International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

Issue link: http://digitalreprints.elsevier.com/i/364061

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International Journal of Drug Policy 25 (2014) 525–532 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Research paper Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana, Mexico Nana Kori a,b , Alexis M. Roth a , Remedios Lozada c , Alicia Vera a , Kimberly C. Brouwer a,∗ a Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507, USA b Graduate School of Public Health, San Diego State University, Hardy Tower 119, 5500 Campanile Drive, San Diego, CA 92182-4162, USA c Pro-COMUSIDA, Ni ˜ nos héroes 697, Oficina 1 y 6, Zona Norte, Tijuana 22000, Baja California, Mexico a r t i c l e i n f o Article history: Received 25 April 2013 Received in revised form 8 October 2013 Accepted 6 December 2013 Keywords: Injection drug use HIV Tijuana Transmission hotspot Mobility Female sex work a b s t r a c t Background: Substance use and HIV are growing problems in the Mexico–U.S. border city of Tijuana, a sex tourism destination situated on a northbound drug trafficking route. In a previous longitudinal study of injection drug users (IDUs), we found that >90% of incident HIV cases occurred within an 'HIV incidence hotspot,' consisting of 2.5-blocks. This study examines behavioral, social, and environmental correlates associated with injecting in this HIV hotspot. Methods: From 4/06 to 6/07, IDUs aged ≥18 years were recruited using respondent-driven sampling. Par- ticipants underwent antibody testing for HIV and syphilis and interviewer-administered surveys eliciting information on demographics, drug use, sexual behaviors, and socio-environmental influences. Partic- ipants were defined as injecting in the hotspot if they most frequently injected within a 3 standard deviational ellipse of the cohort's incident HIV cases. Logistic regression was used to identify individual and structural factors associated with the HIV 'hotspot'. Results: Of 1031 IDUs, the median age was 36 years; 85% were male; HIV prevalence was 4%. As bivariate analysis indicated different correlates for males and females, models were stratified by sex. Factors inde- pendently associated with injecting in the HIV hotspot for male IDUs included homelessness (AOR 1.72; 95%CI 1.14–2.6), greater intra-urban mobility (AOR 3.26; 95%CI 1.67–6.38), deportation (AOR 1.58; 95%CI 1.18–2.12), active syphilis (AOR 3.03; 95%CI 1.63–5.62), needle sharing (AOR 0.57; 95%CI 0.42–0.78), var- ious police interactions, perceived HIV infection risk (AOR 1.52; 95%CI 1.13–2.03), and health insurance status (AOR 0.53; 95%CI 0.33–0.87). For female IDUs, significant factors included sex work (AOR 8.2; 95%CI 2.2–30.59), lifetime syphilis exposure (AOR 2.73; 95%CI 1.08–6.93), injecting inside (AOR 5.26; 95%CI 1.54–17.92), arrests for sterile syringe possession (AOR 4.87; 95%I 1.56–15.15), prior HIV testing (AOR 2.45; 95%CI 1.04–5.81), and health insurance status (AOR 0.12; 95%CI 0.03–0.59). Conclusion: While drug and sex risks were common among IDUs overall, policing practices, STIs, mobility, and lack of healthcare access were correlated with injecting in this HIV transmission hotspot. Although participants in the hotspot were more aware of HIV risks and less likely to report needle sharing, inter- ventions addressing STIs and structural vulnerabilities may be needed to effectively address HIV risk. © 2013 Elsevier B.V. All rights reserved. Introduction Tijuana, a Mexican city of 1.6 million people, has experienced rising HIV prevalence in vulnerable groups over the past decade (Strathdee & Magis-Rodriguez, 2008). Located on the Mexico–U.S. border, adjacent to San Diego, Tijuana is on a major drug trafficking route whereby heroin, cocaine, and methamphetamine are trans- ported to the United States (Bucardo et al., 2005). Of all Mexican ∗ Corresponding author at: The University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093, USA. Tel.: +1 858 822 6467; fax: +1 858 534 7566. E-mail addresses: kbrouwer@ucsd.edu, kcbrouwer@yahoo.com (K.C. Brouwer). cities, Tijuana has the highest number of drug users per capita and an estimated 10,000 injecting drug users (IDUs) (Strathdee et al., 2005). Past modeling of the HIV epidemic in Tijuana revealed that one in every 116 people aged 15–49 years are living with HIV, and that the epidemic is concentrated in certain at-risk groups, including IDUs (Iniguez-Stevens et al., 2009). However, the HIV epidemic is not homogeneous among IDU. Findings by Strathdee and colleagues indicate that HIV prevalence differs significantly by sex (3.5% vs 10.2% among male and female IDUs, respectively) (Strathdee, Lozada, et al., 2008; Strathdee, Philbin, et al., 2008). In a recent paper, we reported that almost all (>90%) of the incident HIV cases among a cohort of Tijuana IDUs (followed for 18 months) had injected within a 2.5 block radius of each other 0955-3959/$ – see front matter © 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.drugpo.2013.12.005

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