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Henson RM, Mullachery PH, Sánchez-Pájaro A, Cruz-Cruz C, Bilal U, Langellier B, Barrientos-Gutiérrez T. Spatial Heterogeneity in Fatal Overdose Rate Trends in Mexican Cities: 2005-2021. Am J Public Health 2024; 114:705-713. [PMID: 38723222 PMCID: PMC11153949 DOI: 10.2105/ajph.2024.307650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 05/18/2024]
Abstract
Objectives. To describe national and city-level fatal drug overdose trends between 2005 and 2021 in Mexico. Methods. We calculated fatal overdose rates at the city level in 3-year periods from 2005 to 2021 and annually at the national level for people aged 15 to 64 years in Mexico. We calculated rate differences and rate ratios for each city between periods. Results. The national fatal overdose rate was 0.53 overdose deaths per 100 000 population and was almost twice as high in urban than in nonurban areas. The national fatal overdose rate was stable over the period 2005 to 2014 and increased monotonically to a peak in 2021. Fatal overdose rates varied across cities. Cities with the 8 highest fatal overdose rates in the period were all in states along the US-Mexico border. Conclusions. Fatal overdoses have doubled over the past 15 years in Mexico. Overdose rates are particularly high and increasing in cities close to the US-Mexico border. Public Health Implications. There is a need for enhanced overdose surveillance data and coordinated harm reduction strategies, particularly in the northern border region of Mexico. (Am J Public Health. 2024;114(7):705-713. https://doi.org/10.2105/AJPH.2024.307650).
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Affiliation(s)
- Rosie Mae Henson
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Pricila H Mullachery
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Andrés Sánchez-Pájaro
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Copytzy Cruz-Cruz
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Usama Bilal
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Brent Langellier
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
| | - Tonatiuh Barrientos-Gutiérrez
- Rosie Mae Henson and Brent Langellier are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Pricila H. Mullachery is with the Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA. Andrés Sánchez-Pájaro and Tonatiuh Barrientos-Gutiérrez are with the Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Mexico City, Mexico. Copytzy Cruz-Cruz is with the Servicios de Atención Psiquiátrica, Secretaría de Salud, Mexico City, Mexico. Usama Bilal is with the Urban Health Collaborative, Dornsife School of Public Health
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Eger WH, Abramovitz D, Bazzi AR, Bórquez A, Vera CF, Harvey-Vera A, Friedman JR, Strathdee SA. Changes in injecting versus smoking heroin, fentanyl, and methamphetamine among people who inject drugs in San Diego, California, 2020-2023. Drug Alcohol Depend 2024; 259:111318. [PMID: 38692135 DOI: 10.1016/j.drugalcdep.2024.111318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Amidst an increasingly toxic drug supply in North America, people who inject drugs may be transitioning to smoking them. We aimed to assess changes in injecting and smoking opioids and methamphetamine among a cohort of people who inject drugs from San Diego, California. METHODS Over five six-month periods spanning October 2020-April 2023, we assessed prevalence of injecting and smoking opioids or methamphetamine and whether participants used these drugs more frequently by smoking than injecting. Multivariable Poisson regression via generalized estimating equations was used to examine time trends. RESULTS Of 362 participants, median age was 40 years; a minority were female (29%), Hispanic/Latinx/Mexican (45%), and housed (33%). Among this cohort, of whom 100% injected (and 84% injected and smoked) in period one (October 2020-April 2021), by period five (November 2022-April 2023), 34% only smoked, 59% injected and smoked, and 7% only injected. By period five, the adjusted relative risk (aRR) of injecting opioids was 0.41 (95% Confidence Interval [CI]: 0.33, 0.51) and the aRR for injecting methamphetamine was 0.50 (95% CI: 0.39, 0.63) compared to period one. Risks for smoking fentanyl rose significantly during period three (aRR=1.44, 95% CI: 1.06, 1.94), four (aRR=1.65, 95% CI: 1.24, 2.20) and five (aRR=1.90, 95% CI: 1.43, 2.53) compared to period one. Risks for smoking heroin and methamphetamine more frequently than injecting these drugs increased across all periods. CONCLUSIONS Opioid and methamphetamine injection declined precipitously, with notable increases in smoking these drugs. Research is needed to understand the health consequences of these trends.
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Affiliation(s)
- William H Eger
- School of Social Work, San Diego State University, San Diego, CA, USA; School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Daniela Abramovitz
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Annick Bórquez
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joseph R Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, Los Angeles, USA
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Rafful C, Orozco R, Peralta D, Jiménez-Rivagorza L, Medina-Mora ME, Gutiérrez N, Morales-Gutierrez M. Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men. Harm Reduct J 2024; 21:95. [PMID: 38755623 PMCID: PMC11097588 DOI: 10.1186/s12954-024-01020-y] [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: 04/01/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment. METHODS The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale ("not useful"-"very useful") for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention. RESULTS Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention. CONCLUSIONS This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.
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Affiliation(s)
- Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico.
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico.
| | - Ricardo Orozco
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Daniela Peralta
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Leonardo Jiménez-Rivagorza
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico
| | - María Elena Medina-Mora
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Nely Gutiérrez
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico
| | - Missael Morales-Gutierrez
- Faculty of Psychology, Universidad Nacional Autónoma de México, Circuito Ciudad Universitaria 04510, Coyoacan, Mexico City, Mexico
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Skaathun B, Strathdee SA, Shrader CH, Nacht CL, Borquez A, Artamonova I, Harvey-Vera A, Vera CF, Rangel G, Ignacio C, Woodworth B, Chaillon A, Vasylyeva TI. HIV-1 transmission dynamics among people who inject drugs on the US/Mexico border during the COVID-19 pandemic: a prosepective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100751. [PMID: 38711788 PMCID: PMC11070707 DOI: 10.1016/j.lana.2024.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/08/2024]
Abstract
Background We examined HIV prevalence and transmission dynamics among people who inject drugs in the U.S./Mexico border region during the COVID-19 pandemic. Methods People who inject drugs aged ≥18 years from 3 groups were recruited: people who inject drugs who live in San Diego (SD) and engaged in cross-border drug use in Tijuana, Mexico (SD CBDUs), and people who inject drugs in SD and Tijuana (TJ) who did not engage in cross-border drug use (NCBDUs). We computed HIV prevalence at baseline and bivariate incidence-density rates (IR) at 18-month follow-up. Bayesian phylogenetic analysis was used to identify local transmission clusters, estimate their age, and effective reproductive number (Re) over time within the clusters. Findings At baseline (n = 612), 26% of participants were female, 9% engaged in sex work, and HIV prevalence was 8% (4% SD CBDU, 4% SD NCBDU, 16% TJ NCBDU). Nine HIV seroconversions occurred over 18 months, IR: 1.357 per 100 person-years (95% CI: 0.470, 2.243); 7 in TJ NCBDU and 2 in SD CBDU. Out of 16 identified phylogenetic clusters, 9 (56%) had sequences from both the U.S. and Mexico (mixed-country). The age of three youngest mixed-country dyads (2018-2021) overlapped with the COVID-related US-Mexico border closure in 2020. One large mixed-country cluster (N = 15) continued to grow during the border closure (Re = 4.8, 95% Highest Posterior Density (HPD) 1.5-9.1) with 47% engaging in sex work. Interpretation Amidst the COVID-19 pandemic and the border closure, cross-border HIV clusters grew. Efforts to end the HIV epidemic in the U.S. should take into account cross-border HIV-1 transmission from Tijuana. Mobile harm reduction services and coordination with municipal HIV programs to initiate anti-retroviral therapy and pre-exposure prophylaxisis are needed to reduce transmission. Funding This research was supported by the James B. Pendleton Charitable Trust and the San Diego Center for AIDS Research.
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Affiliation(s)
- Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Cho-Hee Shrader
- Department of Epidemiology, Columbia University, 116th and Broadway, New York, NY 10027, United States
| | - Carrie L. Nacht
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Alicia Harvey-Vera
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
- U.S.-Mexico Border Health Commission, Paseo del Centenario 10851, Zona Urbana Rio Tijuana, Tijuana, BC 22320, Mexico
| | - Carlos F. Vera
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Gudelia Rangel
- U.S.-Mexico Border Health Commission, Paseo del Centenario 10851, Zona Urbana Rio Tijuana, Tijuana, BC 22320, Mexico
- El Colegio de la Frontera Norte, Carretera Escenica Tijuana-Ensenada Toll Boot Escenica Tijuana-Ensenada Sn San Antonio del Mar, Tijuana, BC 22560, Mexico
| | - Caroline Ignacio
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Brendon Woodworth
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Tetyana I. Vasylyeva
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, CA 92617, United States
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Eger WH, Bazzi AR, Valasek CJ, Vera CF, Harvey-Vera A, Artamonova I, Rangel MG, Strathdee SA, Pines HA. Long-acting Injectable PrEP Interest and General PrEP Awareness among People who Inject Drugs in the San Diego-Tijuana Border Metroplex. AIDS Behav 2024; 28:1650-1661. [PMID: 38319461 DOI: 10.1007/s10461-024-04285-3] [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] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) could help overcome multilevel challenges to HIV prevention for people who inject drugs (PWID), including those in the binational San Diego-Tijuana metroplex. Yet, general PrEP awareness and interest in LAI-PrEP remain underexplored among PWID. From 2020 to 2021, 562 HIV-negative PWID in San Diego and Tijuana completed surveys assessing general PrEP awareness and interest in oral and LAI-PrEP. Modified Poisson regression examined factors associated with general PrEP awareness. Multinomial logistic regression assessed factors associated with interest in both oral and LAI-PrEP, oral PrEP only, LAI-PrEP only, or neither. General PrEP awareness was low (18%) and associated with experiencing unsheltered homelessness (adjusted prevalence ratio [APR] = 1.50, 95% confidence interval [CI]: 0.96-2.33), past 6-month fentanyl injection (APR = 1.53, 95% CI: 1.04-2.25), and transactional sex (APR = 1.71, 95% CI: 1.06-2.76). Interest in oral PrEP only was most common (44%), followed by LAI-PrEP only (25%) and neither (16%). Compared to the odds of being interested in LAI-PrEP only, the odds of being interested in oral PrEP only were lower among those who were stopped by police (AOR = 0.38, 95% CI: 0.22-0.65), reported past 6-month fentanyl injection (AOR = 0.33, 95% CI: 0.20-0.56), polydrug use (AOR = 0.48, 95% CI: 0.27-0.86), injecting multiple times daily (AOR = 0.26, 95% CI: 0.14-0.46), receptive syringe use (AOR = 0.30, 95% CI: 0.19-0.49), and higher perceived HIV risk (AOR = 0.24, 95% CI: 0.15-0.39). Interest in LAI-PrEP was more common among PWID reporting social and structural factors that could interfere with oral PrEP adherence, suggesting LAI-PrEP implementation could increase PrEP coverage among those most vulnerable to HIV.
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Affiliation(s)
- William H Eger
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Chad J Valasek
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Irina Artamonova
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - M Gudelia Rangel
- Mexico Section of the US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | | | - Heather A Pines
- School of Medicine, University of California, San Diego, La Jolla, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
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Pitpitan EV, Horvath KJ, Aldous J, Stockman JK, Patterson TL, Liang M, Barrozo C, Moore V, Penninga K, Smith LR. Peers plus mobile app for treatment in HIV (PATH): protocol for a randomized controlled trial to test a community-based integrated peer support and mHealth intervention to improve viral suppression among Hispanic and Black people living with HIV. Trials 2024; 25:212. [PMID: 38520030 PMCID: PMC10958824 DOI: 10.1186/s13063-024-08042-8] [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: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Significant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes. METHODS We combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated "Peers plus mobile App for Treatment in HIV" (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables. DISCUSSION The efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics. TRIAL REGISTRATION The PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318 . Registered on 22 June 2022.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, San Diego, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA.
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Megan Liang
- San Diego State University Research Foundation, San Diego, USA
| | | | | | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
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Eger WH, Abramovitz D, Bazzi AR, Bórquez A, Vera CF, Harvey-Vera A, Friedman JR, Strathdee SA. Changes in injecting versus smoking heroin, fentanyl, and methamphetamine among people who inject drugs in San Diego, California, 2020 to 2023. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.23.24303293. [PMID: 38464097 PMCID: PMC10925373 DOI: 10.1101/2024.02.23.24303293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Amidst a rapidly evolving drug supply in North America, people who inject drugs may be transitioning to smoking them. We aimed to assess changes in injecting and smoking heroin, fentanyl and methamphetamine among a cohort of people who injected drugs at baseline from San Diego, California. Methods Over five six-month periods spanning October 2020-April 2023, we assessed prevalence of injecting and smoking opioids or methamphetamine and whether participants used these drugs more frequently by smoking than injecting. Multivariable Poisson regression via Generalized Estimating Equations was used to examine time trends. Results Of 362 participants, median age was 40 years; most were male (72%), non-Hispanic (55%), and unhoused (67%). Among this cohort, of whom 100% injected (or injected and smoked) at baseline, by period five (two years later), 34% reported only smoking, while 59% injected and smoked, and 7% only injected. By period five, the adjusted relative risk (aRR) of injecting opioids was 0.41 (95% Confidence Interval [CI]: 0.33, 0.51) compared to period one, and the aRR for injecting methamphetamine was 0.50 (95% CI: 0.39, 0.63). Compared to period one, risks for smoking fentanyl rose significantly during period three (aRR=1.44, 95% CI: 1.06, 1.94), four (aRR=1.65, 95% CI: 1.24, 2.20) and five (aRR=1.90, 95% CI: 1.43, 2.53). Risks for smoking heroin and methamphetamine more frequently than injecting these drugs increased across all periods. Conclusions Opioid and methamphetamine injection declined precipitously, with notable increases in smoking these drugs. Research is urgently needed to understand the health consequences of these trends.
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Affiliation(s)
- William H. Eger
- School of Social Work, San Diego State University, San Diego, California, USA
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniela Abramovitz
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Angela R. Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Annick Bórquez
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Carlos F. Vera
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Joseph R. Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, Los Angeles
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Lechuga J, Ramos R, Dickson-Gomez J, Beachy S, Perez G, Nevola O, Varela A, Ramos ME, Sauceda J, Ludwig-Barrron N, Salazar J. Institutional violence from police militarization and drug cartel wars as a 'Big Event' and its influence on drug use harms and HIV risk in people who inject drugs on the U.S.-Mexico border. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104125. [PMID: 37499305 DOI: 10.1016/j.drugpo.2023.104125] [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: 01/14/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Globally, the US-Mexico Border is one of the largest drug trafficking regions, with Ciudad Juarez (CJ) and El Paso (EP) making up the second-largest border crossing in the world. Border communities are places where the risk of drug use harm and infectious diseases such as HIV are augmented due to the confluence of factors operating across the physical, social, economic and policy environment. Although the two cities are economically, culturally, and socially intertwined, each has distinct criminal justice systems and policy practices aimed at curtailing substance use. Between 2008 and 2011, the CJ/EP region experienced an unprecedented level of violence that stemmed from the intersection of police militarization and drug cartel wars, which profoundly shaped every aspect of life. Little research has documented the impact of drug cartel wars on the drug use and health harms of people who inject drugs (PWID) living in CJ and EP. The purpose of the study is to understand the effect that the drug cartel war had on the drug use harms and HIV risk of PWID. METHODS We conducted 40 in-depth interviews with people who inject drugs who resided in CJ or EP and had used heroin or crack cocaine in the last 30 days, and asked how police militarization and drug cartel war affected their daily lives. The risk environment framework informed the analysis and interpretation of findings. RESULTS Findings indicated that the risk environment was profoundly altered as PWID residing in CJ experienced profound changes in their daily lives that promoted engagement in behaviors that increased drug use and health harms including HIV risk, exacerbated trauma, and prevented use of substance use treatment and harm reduction services. The risk environment was also altered in EP, where PWID experienced drug supply shortages, violent policing practices, and reduced availability of harm reduction services. Findings underscore the permeability of risk environments across geographical borders. CONCLUSION The intersection of law enforcement militarization and drug cartel wars can be conceptualized as a 'big event' because it disrupts the drug market economy, leads to drug shortages, promotes entrance into the drug market economy by people who use drugs, reshapes drug use sites, and constrains the provision of harm reduction services. The stability of the harm reduction system in CJ was negatively impacted and limited the ability of individuals to reduce harm. Our findings show that drug cartel wars render the CJ/EP region extremely susceptible to drug use and health harms, while also creating vulnerability by severely restricting its ability to respond. Traditional recommendations to intervene to limit the impact of risk environments on the drug use harms of PWID need to be reconsidered in the context of drug cartel wars.
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Affiliation(s)
- Julia Lechuga
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States.
| | - Rebeca Ramos
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | | | - Sara Beachy
- Lehigh University, Bethlehem PA, United States
| | - Gilberto Perez
- Texas State Health Department, Houston, TX, United States
| | | | - Alan Varela
- Department of Public Health Sciences, The University of Texas at El Paso, El Paso, TX, United States
| | | | - John Sauceda
- The University of California San Francisco, San Francisco, CA, United States
| | | | - Jorge Salazar
- The University of California San Francisco, San Francisco, CA, United States
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9
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Sauceda JA, Lechuga J, Ramos ME, Puentes J, Ludwig-Barron N, Salazar J, Christopoulos KA, Johnson MO, Gomez D, Covarrubias R, Hernandez J, Montelongo D, Ortiz A, Rojas J, Ramos L, Avila I, Gwadz MV, Neilands TB. A factorial experiment grounded in the multiphase optimization strategy to promote viral suppression among people who inject drugs on the Texas-Mexico border: a study protocol. BMC Public Health 2023; 23:307. [PMID: 36765309 PMCID: PMC9921633 DOI: 10.1186/s12889-023-15172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND People who inject drugs living with HIV (PWIDLH) suffer the lowest rates of HIV viral suppression due to episodic injection drug use and poor mental health coupled with poor retention in HIV care. Approximately 44% of PWIDLH along the US-Mexico border are retained in care and only 24% are virally suppressed. This underserved region faces a potential explosion of transmission of HIV due to highly prevalent injection drug use. This protocol describes an optimization trial to promote sustained viral suppression among Spanish-speaking Latinx PWIDLH. METHODS The multiphase optimization strategy (MOST) is an engineering-inspired framework for designing and building optimized interventions and guides this intervention. The primary aim is to conduct a 24 factorial experiment in which participants are randomized to one of 16 intervention conditions, with each condition comprising a different combination of four behavioral intervention components. The components are peer support for methadone uptake and persistence; behavioral activation therapy for depression; Life-Steps medication adherence counseling; and patient navigation for HIV care. Participants will complete a baseline survey, undergo intervention, and then return for 3-,6-,9-, and 12-month follow-up assessments. The primary outcome is sustained viral suppression, defined as viral loads of < 40 copies per mL at 6-,9-, and 12-month follow-up assessments. Results will yield effect sizes for each component and each additive and interactive combination of components. The research team and partners will make decisions about what constitutes the optimized multi-component intervention by judging the observed effect sizes, interactions, and statistical significance against real-world implementation constraints. The secondary aims are to test mediators and moderators of the component-to-outcome relationship at the 6-month follow-up assessment. DISCUSSION We are testing well-studied and available intervention components to support PWIDLH to reduce drug use and improve their mental health and engagement in HIV care. The intervention design will allow for a better understanding of how these components work in combination and can be optimized for the setting. TRIAL REGISTRATION This project was registered at clinicaltrials.gov (NCT05377463) on May 17th, 2022.
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Affiliation(s)
- John A Sauceda
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA.
| | - Julia Lechuga
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Maria Elena Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Jorge Puentes
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Natasha Ludwig-Barron
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - Jorge Salazar
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - David Gomez
- Centro de Integración Juvenil (CIJ), Cuidad Juárez, Blvd Ing Bernardo Norzagaray, 32130, Cazatecas, Chihuahua, México
| | - Rogelio Covarrubias
- Centro Ambulatorio para la prevención y Atención de SIDA y de las Enfermedades de Transmisión Sexual (CAPASITS), Cuidad Juárez, Avenue Paseo Triunfo de la Republica 3530, 32330, Partido Escobedo, Chihuahua, México
| | - Joselyn Hernandez
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - David Montelongo
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Alejandro Ortiz
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Julian Rojas
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Luisa Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Itzia Avila
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Marya V Gwadz
- Silver School of Social Work, New York University, 1 Washington Square N, 10003, New York, NY, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
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Shrader CH, Borquez A, Vasylyeva TI, Chaillon A, Artamanova I, Harvey-Vera A, Vera CF, Rangel G, Strathdee SA, Skaathun B. Network-level HIV risk norms are associated with individual-level HIV risk and harm reduction behaviors among people who inject drugs: a latent profile analysis. AIDS Behav 2023; 27:484-495. [PMID: 35939177 PMCID: PMC9358371 DOI: 10.1007/s10461-022-03783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
The COVID-19 related U.S.-Mexico border-crossing restrictions disrupted social networks and HIV harm reduction services among people who inject drugs (PWID) in San Diego and Tijuana. We assessed associations of descriptive network norms on PWID's HIV vulnerability during this period. Between 10/2020 and 10/2021, 399 PWID completed a behavioral and egocentric questionnaire. We used Latent Profile Analysis to categorize PWID into network norm risk profiles based on proportions of their network (n = 924 drug use alters) who injected drugs and engaged in cross-border drug use (CBDU), among other vulnerabilities. We used logistic and linear regressions to assess network profile associations with individual-level index of HIV vulnerability and harm reduction behaviors. Fit indices specified a 4-latent profile solution of descriptive network risk norms: lower (n = 178), moderate with (n = 34) and without (n = 94) CBDU and obtainment, and higher (n = 93). Participants in higher risk profiles reported more HIV vulnerability behaviors and fewer harm reduction behaviors. PWID's gradient of HIV risk was associated with network norms, warranting intervention on high-vulnerability networks when services are limited.
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Affiliation(s)
- Cho-Hee Shrader
- ICAP at Columbia University, New York, NY United States of America
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Tetyana I. Vasylyeva
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Irina Artamanova
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Alicia Harvey-Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
- Facultad de Medicina, Universidad Xochicalco Campus Tijuana, Tijuana, Baja California Mexico
- Mexican Section, United States-Mexico Border Health Commission, Tijuana, Baja California Mexico
| | - Carlos F. Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Gudelia Rangel
- Mexican Section, United States-Mexico Border Health Commission, Tijuana, Baja California Mexico
- Departmento de Estudios de Población, El Colegio de la Frontera Norte, 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 United States of America
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
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Gómez-Ruiz LM, Marchei E, Rotolo MC, Brunetti P, Mannocchi G, Acosta-López A, Ramos-Gutiérrez RY, Varela-Busaka MB, Pichini S, Garcia-Algar O. Prevalence of Licit and Illicit Drugs Use during Pregnancy in Mexican Women. Pharmaceuticals (Basel) 2022; 15:ph15030382. [PMID: 35337179 PMCID: PMC8953434 DOI: 10.3390/ph15030382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022] Open
Abstract
For the first time, the present study employed hair testing to investigate the prevalence of classical drugs of abuse and new psychoactive substances use during gestation in a cohort of 300 Mexican pregnant women. An interview was conducted to collect data on sociodemographic aspects of the patients, and a 9 cm-long hair strand was taken from the back of the head of each mother one month after delivery. A validated ultra-high-performance liquid chromatography−high-resolution mass spectrometry method was used for the screening of classic drugs, new psychoactive substances, and medications in maternal hair. Out of 300 examined hair samples from pregnant women, 127 (42.3%) resulted positive for psychoactive substances: 45 (35.4%) for cannabis only, 24 (18.9%) for methamphetamine only, 13 (10.2%) for cocaine only, 1 (0.3%) for heroin, 1 for N-N-dimethyltryptamine (0.3%), 1 for ketamine (0.8%), and 35 (16.3%) for more than one psychoactive substance. Furthermore, seven samples (2.3%) resulted positive for new psychoactive substances (NPS): two samples for synthetic cannabinoids, two for synthetic cathinones, and three for nor-fentanyl, and 3.3% of women hair resulted positive for anticonvulsant, antidepressant, and antipsychotic medications. Finally, 83 women hair samples (27.7%) tested positive for nicotine. Nonsteroidal anti-inflammatory drugs (NSAIDs) and other painkillers (60.0%), medications for the treatment of nausea and vomiting (12.3%), antihistamines (8.7%) and nasal/sinus decongestants (6.7%), cough suppressants (5.0%), and bronchodilator agents (5.0%) were also detected in pregnant women hair. The gestational use of psychoactive substances and exposure to tobacco smoke, assessed by hair testing, were associated with a significantly younger age and with a low education grade of the mothers (p < 0.005). This study provides a significant preliminary indication of the under-reported gestational consumption of licit and illicit psychoactive and pharmacologically active drugs in a Mexican environment, showing the value of toxicological and forensic analyses in the global effort to determine the health risks caused by classic drugs and new psychoactive substances during pregnancy.
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Affiliation(s)
- Larissa-María Gómez-Ruiz
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Barcelona, 08036 Barcelona, Spain;
| | - Emilia Marchei
- National Centre on Addiction and Doping, Italian National Institute of Health (ISS), V.Le Regina Elena 299, 00161 Rome, Italy; (E.M.); (M.C.R.)
| | - Maria Concetta Rotolo
- National Centre on Addiction and Doping, Italian National Institute of Health (ISS), V.Le Regina Elena 299, 00161 Rome, Italy; (E.M.); (M.C.R.)
| | - Pietro Brunetti
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Scienc-Es and Public Health, Marche Polytechnic University, 60126 Ancona, Italy;
| | | | - Aracely Acosta-López
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
| | - Ruth-Yesica Ramos-Gutiérrez
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
| | - Mary-Buhya Varela-Busaka
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
| | - Simona Pichini
- National Centre on Addiction and Doping, Italian National Institute of Health (ISS), V.Le Regina Elena 299, 00161 Rome, Italy; (E.M.); (M.C.R.)
- Correspondence: ; Tel.: +39-064990-6545
| | - Oscar Garcia-Algar
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Barcelona, 08036 Barcelona, Spain;
- Neonatology Unit, Hospital Clinic-Maternitat, ICGON, BCNatal, C/Sabino Arana 1, 08028 Barcelona, Spain
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12
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Meyers-Pantele SA, Jain S, Sun X, Marks C, DeBeck K, Hayashi K, Strathdee SA, Werb D. Gender and the first-time provision of injection initiation assistance among people who inject drugs across two distinct North American contexts: Tijuana, Mexico and Vancouver, Canada. Drug Alcohol Rev 2022; 41:686-696. [PMID: 34636100 PMCID: PMC8930605 DOI: 10.1111/dar.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Injection drug use initiation is commonly facilitated by other people who inject drugs (PWID). We investigated how the gender of PWID influences their risk of providing initiation assistance to others across two distinct geo-cultural settings. METHODS Data were drawn from two prospective cohorts in Tijuana, Mexico and Vancouver, Canada which conducted semi-annual interviews within the PReventing Injecting by Modifying Existing Responses (PRIMER) study. Participants consisted of PWID who had reported never providing injection initiation assistance at baseline. We then conducted site-specific discrete-time survival analyses assessing the relationship between gender and other relevant covariates (e.g. age and past 6-month sex work) on the risk of the first reported instance of providing initiation assistance. RESULTS Of 1988 PWID (Tijuana: n = 596; Vancouver: n = 1392), 256 (43%) and 511 (36.7%) participants were women, and 42 (1.7%) and 78 (1.6%) reported recent injection initiation assistance across a median of three and two follow-up visits, respectively. Women had a lower risk of providing injection initiation assistance for the first time in Tijuana (adjusted hazard ratio = 0.52, 95% confidence interval 0.27-0.99), but not in Vancouver. Gendered pathways, like sex work, were associated with providing initiation assistance for the first time in Vancouver (adjusted hazard ratio = 1.97, 95% confidence interval 1.08-3.61). DISCUSSION AND CONCLUSIONS Women in Tijuana, but not Vancouver, were less likely to provide first-time initiation assistance among PWID. These results can inform gender- and site-specific prevention efforts aimed at reducing transitions into drug injecting across geographic contexts.
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Affiliation(s)
- Stephanie A. Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, USA,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Charles Marks
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,School of Public Health, University of Nevada, Reno, USA
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, Canada
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Sa M, C R, Ml M, Lr S, J TM, S J, X S, Rs G, Sa S, K D, K H, R M, Mj M, M O, A G, D W, Ai S. Examining the gender composition of drug injecting initiation events: A mixed methods investigation of three North American contexts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103056. [PMID: 33310638 PMCID: PMC8046711 DOI: 10.1016/j.drugpo.2020.103056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gender influences the health and social risks faced by individuals initiating drug injecting. Using mixed methods across three settings in North America, we investigated the gender composition of injection initiation events and the gendered risk environments in which they occurred. METHODS The PReventing Injecting by Modifying Existing Responses (PRIMER) study pooled data from three prospective community-recruited cohorts of people who inject drugs (PWID) in San Diego, USA, Vancouver, Canada, and Tijuana, Mexico. A qualitative subsample provided narrative data on their experiences of, and the contexts for, injection initiation events. Guided by Rhodes' risk environment framework, we examined the gender composition of initiation events stratified by city, and analyzed qualitative data using abductive thematic analyses. RESULTS Among 2,622 PWID (Tijuana: n = 531; San Diego: n = 352; Vancouver: n = 1,739), 112 (4.3%) reported providing initiation assistance to injection-naïve individuals in the previous six months. The proportion of gender concordant (e.g., male-male) initiation pairs varied, (χ2 = 10.32, p <0.001) with greater than expected concordance among pairs in Tijuana compared with those in Vancouver or San Diego. Sixty-one interviews provided context for the discrepancy across sites by highlighting the gendered injection initiation risk environments of prison/jail detention in Tijuana, intimate partnerships in San Diego, and overdose risk in Vancouver. CONCLUSIONS These results highlight how gender influences injection initiation events within spatial, social, and economic risk environments, and how this influence varies across settings. These findings can inform interventions to reduce the risk of injection initiation and related harms.
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Affiliation(s)
- Meyers Sa
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Rafful C
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
| | - Mittal Ml
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, Mexico
| | - Smith Lr
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Tirado-Muñoz J
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jain S
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Sun X
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Garfein Rs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Strathdee Sa
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - DeBeck K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - Hayashi K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - McNeil R
- School of Medicine, Yale, 333 Cedar Street, New Haven, CT, 06510, United States
| | - Milloy Mj
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9 Canada
| | - Olding M
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada
| | - Guise A
- Addison House, Guy's Hospital, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Werb D
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - Scheim Ai
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
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McKetin R, Chrzanowska A, Man N, Peacock A, Sutherland R, Degenhardt L. Trends in treatment episodes for methamphetamine smoking and injecting in Australia, 2003–2019. Drug Alcohol Rev 2021; 40:1281-1286. [DOI: 10.1111/dar.13258] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research Centre UNSW Sydney Sydney Australia
| | - Agata Chrzanowska
- National Drug and Alcohol Research Centre UNSW Sydney Sydney Australia
| | - Nicola Man
- National Drug and Alcohol Research Centre UNSW Sydney Sydney Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre UNSW Sydney Sydney Australia
- School of Psychology University of Tasmania Hobart Australia
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre UNSW Sydney Sydney Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre UNSW Sydney Sydney Australia
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15
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Bonk R, Miller RJ, Lanter J, Niblo C, Kemp J, Shelton J. Accidental Overdose Deaths in Oklahoma, 2002-2017: Opioid and Methamphetamine Trends. J Anal Toxicol 2020; 44:672-678. [PMID: 32542332 DOI: 10.1093/jat/bkaa068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To evaluate trends related to accidental overdose deaths in Oklahoma, with a focus on opioids and methamphetamine. All accidental drug overdose deaths in the state of Oklahoma from 2002 to 2017 were reviewed. Opioids were grouped into the following categories: all opioids, prescription opioids, synthetic opioids and heroin. Age-adjusted death rates for methamphetamine and each opioid category were calculated and analyzed. Accidental overdoses accounted for 9,936 deaths during the study period. Of these, opioids were seen in 62.9%, with prescription opioids comprising 53.8%, synthetic opioids 10.3% and heroin 2.8%. Synthetic opioids, despite a recent upward nationwide trend, showed a slight overall decrease (-6.8%) from 2009 to 2017. In contrast, methamphetamine showed a 402.2% increase from 2009 to 2017 and an overall increase of 1,526.7%. Methamphetamine was involved in the most overdoses (1,963), followed by oxycodone (1,724). Opioid-related deaths were most common among white individuals (90.3%) and showed a slight male predilection (56.9%). With the intent of assessing the opioid epidemic as it relates to accidental overdoses in Oklahoma, this study suggests that opioid-related overdoses have slowed in recent years amidst a sharp increase in methamphetamine deaths.
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Affiliation(s)
- Rachel Bonk
- Oklahoma State University Center for Health Sciences 1111 W. 17th Street Tulsa, OK 74107
| | - Ross J Miller
- Office of the Chief Medical Examiner-Pathology Department 1115 W. 17th Street Tulsa, OK 74107
| | - Joshua Lanter
- Office of the Chief Medical Examiner-Pathology Department 1115 W. 17th Street Tulsa, OK 74107
| | - Cheryl Niblo
- Office of the Chief Medical Examiner-Pathology Department 1115 W. 17th Street Tulsa, OK 74107
| | - Jesse Kemp
- Office of the Chief Medical Examiner-Pathology Department 1115 W. 17th Street Tulsa, OK 74107
| | - Jeremy Shelton
- Office of the Chief Medical Examiner-Pathology Department 1115 W. 17th Street Tulsa, OK 74107
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Meyers SA, Rafful C, Jain S, Sun X, Skaathun B, Guise A, Gonzalez-Zuñiga P, Strathdee SA, Werb D, Mittal ML. The role of drug treatment and recovery services: an opportunity to address injection initiation assistance in Tijuana, Mexico. Subst Abuse Treat Prev Policy 2020; 15:78. [PMID: 33046125 PMCID: PMC7552370 DOI: 10.1186/s13011-020-00322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the U.S. and Canada, people who inject drugs' (PWID) enrollment in medication-assisted treatment (MAT) has been associated with a reduced likelihood that they will assist others in injection initiation events. We aimed to qualitatively explore PWID's experiences with MAT and other drug treatment and related recovery services in Tijuana Mexico, a resource-limited setting disproportionately impacted by injection drug use. METHODS PReventing Injecting by Modifying Existing Responses (PRIMER) seeks to assess socio-structural factors associated with PWID provision of injection initiation assistance. This analysis drew on qualitative data from Proyecto El Cuete (ECIV), a Tijuana-based PRIMER-linked cohort study. In-depth qualitative interviews were conducted with a subset of study participants to further explore experiences with MAT and other drug treatment services. Qualitative thematic analyses examined experiences with these services, including MAT enrollment, and related experiences with injection initiation assistance provision. RESULTS At PRIMER baseline, 607(81.1%) out of 748 participants reported recent daily IDU, 41(5.5%) reported recent injection initiation assistance, 92(12.3%) reported any recent drug treatment or recovery service access, and 21(2.8%) reported recent MAT enrollment (i.e., methadone). Qualitative analysis (n = 21; female = 8) revealed that, overall, abstinence-based recovery services did not meet participants' recovery goals, with substance use-related social connections in these contexts potentially shaping injection initiation assistance. Themes also highlighted individual-level (i.e., ambivalence and MAT-related stigma) and structural-level (i.e., cost and availability) barriers to MAT enrollment. CONCLUSION Tijuana's abstinence-based drug treatment and recovery services were viewed as unable to meet participants' recovery-related goals, which could be limiting the potential benefits of these services. Drug treatment and recovery services, including MAT, need to be modified to improve accessibility and benefits, like preventing transitions into drug injecting, for PWID.
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Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Claudia Rafful
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
- Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Andrew Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
- Addison House, Guy's Hospital, King's College London, Strand, London, WC2R 2LS, UK
| | - Patricia Gonzalez-Zuñiga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
- Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA.
- Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P, 22540, Tijuana, Baja California, Mexico.
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Onoka I, Banyika AT, Banerjee PN, Makangara JJ, Dujourdy L. A review of the newly identified impurity profiles in methamphetamine seizures. Forensic Sci Int Synerg 2020; 2:194-205. [PMID: 32637907 PMCID: PMC7327898 DOI: 10.1016/j.fsisyn.2020.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
Forensic intelligence of synthetic illicit drugs suffers a problem of continuous introduction of new synthetic methods, modification of the existing routes of manufacture, and adulterations practiced by criminal networks. Impurity profiling has been indispensable in methamphetamine intelligence based on precursors, synthetic routes, and chemical modifications during trafficking. Law enforcement authorities maintain the credibility and integrity of intelligence information through constant monitoring of the chemical signatures in the illicit drug market. Changes in the synthetic pattern result in new impurity profiles that are important in keeping valuable intelligence information on clandestine laboratories, new synthetic routes, trafficking patterns, and geographical sources of illicit Methamphetamine. This review presents a critical analysis of the methamphetamine impurity profiles and more specifically, profiling based on impurity profiles from Leuckart, Reductive amination, Moscow, Emde, Nagai, Birch, Moscow route; a recent nitrostyrene route and stable isotope signatures. It also highlights the discrimination of ephedrine from pseudoephedrine sources and the emerging methamphetamine profiling based on stable isotopes.
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Affiliation(s)
- Isaac Onoka
- Department of Chemistry, College of Natural and Mathematical Sciences, University of Dodoma, P.O Box 259, Dodoma, Tanzania
| | - Andrew Toyi Banyika
- Department of Chemistry, College of Natural and Mathematical Sciences, University of Dodoma, P.O Box 259, Dodoma, Tanzania
| | - Protibha Nath Banerjee
- Department of Chemistry, College of Natural and Mathematical Sciences, University of Dodoma, P.O Box 259, Dodoma, Tanzania
| | - John J Makangara
- Department of Chemistry, College of Natural and Mathematical Sciences, University of Dodoma, P.O Box 259, Dodoma, Tanzania
| | - Laurence Dujourdy
- Agrosup Dijon, Department of Engineering and Process Science, Research Support Service Agrosup Dijon - DSIP - Bât. Longelles 26 bd Dr Petitjean, BP 87999 21079, Dijon Cedex, France
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Ulibarri MD, Salazar M, Syvertsen JL, Bazzi AR, Rangel MG, Orozco HS, Strathdee SA. Intimate Partner Violence Among Female Sex Workers and Their Noncommercial Male Partners in Mexico: A Mixed-Methods Study. Violence Against Women 2019; 25:549-571. [PMID: 30156143 PMCID: PMC6391174 DOI: 10.1177/1077801218794302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Utilizing mixed methods, we examined intimate partner violence (IPV) behaviors among 428 female sex workers (FSWs) who use drugs and their noncommercial male partners in Tijuana and Ciudad Juarez, Mexico. Half of all participants reported perpetrating and experiencing at least one type of IPV behavior in the past year. In interviews, drug use emerged as an important theme associated with IPV behaviors, and we found men and women differed in their motivations for engaging in IPV behaviors. Findings highlight how gender and power are interlinked with and may exacerbate drug use and IPV behaviors among marginalized populations.
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García-Aurrecoechea VR, Gutiérrez-López AD, Rodríguez-Kuri SE, Velázquez-Altamirano M, Fernández-Cáceres C. Increasing methamphetamine use trends alert among patients in Mexico. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1430182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V. Raúl García-Aurrecoechea
- Researcher of Clinical and Epidemiological Research Department, Centros de Integración Juvenil, A.C., Mexico City, Mexico
| | - Alma D. Gutiérrez-López
- Researcher of Clinical and Epidemiological Research Department, Centros de Integración Juvenil, A.C., Mexico City, Mexico
| | - Solveig E. Rodríguez-Kuri
- Researcher of Clinical and Epidemiological Research Department, Centros de Integración Juvenil, A.C., Mexico City, Mexico
| | - Marina Velázquez-Altamirano
- Researcher of Clinical and Epidemiological Research Department, Centros de Integración Juvenil, A.C., Mexico City, Mexico
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Horyniak D, Pinedo M, Burgos JL, Ojeda VD. Relationships Between Integration and Drug Use Among Deported Migrants in Tijuana, Mexico. J Immigr Minor Health 2018; 19:1196-1206. [PMID: 27778138 DOI: 10.1007/s10903-016-0518-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Deported migrants face numerous challenges which may elevate their risk for drug use. We examined relationships between integration and drug use among deported migrants in Tijuana, Mexico. A cross-sectional survey conducted at a free health clinic included 255 deported Mexican-born migrants residing in Tijuana ≥6 months. Multivariable logistic regression examined associations between variables across four integration domains (public participation, social connections, macro-level facilitators and foundations) and recent (past 6-month) drug use. The prevalence of recent drug use was 46 %. Having sought work in Tijuana in the past 6 months, greater household affluence, lifetime history of incarceration in both US and Mexico, and lacking health insurance were independently associated with recent drug use. Policies that support access to employment, adequate housing and healthcare in Mexico, particularly for justice-involved deportees, may facilitate successful integration and reduce potential stressors that may contribute to drug use.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Centre for Population Health, Burnet Institute, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Miguel Pinedo
- Alcohol Research Group, University of California Berkeley, Emeryville, CA, 94608, USA
| | - Jose Luis Burgos
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Victoria D Ojeda
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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Conners EE, Gaines TL, Strathdee SA, Magis-Rodriguez C, Brouwer KC. Structural factors associated with methamphetamine smoking among female sex workers in Tijuana, Mexico. Drug Alcohol Rev 2018; 37 Suppl 1:S294-S302. [PMID: 29218799 PMCID: PMC5940512 DOI: 10.1111/dar.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Smoking methamphetamine is associated with increased risk of HIV among female sex workers (FSW). The structural context of substance use is an important shaper of individual behaviour; however, structural determinants of methamphetamine use among FSWs are largely unknown. We identified individual, structural and neighbourhood factors associated with smoking methamphetamine among FSWs in the border city of Tijuana, Baja California, Mexico. DESIGN AND METHODS A prospective cohort of 301 FSWs sampled from indoor and outdoor sex work venues throughout Tijuana participated in quantitative surveys on behaviours and mapping of home and work neighbourhoods across three visits. Multinomial logistic regression using generalised estimating equations identified individual, structural and neighbourhood variables associated with smoking methamphetamine. RESULTS Methamphetamine use, particularly smoking, was highly prevalent among FSWs. Over half (61%) of FSWs had ever used methamphetamine in their lifetime and at baseline, 38% currently smoked methamphetamine. Smoking methamphetamine daily was associated with living in the red light district [adjusted odds ratio (AOR) = 2.72, 95% confidence interval (CI) = 1.23-6.02] and with perceived homelessness, but only among women in a good financial situation (AOR = 4.08, 95% CI = 1.58-10.50). Smoking methamphetamine less than daily was associated with older age (AOR = 1.06, 95% CI = 1.02-1.10). DISCUSSION AND CONCLUSIONS Our findings point to the important dynamic between the residential environment and more severe methamphetamine use. FSWs may prioritise the purchase of methamphetamine over stable housing if they have the financial means. Given the high prevalence of smoking methamphetamine among FSWs in Tijuana, drug treatment options, especially for women living in the red light district, are needed.
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Affiliation(s)
- Erin E. Conners
- Department of Medicine, University of California, San Diego, USA
- San Diego State University, San Diego, USA
| | - Tommi L. Gaines
- Department of Medicine, University of California, San Diego, USA
| | | | - Carlos Magis-Rodriguez
- National Center for the Prevention and Control of HIV and AIDS, Col Anzures, Distrito Federal, Mexico
| | - Kimberly C. Brouwer
- Department of Family Medicine & Public Health, University of California, San Diego, USA
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Horyniak D, Strathdee SA, West BS, Meacham M, Rangel G, Gaines TL. Predictors of injecting cessation among a cohort of people who inject drugs in Tijuana, Mexico. Drug Alcohol Depend 2018; 185:298-304. [PMID: 29482055 PMCID: PMC5889739 DOI: 10.1016/j.drugalcdep.2017.12.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Little is known about the cessation of injecting drug use (IDU) among people who inject drugs (PWID) in low and middle-income settings, where access to effective interventions for reducing drug use (e.g., opioid substitution treatment; OST), may be limited. We measured the incidence and identified predictors of IDU cessation among a cohort of PWID in Tijuana, Mexico. METHODS Data were drawn from 621 participants in Proyecto El Cuete IV, a prospective cohort of PWID recruited in 2011 and interviewed biannually to 2016. A multivariable Extended Cox model was constructed to identify socio-demographic, drug use, risk environment and health-related predictors of IDU cessation (no IDU for ≥six months). RESULTS 141 participants (23%) reported at least one IDU cessation event during follow-up. The crude IDU cessation rate was 7.3 per 100 person-years (95% Confidence Interval [CI]: 6.2-8.7). IDU cessation was negatively associated with injecting at least daily on average and heroin/methamphetamine co-injection in the past six months, and positively associated with testing HIV positive at baseline, being on methadone maintenance therapy in the past six months, and recent arrest. Concern for personal safety was also independently associated with IDU cessation. CONCLUSIONS The rate of IDU cessation among PWID in Tijuana was low. These findings underscore the importance of expansion of services including OST to help reduce drug use and facilitate IDU cessation for those who wish to do so. In this setting, interventions addressing individual-level economic barriers as well as broader social and structural barriers to harm reduction services are integral.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States,Behaviours and Health Risks Program, Burnet Institute, Melbourne, VIC, 3004, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Steffanie A. Strathdee
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States
| | - Brooke S. West
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States
| | - Meredith Meacham
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, United States
| | - Gudelia Rangel
- United States-Mexico Border Health Commission, Tijuana, BC, 22320, Mexico
| | - Tommi L. Gaines
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States,Correspondence: Tommi L. Gaines, Division of Global Public Health, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, Phone: 858-246-0600,
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Abstract
Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.
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Arredondo J, Gaines T, Manian S, Vilalta C, Bañuelos A, Strathdee SA, Beletsky L. The law on the streets: Evaluating the impact of Mexico's drug decriminalization reform on drug possession arrests in Tijuana, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:1-8. [PMID: 29306177 DOI: 10.1016/j.drugpo.2017.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 2009, Mexican Federal Government enacted "narcomenudeo" reforms decriminalizing possession of small amounts of drugs, delegating prosecution of retail drug sales to the state courts, and mandating treatment diversion for habitual drug users. There has been insufficient effort to formally assess the decriminalization policy's population-level impact, despite mounting interest in analagous reforms across the globe. METHODS Using a dataset of municipal police incident reports, we examined patterns of drug possession, and violent and non-violent crime arrests between January 2009 and December 2014. A hierarchical panel data analysis with random effects was conducted to assess the impact of narcomenudeo's drug decriminalization provision. RESULTS The reforms had no significant impact on the number of drug possession or violent crime arrests, after controlling for other variables (e.g. time trends, electoral cycles, and precinct-level socioeconomic factors). Time periods directly preceding local elections were observed to be statistically associated with elevated arrest volume. CONCLUSIONS Analysis of police statistics parallel prior findings that Mexico's reform decriminalizing small amounts of drugs does not appear to have significantly shifted drug law enforcement in Tijuana. More research is required to fully understand the policy transformation process for drug decriminalization and other structural interventions in Mexico and similar regional and international efforts. Observed relationship between policing and political cycles echo associations in other settings whereby law-and-order activities increase during mayoral electoral campaigns.
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Affiliation(s)
- J Arredondo
- University of California, San Diego. 9500 Gilman Dr, La Jolla, CA 92093, USA; San Diego State University, San Diego. 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - T Gaines
- University of California, San Diego. 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - S Manian
- University of California, San Diego. 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - C Vilalta
- Center for Research in Geography and Geomatics (CentroGeo), Lomas de Padierna, CP 14240, CDMX, Mexico.
| | - A Bañuelos
- Secretaría de Seguridad Pública Municipal, Dirección de Planeación y Proyectos Estratégicos. Blvd Cuauhtémoc Sur y Rio Suchiate #2141, Colonia Marrón, CP 22015, Tijuana, Mexico.
| | - S A Strathdee
- University of California, San Diego. 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - L Beletsky
- University of California, San Diego. 9500 Gilman Dr, La Jolla, CA 92093, USA; Northeastern University, School of Law & Bouvé College of Health Sciences. 360 Huntington Ave., Boston, MA 02115, USA.
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Copes H, Tchoula W, Kim J, Ragland J. Symbolic perceptions of methamphetamine: Differentiating between ice and shake. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 51:87-94. [DOI: 10.1016/j.drugpo.2017.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
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Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington. Drug Alcohol Depend 2018; 182:86-92. [PMID: 29175463 PMCID: PMC6457905 DOI: 10.1016/j.drugalcdep.2017.10.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND In King County, Washington, the HIV prevalence among men who have sex with men (MSM) who inject methamphetamine is high, while it is low among other people who inject drugs (PWID). Local drug problem indicators suggest that methamphetamine use is increasing. The extent to which this increase affects MSM and non-MSM, and whether MSM and non-MSM networks are connected through injection equipment sharing, is unknown. METHODS We used data from two serial cross-sectional surveys of PWID including five biannual surveys of Public Health-Seattle and King County Needle and Syringe Exchange Program clients (NSEP, N=2135, 2009-2017) and three National HIV Behavioral Surveillance IDU surveys (NHBS, N=1709, 2009-2015). RESULTS The proportion of non-MSM PWID reporting any recent methamphetamine injection increased significantly from approximately 20% in 2009 to 65% in 2017. Most of this increase was attributable to injecting methamphetamine in combination with heroin (goofballs). PWID who injected goofballs were more likely to be younger, homeless or unstably housed, report daily injection, and self-report an opioid overdose in the past year than other PWID. The majority of PWID who injected methamphetamine reported sharing any injection equipment. Among these PWID, 43% of MSM had last shared injection equipment with a non-MSM. Eight percent of non-MSM men and 15% of women had last shared equipment with an MSM. CONCLUSIONS Given non-trivial rates of sharing injection equipment with methamphetamine-using MSM, a population with an HIV prevalence of 40%, non-MSM who inject methamphetamine could be an emerging population at risk for acquiring HIV.
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Meacham MC, Roesch SC, Strathdee SA, Gaines TL. Perceived Treatment Need and Latent Transitions in Heroin and Methamphetamine Polydrug Use among People who Inject Drugs in Tijuana, Mexico. J Psychoactive Drugs 2017; 50:62-71. [PMID: 28960166 DOI: 10.1080/02791072.2017.1370747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
People who inject drugs (PWID) in Tijuana, Mexico, use heroin and/or methamphetamine. While polydrug use is associated with HIV risk behavior, less is known about the stability of polydrug use patterns over time and how polydrug use is related to perceived treatment need. Within a cohort of PWID in Tijuana (N = 735) we sought to (1) characterize subgroups of polydrug and polyroute use from baseline to six months; (2) determine the probabilities of transitioning between subgroups; and (3) examine whether self-reported need for help for drug use modified these transition probabilities. Latent transition analysis (LTA) identified four latent statuses: heroin-only injection (38% at both baseline and follow-up); co-injection of heroin with methamphetamine (3% baseline, 15% follow-up); injection of heroin and methamphetamine (37% baseline, 32% follow-up); and polydrug and polyroute users who injected heroin and both smoked and injected methamphetamine (22% baseline, 14% follow-up). Heroin-only injectors had the highest probability of remaining in the same latent status at follow-up. The majority reported great or urgent need for treatment (51%) and these PWID had greater odds of transitioning to a higher-risk status at follow-up, emphasizing the need for evidence-based drug treatment options for PWID.
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Affiliation(s)
- Meredith C Meacham
- a Postdoctoral Fellow, Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,b Doctoral Student, School of Public Health , San Diego State University , San Diego , CA , USA.,c Doctoral Student, Division of Global Public Health , Department of Medicine, University of California , San Diego, La Jolla , CA , USA
| | - Scott C Roesch
- d Professor, Department of Psychology , San Diego State University , San Diego , CA , USA
| | - Steffanie A Strathdee
- e Professor, Division of Global Public Health, Department of Medicine , University of California , San Diego, La Jolla , CA , USA
| | - Tommi L Gaines
- f Assistant Professor, Division of Global Public Health, Department of Medicine , University of California , San Diego, La Jolla , CA , USA
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Meacham MC, Strathdee SA, Rangel G, Armenta RF, Gaines TL, Garfein RS. Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico. J Stud Alcohol Drugs 2017; 77:774-81. [PMID: 27588536 DOI: 10.15288/jsad.2016.77.774] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although persons who inject drugs (PWID) in the western United States-Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant-stimulant combination (also known as "goofball" and "Mexican speedball"). METHOD Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin-methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin-meth-amphetamine co-injection. RESULTS The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. CONCLUSIONS These findings indicate that heroin-methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin-methamphetamine coinjection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants.
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Affiliation(s)
- Meredith C Meacham
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.,Graduate School of Public Health, San Diego State University, San Diego, California.,Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Gudelia Rangel
- U.S.-Mexico Border Health Commission, Mexico Section, Tijuana, Baja California, Mexico
| | - Richard F Armenta
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.,Graduate School of Public Health, San Diego State University, San Diego, California.,Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Tommi L Gaines
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Richard S Garfein
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California
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Roth AM, Armenta RF, Wagner KD, Strathdee SA, Goldshear JL, Cuevas-Mota J, Garfein RS. Cold Preparation of Heroin in a Black Tar Market. Subst Use Misuse 2017; 52:1202-1206. [PMID: 28605301 PMCID: PMC6125133 DOI: 10.1080/10826084.2017.1302956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Black tar heroin is typically prepared for injection with heat which decreases the risk of HIV transmission by inactivating the virus. We received reports that persons who inject drugs (PWID) in Tijuana, Baja California, Mexico, a black tar heroin market, were using only water to dissolve heroin. OBJECTIVES Because Tijuana abuts San Diego County, CA, United States, we undertook the present analyses to determine the prevalence of this practice among PWID in San Diego, California. METHODS PWID completed quarterly behavioral assessments and serological testing for blood-borne viruses. Bivariate and multivariable logistic regression models were constructed to assess for individual, social, and structural correlates of preparing heroin without heat within the preceding 6 months. RESULTS Nearly half of black tar heroin users (149/305) reported they had prepared heroin without heat within 6 months. In multivariable analysis, cold preparation was independently associated with younger age (10 year decrease; AOR = 1.25; 95% CI 1.03, 1.53), more drug injecting acquaintances (per 5 acquaintance increase; AOR = 1.05; 95% CI 1.01, 1.09) and prefilled syringe use (injecting drugs from syringes that are already filled with drugs before purchase; AOR = 1.86; 95% CI 1.14, 3.02). Conclusions/Importance: To our knowledge, this is the first paper to report that PWID living in a black tar heroin market are preparing heroin without heat. Additional research is needed to determine whether this is an endemic practice or PWID are engaging in new forms of drug preparation in response to changes in the environment.
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Affiliation(s)
- Alexis M Roth
- a Department of Community Health & Prevention , Drexel University , Philadelphia , Pennsylvania , USA
| | - Richard F Armenta
- b Family Medicine and Public Health , University of California San Diego , San Diego , California , USA
| | - Karla D Wagner
- c School of Community Health Sciences , University of Nevada, Reno, Reno , Nevada , USA
| | - Steffanie A Strathdee
- d Division of Global Public Health , University of California San Diego , San Diego , California , USA
| | - Jesse L Goldshear
- a Department of Community Health & Prevention , Drexel University , Philadelphia , Pennsylvania , USA
| | - Jazmine Cuevas-Mota
- d Division of Global Public Health , University of California San Diego , San Diego , California , USA
| | - Richard S Garfein
- d Division of Global Public Health , University of California San Diego , San Diego , California , USA
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30
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Horyniak D, Wagner KD, Armenta RF, Cuevas-Mota J, Hendrickson E, Garfein RS. Cross-border injection drug use and HIV and hepatitis C virus seropositivity among people who inject drugs in San Diego, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:9-17. [PMID: 28683432 DOI: 10.1016/j.drugpo.2017.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The prevalence of HIV and Hepatitis C Virus (HCV) are significantly lower among people who inject drugs (PWID) in San Diego, CA, USA compared with PWID in Tijuana, Mexico, located directly across the border. We investigated associations between cross-border injection drug use (IDU), HIV and HCV seroprevalence and engagement in injecting risk behaviours while on each side of the border. METHODS Using baseline interviews and serologic testing data from STAHR II, a longitudinal cohort study of PWID in San Diego, bivariate and multivariable logistic regression analyses examined associations between recent (past six months) cross-border IDU and HIV and HCV antibody seropositivity, socio-demographics, drug use characteristics, and participants' connections to, and perceptions about Mexico. Chi-squared tests and McNemar tests examined associations between cross-border IDU and injecting risk behaviours. RESULTS Of the 567 participants (93% U.S.-born, 73% male, median age 45 years), 86 (15%) reported recent cross-border IDU. Cross-border IDU was not associated with HIV (OR: 0.85, 95% CI: 0.37-1.95) or HCV seropositivity (OR: 1.01, 95% CI: 0.62-1.65). Age, identifying as Hispanic or Latino/a, and being concerned about risk of violence when travelling to Mexico were independently associated with decreased odds of recent cross-border IDU. Injecting cocaine at least weekly, having ever lived in Mexico and knowing PWID who reside in Mexico were associated with increased odds of recent cross-border IDU. PWID who reported cross-border IDU were significantly less likely to engage in receptive needle sharing, equipment sharing, and public injection while in Mexico compared with in San Diego (all p<0.001). CONCLUSION Prevalence of HIV and HCV infection was similar among PWID who had and had not injected in Mexico, possibly due to practising safer injecting while in Mexico. Research is needed to elucidate contextual factors enabling U.S. PWID to inject safely while in Mexico.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA; Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd., Melbourne, VIC 3004, Australia; School of Public Health and Preventive Medicine, 99 Commercial Rd., Melbourne, VIC 3004, Australia.
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada Reno, 1664 N. Virginia St., Reno, NV 89557, USA.
| | - Richard F Armenta
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Jazmine Cuevas-Mota
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Erik Hendrickson
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Richard S Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
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31
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Garza-Villarreal EA, Chakravarty MM, Hansen B, Eskildsen SF, Devenyi GA, Castillo-Padilla D, Balducci T, Reyes-Zamorano E, Jespersen SN, Perez-Palacios P, Patel R, Gonzalez-Olvera JJ. The effect of crack cocaine addiction and age on the microstructure and morphology of the human striatum and thalamus using shape analysis and fast diffusion kurtosis imaging. Transl Psychiatry 2017; 7:e1122. [PMID: 28485734 PMCID: PMC5534960 DOI: 10.1038/tp.2017.92] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 01/18/2023] Open
Abstract
The striatum and thalamus are subcortical structures intimately involved in addiction. The morphology and microstructure of these have been studied in murine models of cocaine addiction (CA), showing an effect of drug use, but also chronological age in morphology. Human studies using non-invasive magnetic resonance imaging (MRI) have shown inconsistencies in volume changes, and have also shown an age effect. In this exploratory study, we used MRI-based volumetric and novel shape analysis, as well as a novel fast diffusion kurtosis imaging sequence to study the morphology and microstructure of striatum and thalamus in crack CA compared to matched healthy controls (HCs), while investigating the effect of age and years of cocaine consumption. We did not find significant differences in volume and mean kurtosis (MKT) between groups. However, we found significant contraction of nucleus accumbens in CA compared to HCs. We also found significant age-related changes in volume and MKT of CA in striatum and thalamus that are different to those seen in normal aging. Interestingly, we found different effects and contributions of age and years of consumption in volume, displacement and MKT changes, suggesting that each measure provides different but complementing information about morphological brain changes, and that not all changes are related to the toxicity or the addiction to the drug. Our findings suggest that the use of finer methods and sequences provides complementing information about morphological and microstructural changes in CA, and that brain alterations in CA are related cocaine use and age differently.
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Affiliation(s)
- E A Garza-Villarreal
- CONACYT, Instituto Nacional de Psiquiatría ‘Ramon de la Fuente Muñiz’, Mexico City, Mexico,Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría ‘Ramón de la Fuente Muñiz’, Mexico City, Mexico,Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría ‘Ramón de la Fuente Muñiz’, Calzada Mexico-Xochimilco 101, Col. San Lorenzo Huipulco, Delegación Tlalpan, Mexico City C.P. 14370, Mexico. E-mail:
| | - MM Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada,Department of Psychiatry, McGill University, Montreal, QC, Canada,Department of Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - B Hansen
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S F Eskildsen
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - G A Devenyi
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - D Castillo-Padilla
- CONACYT, Instituto Nacional de Psiquiatría ‘Ramon de la Fuente Muñiz’, Mexico City, Mexico,Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría ‘Ramón de la Fuente Muñiz’, Mexico City, Mexico
| | - T Balducci
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría ‘Ramón de la Fuente Muñiz’, Mexico City, Mexico
| | - E Reyes-Zamorano
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría ‘Ramón de la Fuente Muñiz’, Mexico City, Mexico,School of Psychology, Universidad Anáhuac México Sur, Mexico City, Mexico
| | - S N Jespersen
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - P Perez-Palacios
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría ‘Ramón de la Fuente Muñiz’, Mexico City, Mexico
| | - R Patel
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada,Department of Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - J J Gonzalez-Olvera
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría ‘Ramón de la Fuente Muñiz’, Mexico City, Mexico
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32
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Syvertsen JL, Bazzi AR, Mittal ML. Hope Amidst Horror: Documenting the Effects of the "War On Drugs" Among Female Sex Workers and Their Intimate Partners in Tijuana, Mexico. Med Anthropol 2017; 36:566-583. [PMID: 28414530 DOI: 10.1080/01459740.2017.1317770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sensationalistic media coverage has fueled stereotypes of the Mexican border city of Tijuana as a violent battleground of the global drug war. While the drug war shapes health and social harms in profoundly public ways, less visible are the experiences and practices of hope that forge communities of care and represent more private responses to this crisis. In this article, we draw on ethnographic fieldwork and photo elicitation with female sex workers who inject drugs and their intimate, non-commercial partners in Tijuana to examine the personal effects of the drug war. Drawing on a critical phenomenology framework, which links political economy with phenomenological concern for subjective experience, we explore the ways in which couples try to find hope amidst the horrors of the drug war. Critical visual scholarship may provide a powerful alternative to dominant media depictions of violence, and ultimately clarify why this drug war must end.
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Affiliation(s)
- Jennifer L Syvertsen
- a Department of Anthropology , The Ohio State University , Columbus , Ohio , USA
| | - Angela Robertson Bazzi
- b Department of Community Health Sciences , Boston University School of Public Health , Boston , Massachusetts , USA
| | - María Luisa Mittal
- c Division of Global Public Health, Department of Medicine , University of California, San Diego , San Diego , California , USA.,d Facultad de Medicina , Universidad Xochicalco , Tijuana , Mexico
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33
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Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez-Zuniga P, Gaines TL. Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico. Drug Alcohol Rev 2017; 37:128-136. [PMID: 28337798 DOI: 10.1111/dar.12524] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/17/2016] [Accepted: 11/27/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND AIMS Patterns of polydrug use among people who inject drugs (PWID) may be differentially associated with overdose and unique human immunodeficiency virus (HIV) risk factors. Subgroups of PWID in Tijuana, Mexico, were identified based on substances used, route of administration, frequency of use and co-injection indicators. DESIGN AND METHODS Participants were PWID residing in Tijuana age ≥18 years sampled from 2011 to 2012 who reported injecting an illicit substance in the past month (n = 735). Latent class analysis identified discrete classes of polydrug use characterised by 11 indicators of past 6 months substance use. Multinomial logistic regression examined class membership association with HIV risk behaviours, overdose and other covariates using an automated three-step procedure in mplus to account for classification error. RESULTS Participants were classified into five subgroups. Two polydrug and polyroute classes were defined by use of multiple substances through several routes of administration and were primarily distinguished from each other by cocaine use (class 1: 5%) or no cocaine use (class 2: 29%). The other classes consisted primarily of injectors: cocaine, methamphetamine and heroin injection (class 3: 4%); methamphetamine and heroin injection (class 4: 10%); and heroin injection (class 5: 52%). Compared with the heroin-only injection class, memberships in the two polydrug and polyroute use classes were independently associated with both HIV injection and sexual risk behaviours. DISCUSSION AND CONCLUSIONS Substance use patterns among PWID in Tijuana are highly heterogeneous, and polydrug and polyroute users are a high-risk subgroup who may require more tailored prevention and treatment interventions. [Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez-Zuniga P, Gaines TL. Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico. Drug Alcohol Rev 2018;37:128-136].
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Affiliation(s)
- Meredith C Meacham
- Department of Psychiatry, University of California San Francisco, San Francisco, USA.,Division of Global Public Health, University of California San Diego, San Diego, USA.,Graduate School of Public Health, San Diego State University, San Diego, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, University of California San Diego, San Diego, USA
| | - Suzanne Lindsay
- Graduate School of Public Health, San Diego State University, San Diego, USA
| | | | - Tommi L Gaines
- Division of Global Public Health, University of California San Diego, San Diego, USA
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34
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Zhang X, Rhoads N, Rangel MG, Hovell MF, Magis-Rodriguez C, Sipan CL, Gonzalez-Fagoaga JE, Martínez-Donate AP. Understanding the Impact of Migration on HIV Risk: An Analysis of Mexican Migrants' Sexual Practices, Partners, and Contexts by Migration Phase. AIDS Behav 2017; 21:935-948. [PMID: 27888370 PMCID: PMC5837820 DOI: 10.1007/s10461-016-1622-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HIV risk among Mexican migrants varies across migration phases (pre-departure, transit, destination, interception, and return), but there is limited knowledge about specific sexual behaviors, characteristics of sexual partners, and sexual contexts at different migration stages. To fill the gap, we used data from a cross-sectional population-based survey conducted in Tijuana, Mexico. Information on migration phase and last sexual encounter was collected from 1219 male migrants. Our findings suggest that compared to pre-departure migrants, repeat migrants returning from communities of origin were more likely to have sex with male partners, use substances before sex, and not use condoms; migrants in the transit phase in the Mexican border were more likely to have sex with casual partners and sex workers; and migrants in the interception phase were more likely to engage in anal sex and use substances before sex. Sexual behaviors, partners, and contexts vary significantly among migrants at different migration phases. Tailored HIV prevention programs targeting Mexican migrants need to be developed and implemented at all migration phases.
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Affiliation(s)
- Xiao Zhang
- UW Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Natalie Rhoads
- Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, CA, USA
| | - Maria Gudelia Rangel
- Mexico Section of the U.S.-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | - Melbourne F Hovell
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Carol L Sipan
- Department of Health Sciences, University of California-Merced, Merced, CA, USA
| | | | - Ana P Martínez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Hesbitt Hall 458, Philadelphia, PA, 19104, USA.
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35
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Martin NK, Vickerman P, Hickman M, Patterson TL, Rand E, Abramovitz D, Strathdee SA. Overlapping substance using high-risk groups and infectious diseases: how dynamic modelling can evaluate risk and target HIV prevention. Addiction 2016; 111:1512-5. [PMID: 27075692 PMCID: PMC4983200 DOI: 10.1111/add.13338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/14/2016] [Accepted: 01/29/2016] [Indexed: 11/26/2022]
Abstract
It’s difficult to develop infectious disease interventions (such as for HIV) for overlapping high-risk populations such as people who inject drugs, men who have sex with men, and female sex workers, where there are multiple transmission routes. Recent advances in dynamic modelling of coinfection epidemics could disentangle the contributions of different risk groups and behaviours to help develop more efficient and effective prevention interventions.
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Affiliation(s)
- Natasha K Martin
- Division of Global Public Health, University of California San Diego,School of Social and Community Medicine, University of Bristol
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol
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36
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37
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Ferraiolo N, Pinedo M, McCurley J, Burgos JL, Vargas-Ojeda AC, Rodriguez MA, Ojeda VD. Depressive symptoms among patients at a clinic in the Red Light District of Tijuana, Mexico. ACTA ACUST UNITED AC 2016; 9:151-163. [PMID: 28042307 DOI: 10.1080/17542863.2016.1144776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Little is known about depression among structurally vulnerable groups living in Tijuana (e.g., migrants, deportees, substance users, sex workers, homeless) who may be at high risk for poor mental health. This study investigates the prevalence and correlates of depressive symptoms among vulnerable patients receiving services at a free clinic in Tijuana, Mexico. A convenience sample of 584 adult Mexican patients completed an interviewer-administered questionnaire in English or Spanish that included the 8-item NIH PROMIS depression short form and measures of individual, social, and structural factors affecting health. The prevalence of clinically significant depressive symptoms in our sample was 55%. In the multivariate analysis, female gender, poor/fair self-rated health, recent illicit drug use (past six months), feeling rejected (past six months), history of forced sex, and history of violence were independently associated with increased odds of experiencing depressive symptoms. When stratified by gender, we found important differences in significant factors, including recent illicit drug use in men and deportation in women. Among study participants, prevalence of depressive symptoms exceeds prevalence rates reported elsewhere in the U.S.-Mexico border region. These findings suggest that public health efforts to support mental health services in the border region are needed.
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Affiliation(s)
- Natalie Ferraiolo
- University of California, San Diego School of Medicine, La Jolla CA, USA
| | - Miguel Pinedo
- Alcohol Research Group, University of California, Berkeley, Emeryville CA, USA
| | - Jessica McCurley
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jose Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla CA, USA
| | - Adriana Carolina Vargas-Ojeda
- Postgraduate Studies and Research Department, School of Medicine and Psychology, Autonomous University of Baja California, Tijuana, Baja California, México
| | - Michael A Rodriguez
- Department of Family Medicine/UCLA Blum Center on Poverty and Health in Latin America, University of California, Los Angeles, Los Angeles CA, USA
| | - Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla CA, USA
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38
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Zhang X, Martinez-Donate AP, Simon NJE, Hovell MF, Rangel MG, Magis-Rodriguez C, Sipan CL. Risk behaviours for HIV infection among travelling Mexican migrants: The Mexico-US border as a contextual risk factor. Glob Public Health 2016; 12:65-83. [PMID: 26878494 DOI: 10.1080/17441692.2016.1142591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Mexico-US border region is a transit point in the trajectory of Mexican migrants travelling to and from the USA and a final destination for domestic migrants from other regions in Mexico. This region also represents a high-risk environment that may increase risk for HIV among migrants and the communities they connect. We conducted a cross-sectional, population-based survey, in Tijuana, Mexico, and compared Mexican migrants with a recent stay on the Mexico-US border region (Border, n = 553) with migrants arriving at the border from Mexican sending communities (Northbound, n = 1077). After controlling for demographics and migration history, border migrants were more likely to perceive their risk for HIV infection as high in this region and regard this area as a liberal place for sexual behaviours compared to Northbound migrants reporting on their perceptions of the sending communities (p < .05). Male border migrants were more likely to engage in sex, and have unprotected sex, with female sex workers during their recent stay on the border compared to other contexts (rate ratio = 3.0 and 6.6, respectively, p < .05). Binational and intensified interventions targeting Mexican migrants should be deployed in the Mexican border region to address migration related HIV transmission in Mexico and the USA.
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Affiliation(s)
- Xiao Zhang
- a Department of Population Health Sciences , University of Wisconsin-Madison , Madison , USA
| | - Ana P Martinez-Donate
- b Department of Community Health and Prevention , Drexel University , Philadelphia , USA
| | - Norma-Jean E Simon
- a Department of Population Health Sciences , University of Wisconsin-Madison , Madison , USA
| | - Melbourne F Hovell
- c Graduate School of Public Health , San Diego State University , San Diego , USA
| | | | - Carlos Magis-Rodriguez
- e Sexually Transmitted Infections Research Center, HIV/AIDS Program , Mexico City , Mexico
| | - Carol L Sipan
- f Department of Health Sciences , University of California-Merced , Merced , USA
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39
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Bazzi AR, Syvertsen JL, Rolón ML, Martinez G, Rangel G, Vera A, Amaro H, Ulibarri MD, Hernandez DO, Strathdee SA. Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities. J Subst Abuse Treat 2016; 61:26-33. [PMID: 26470596 PMCID: PMC4695257 DOI: 10.1016/j.jsat.2015.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/03/2015] [Accepted: 08/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Available drug treatment modalities may inadequately address social and structural contexts surrounding recovery efforts. METHODS This mixed methods analysis drew on (1) surveys with female sex workers and their intimate male partners and (2) semi-structured interviews with a subsample of 41 couples (n=82 individuals, 123 total interviews) in Northern Mexico. Descriptive and content analyses examined drug cessation and treatment experiences. RESULTS Perceived need for drug treatment was high, yet only 35% had ever accessed services. Financial and institutional barriers (childcare needs, sex-segregated facilities) prevented partners from enrolling in residential programs together or simultaneously, leading to self-treatment attempts. Outpatient methadone was experienced more positively, yet financial constraints limited access and treatment duration. Relapse was common, particularly when one partner enrolled alone while the other continued using drugs. CONCLUSIONS Affordable, accessible, evidence-based drug treatment and recovery services that acknowledge social and structural contexts surrounding recovery are urgently needed for drug-involved couples.
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Affiliation(s)
- Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA.
| | - Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174W. 18th Avenue, Columbus OH 43210, USA
| | - María Luisa Rolón
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México
| | - Gustavo Martinez
- Federación Mexicana de Asociaciones Privadas, Plutarco Elías Calles No. 744 Norte, Col. Progresista, C.P. 32310, Ciudad Juárez, Chihuahua, México
| | - Gudelia Rangel
- Comisión de Salud Fronteriza México-Estados Unidos, Sección México, Paseo del Centenario #10851, Zona Río. C.P. 22010, Tijuana, Baja California, México; Secretaría de Salud, Homero 213, piso 19, Col. Chapultepec Morales, Delegación Miguel Hidalgo C.P. 11570, México, D.F
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, México
| | - Hortensia Amaro
- School of Social Work and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Montgomery Ross Fisher Building, Room 221 669W. 34th St., Los Angeles, CA 90089
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0849, USA; California School of Professional Psychology, Alliant International University-San Diego, San Diego, CA
| | - Daniel O Hernandez
- School of Medicine, University of California, Davis, 4610 X Street, Sacramento, CA 95817, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla CA 92093-0507, USA
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Loza O, Ramos R, Ferreira-Pinto J, Hernandez MT, Villalobos SA. A qualitative exploration of perceived gender differences in methamphetamine use among women who use methamphetamine on the Mexico–U.S. border. J Ethn Subst Abuse 2015; 15:405-424. [DOI: 10.1080/15332640.2015.1070392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Oralia Loza
- College of Health Sciences, University of Texas at El Paso, El Paso, TX
| | - Rebeca Ramos
- Alliance of Border Collaboratives (ABC), El Paso, TX
| | | | | | - Susana A. Villalobos
- Department of Emergency Medicine, Texas Tech Health Sciences of El Paso, Paul Foster School of Medicine, El Paso, TX
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Martinez-Donate AP, Rangel MG, Zhang X, Simon NJ, Rhoads N, Gonzalez-Fagoaga JE, Gonzalez AA. HIV Prevention Among Mexican Migrants at Different Migration Phases: Exposure to Prevention Messages and Association With Testing Behaviors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:547-65. [PMID: 26595267 PMCID: PMC4751078 DOI: 10.1521/aeap.2015.27.6.547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Mobile populations are at increased risk for HIV infection. Exposure to HIV prevention messages at all phases of the migration process may help decrease im/migrants' HIV risk. We investigated levels of exposure to HIV prevention messages, factors associated with message exposure, and the association between exposure to prevention messages and HIV testing behavior among Mexican im/migrants at different phases of the migration process. We conducted a cross-sectional, probability survey of Mexican im/migrants (N = 3,149) traveling through the border city of Tijuana, Mexico. The results indicate limited exposure to prevention messages (57-75%) and suboptimal last 12-month HIV testing rates (14-25%) across five migration phases. Compared to pre-departure levels (75%), exposure to messages decreases at all post-departure migration phases (57-63%, p < .001). In general, exposure to prevention messages is positively associated with greater odds of HIV testing at the pre-departure, destination, and interception phases. Binational efforts need to be intensified to reach and deliver HIV prevention to Mexican im/migrants across the migration continuum.
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Affiliation(s)
- Ana P. Martinez-Donate
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - M. Gudelia Rangel
- U.S.-Mexico Border Health Commission, Mexico Section, Tijuana, Baja California, Mexico
| | - Xiao Zhang
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Norma-Jean Simon
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Natalie Rhoads
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Ahmed Asadi Gonzalez
- School of Medicine and Psychology, Autonomous University of Baja California (Universidad Autonoma de Baja California), Tijuana, Baja California, Mexico
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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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López J AM, Uribe S FJ. Mortalidad evitable en los estados de la frontera del norte de México: posibles implicaciones sociales y para los servicios de salud. REVISTA FACULTAD NACIONAL DE SALUD PÚBLICA 2015. [DOI: 10.17533/udea.rfnsp.v33n2a05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bazzi AR, Rangel G, Martinez G, Ulibarri MD, Syvertsen JL, Bazzi SA, Roesch S, Pines HA, Strathdee SA. Incidence and Predictors of HIV and Sexually Transmitted Infections Among Female Sex Workers and Their Intimate Male Partners in Northern Mexico: A Longitudinal, Multilevel Study. Am J Epidemiol 2015; 181:723-31. [PMID: 25769307 PMCID: PMC4408950 DOI: 10.1093/aje/kwu340] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/05/2014] [Indexed: 11/12/2022] Open
Abstract
Preventing human immunodeficiency virus (HIV) infection and other sexually transmitted infections (STIs) requires an understanding of sexual relationship factors beyond the individual level. We estimated HIV/STI incidence and identified time-varying predictors of STI acquisition in a prospective cohort study of female sex workers and their intimate (noncommercial) male partners in northern Mexico. From 2010 to 2013, couples underwent behavioral and biological assessments biannually for 24 months. Among 413 initially HIV-uninfected participants, 8 seroconverted during follow-up. Incidence of HIV (1.12 cases/100 person-years (PY)), chlamydia (9.47 cases/100 PY), active syphilis (4.01 cases/100 PY), and gonorrhea (1.78 cases/100 PY) was higher among women than among men (HIV: P = 0.069; all STIs combined: P < 0.001). In multivariable conditional logistic regression with individual fixed effects and correlated error terms within couples, risk of STI acquisition was significantly higher among women who had recently used cocaine, crack, or methamphetamine (adjusted odds ratio (OR) = 2.13, 95% confidence interval (CI): 1.07, 4.28). STI risk was lower among women who reported physically assaulting their male partners (adjusted OR = 0.44, 95% CI: 0.22, 0.86) and among men whose female partners had regular sex-work clients (adjusted OR = 0.38, 95% CI: 0.14, 1.03). Improving vulnerable couples' sexual health will require addressing the contexts in which drug use, interpersonal conflict, and economic vulnerability converge.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Steffanie A. Strathdee
- Correspondence to Dr. Steffanie A. Strathdee, Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507 (e-mail: )
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Martinez-Donate AP, Hovell MF, Rangel MG, Zhang X, Sipan CL, Magis-Rodriguez C, Gonzalez-Fagoaga JE. Migrants in transit: the importance of monitoring HIV risk among migrant flows at the Mexico-US border. Am J Public Health 2015; 105:497-509. [PMID: 25602882 PMCID: PMC4330846 DOI: 10.2105/ajph.2014.302336] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 11/04/2022]
Abstract
We conducted a probability-based survey of migrant flows traveling across the Mexico-US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.
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Affiliation(s)
- Ana P Martinez-Donate
- Ana P. Martinez-Donate and Xiao Zhang are with the Department of Population Health Sciences, University of Wisconsin, Madison. Melbourne F. Hovell is with the Graduate School of Public Health, San Diego State University, San Diego, CA. Maria Gudelia Rangel and J. Eduardo Gonzalez-Fagoaga are with El Colegio de la Frontera Norte, Tijuana, Mexico. Carol L. Sipan is with the School of Social Sciences, University of California, Merced. At the time of the study, Carlos Magis-Rodriguez was with the Sexually Transmitted Infections Research Center, HIV/AIDS Program, Mexico City, Mexico
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Prevalence and correlates of HIV among men who have sex with men in Tijuana, Mexico. J Int AIDS Soc 2015; 18:19304. [PMID: 25669423 PMCID: PMC4323407 DOI: 10.7448/ias.18.1.19304] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 11/03/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city. Methods We conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation. Results A total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4–46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0–40.0) were estimated to have ever used methamphetamine. Independent correlates of being infected with HIV were methamphetamine use (odds ratio [OR]=2.24, p=0.045, 95% CI: 1.02, 4.92) and active syphilis infection (OR=4.33, p=0.01, 95% CI: 1.42, 13.19). Conclusions Our data indicate that MSM are a key sub-population in Tijuana at higher risk for HIV. Tijuana would also appear to have the highest proportion among upper-middle-income countries of HIV-positive MSM who are unknowingly infected. More HIV prevention research on MSM is urgently needed in Tijuana.
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Roth AM, Armenta RA, Wagner KD, Roesch SC, Bluthenthal RN, Cuevas-Mota J, Garfein RS. Patterns of drug use, risky behavior, and health status among persons who inject drugs living in San Diego, California: a latent class analysis. Subst Use Misuse 2015; 50:205-14. [PMID: 25313832 PMCID: PMC4356115 DOI: 10.3109/10826084.2014.962661] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Among persons who inject drugs (PWID), polydrug use (the practice of mixing multiple drugs/alcohol sequentially or simultaneously) increases risk for HIV transmission and unintentional overdose deaths. Research has shown local drug markets influence drug use practices. However, little is known about the impact of drug mixing in markets dominated by black tar heroin and methamphetamine, such as the western United States. METHODS Data were collected through an ongoing longitudinal study examining drug use, risk behavior, and health status among PWID. Latent class analysis (LCA) was used to identify patterns of substance use (heroin, methamphetamine, prescription drugs, alcohol, and marijuana) via multiple administration routes (injecting, smoking, and swallowing). Logistic regression was used to identify behaviors and health indicators associated with drug use class. RESULTS The sample included 511 mostly white (51.5%) males (73.8%), with mean age of 43.5 years. Two distinct classes of drug users predominated: methamphetamine by multiple routes (51%) and heroin by injection (49%). In multivariable logistic regression, class membership was associated with age, race, and housing status. PWID who were HIV-seropositive and reported prior sexually transmitted infections had increased odds of belonging to the methamphetamine class. Those who were HCV positive and reported previous opioid overdose had an increased odds of being in the primarily heroin injection class (all P-values < .05). CONCLUSION Risk behaviors and health outcomes differed between PWID who primarily inject heroin vs. those who use methamphetamine. The findings suggest that in a region where PWID mainly use black tar heroin or methamphetamine, interventions tailored to sub-populations of PWID could improve effectiveness.
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Affiliation(s)
- Alexis M Roth
- 1Drexel University, Philadelphia , Pennsylvania , USA
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48
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Meacham MC, Rudolph AE, Strathdee SA, Rusch ML, Brouwer KC, Patterson TL, Vera A, Rangel G, Roesch SC. Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana, Mexico: A Latent Class Analysis. Subst Use Misuse 2015; 50:1351-9. [PMID: 26444185 PMCID: PMC4786000 DOI: 10.3109/10826084.2015.1013132] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. METHODS Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. RESULTS Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. CONCLUSIONS Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.
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Affiliation(s)
- Meredith C Meacham
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA.,b Graduate School of Public Health, San Diego State University , San Diego , California , USA
| | - Abby E Rudolph
- c Pacific Institute for Research and Evaluation , Calverton , Maryland , USA
| | - Steffanie A Strathdee
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA
| | - Melanie L Rusch
- d Vancouver Island Health Authority , Victoria , British Columbia , Canada
| | - Kimberly C Brouwer
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA
| | - Thomas L Patterson
- e Department of Psychiatry, University of California , San Diego, La Jolla , California , USA
| | - Alicia Vera
- a Division of Global Public Health, University of California, San Diego School of Medicine , La Jolla , California , USA
| | | | - Scott C Roesch
- g Department of Psychology, San Diego State University , San Diego , California , USA
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Social and clinical predictors of drug-resistant tuberculosis in a public hospital, Monterrey, Mexico. Ann Epidemiol 2014; 24:771-5. [DOI: 10.1016/j.annepidem.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 11/21/2022]
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Robertson AM, Syvertsen JL, Ulibarri MD, Rangel MG, Martinez G, Strathdee SA. Prevalence and correlates of HIV and sexually transmitted infections among female sex workers and their non-commercial male partners in two Mexico-USA border cities. J Urban Health 2014; 91:752-67. [PMID: 24488651 PMCID: PMC4134454 DOI: 10.1007/s11524-013-9855-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Female sex workers (FSWs) acquire HIV and other sexually transmitted infections (STIs) through unprotected sex with commercial and non-commercial (intimate) male partners. Little research has focused on FSWs' intimate relationships, within which condom use is rare. We sought to determine the prevalence and correlates of HIV/STIs within FSWs' intimate relationships in Northern Mexico. From 2010 to 2011, we conducted a cross-sectional survey of FSWs and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico. Eligible FSWs and their verified male partners were aged ≥18 years; FSWs reported lifetime use of heroin, cocaine, crack, or methamphetamine and recently exchanged sex (past month). Participants completed baseline questionnaires and testing for HIV, chlamydia, gonorrhea, and syphilis. We determined the prevalence and correlates of individuals' HIV/STI positivity using bivariate probit regression. Among 212 couples (n = 424), prevalence of HIV was 2.6 % (n = 11). Forty-two (9.9 %) tested positive for any HIV/STIs, which was more prevalent among women than men (12.7 % vs. 7.1 %, p < 0.05). FSWs with regular sex work clients were less likely to test positive for HIV/STIs than those without regular clients. Similarly, male partners of FSWs who had regular clients were 9 % less likely to have HIV/STIs. Higher sexual decision-making power was protective against HIV/STIs for women. Men who recently used methamphetamine or reported perpetrating any conflict within steady relationships were more likely to test positive for HIV/STIs. Within FSWs' intimate relationships in two Mexican-US border cities, nearly one in ten partners tested positive for HIV/STIs. Couple-based prevention interventions should recognize how intimate relationship factors and social contexts influence HIV/STI vulnerability.
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Affiliation(s)
- Angela M. Robertson
- />Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- />The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215 USA
| | - Jennifer L. Syvertsen
- />Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210 USA
| | - Monica D. Ulibarri
- />Department of Psychiatry, University of California at San Diego, 9500 Gilman Drive, Mail Code 0603, La Jolla, CA 92093-0603 USA
| | - M. Gudelia Rangel
- />Department of Population Studies, El Colegio de La Frontera Norte, Carretera Escénica Tijuana-Ensenada, Km 18.5, San Antonio del Mar, 22560 Tijuana, Baja California Mexico
| | - Gustavo Martinez
- />Federación Mexicana de Asociaciones Privadas (FEMAP), Ave. Malecón No. 788 Col. Centro C.P., 32000 Ciudad Juárez, Chihuahua Mexico
| | - Steffanie A. Strathdee
- />Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA 92093-0507 USA
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