI: 10.1016/j.drugalcdep.2011.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/30/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Among male injection drug users (IDUs) in Tijuana, Mexico, U.S. deportation is associated with HIV transmission. Changing drug use behaviors following deportation, including the use of new drugs, may increase HIV risk but are understudied. We identify correlates of trying new drugs following male IDUs' most recent U.S. deportation to Mexico. METHODS In 2010, we recruited 328 deported male IDUs in Tijuana, Mexico. Questionnaires collected retrospective data on drug use and other HIV risk behaviors throughout migratory events. Logistic regression identified correlates of trying new drugs/combinations following their most recent deportations. Informed consent was obtained from all participants. RESULTS Nearly one in six men (n=52, 16%) tried new drugs following their most recent deportation, including heroin (n=31), methamphetamine (n=5), and heroin/methamphetamine combined (n=17). Trying new drugs following deportation was independently associated with U.S. incarceration (adjusted odds ratio [AOR]=3.96; 95% confidence interval [C.I.] 1.78, 8.84), increasing numbers of U.S. deportations (AOR=1.11 per deportation; C.I. 1.03, 1.20), feeling sad following deportation (AOR 2.69; C.I. 1.41, 5.14), and perceiving that one's current lifestyle increases HIV/AIDS risk (AOR 3.91; C.I. 2.05, 7.44). CONCLUSIONS Trying new drugs following U.S. deportation may be related to the unique contexts and stressors experienced by drug-abusing migrants as they attempt to reestablish their lives in Mexico. Findings imply an unmet need for health and social programs to alleviate pre- and post-deportation stressors faced by undocumented and return migrants in the U.S.-Mexico context.
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Affiliation(s)
- Angela M. Robertson
- San Diego State University/University of California, San Diego; Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093-0507
| | - M. Gudelia Rangel
- El Colegio de la Frontera Norte; Carretera Escénica Tijuana - Ensenada, Km. 18.5, San Antonio del Mar, Tijuana, Mexico; y Secretaría de Salud de México, Distrito Federal, México
| | - Remedios Lozada
- Patronato Pro-COMUSIDA; Ave. Baja California 7580, Zona Norte, Tijuana, Mexico
| | - Alicia Vera
- University of California, San Diego; Institute of the Americas, 10111 N. Torrey Pines Rd., Mail Code 0507, La Jolla, CA 92093-0507
| | - Victoria D. Ojeda
- University of California, San Diego; Institute of the Americas, 10111 N. Torrey Pines Rd., Mail Code 0507, La Jolla, CA 92093-0507
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Morris MD, Case P, Robertson AM, Lozada R, Vera A, Clapp JD, Medina-Mora ME, Strathdee SA. Prevalence and correlates of 'agua celeste' use among female sex workers who inject drugs in Ciudad Juarez, Mexico. Drug Alcohol Depend 2011; 117:219-25. [PMID: 21441001 PMCID: PMC3148352 DOI: 10.1016/j.drugalcdep.2011.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 02/05/2011] [Accepted: 02/08/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Agua celeste, or "heavenly water", is the street name for a sky-blue colored solvent reportedly inhaled or ingested to produce an intoxicating effect. Study aims were to (1) describe prevalence of agua celestse (AC) use, and (2) identify correlates of lifetime and recent use of AC use among female sex workers who also inject drugs (FSW-IDUs) in northern Mexico. METHODS Between 2008 and 2010, baseline data from FSW-IDUs≥18 years old living in Tijuana or Ciudad Juarez participating in a longitudinal behavioral intervention were analyzed using logistic regression. RESULTS Among 623 FSW-IDUs (307 from Tijuana and 316 from Ciudad Juarez (CJ)), 166 (26%) reported ever using AC, all of whom lived in CJ. Among the CJ sample, lifetime prevalence of AC use was 53%, median age of first use was 16 years (IQR: 14-23), and 10% reported it as their first abused substance. Ever using AC was independently associated with ever being physically abused and younger age, and was marginally associated with initiating injection drug use and regular sex work at age eighteen or younger. Among those ever using AC, 70/166 (42.2%) reported using it within the last 6 months, which was independently associated with using drugs with clients before or during sex, being on the street more than 8h per day, and younger age. DISCUSSION We observed considerable geographic variation in the use of AC in northern Mexico. Future studies exploring factors influencing use, its precise formulation(s), and its potential health effects are needed to guide prevention and treatment.
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Affiliation(s)
| | | | | | - Remedios Lozada
- Prevencasa, AC, Baja California, Mexico, ISESALUD, Baja California, Mexico
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