Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego

Abstract

Background Research among people who inject drugs (PWIDs) in the USA and Mexico has identified a range of adverse health impacts associated with policing of PWIDs. We employed a mixed methods design to investigate how PWIDs from San Diego and Mexico experienced policing in Tijuana, and how these interactions affect PWIDs behavior, stratifying by country of origin. Methods In 2012–2014, 575 PWIDs in San Diego, 102 of whom had used drugs in Mexico in the past six months, were enrolled in the STAHR-II study, with qualitative interviews conducted with a subsample of 20 who had recently injected drugs in Mexico. During this period, 735 PWIDs in Tijuana were also enrolled in the El Cuete-IV study, with qualitative interviews conducted with a subsample of 20 recently stopped by police. We calculated descriptive statistics for quantitative variables and conducted thematic analysis of qualitative transcripts. Integration of these data involved comparing frequencies across cohorts and using qualitative themes to explain and explore findings. Results Sixty-one percent of San Diego-based participants had been recently stopped by law enforcement officers (LEOs) in Mexico; 53% reported it was somewhat or very likely that they would be arrested while in Mexico because they look like a drug user. Ninety percent of Tijuana-based participants had been recently stopped by LEOs; 84% reported it was somewhat or very likely they could get arrested because they look like a drug user. Participants in both cohorts described bribery and targeting by LEOs in Mexico. However, most San Diego-based participants described compliance with bribery as a safeguard against arrest and detention, with mistreatment being rare. Tijuana-based participants described being routinely targeted by LEOs, were frequently detained, and reported instances of sexual and physical violence. Tijuana-based participants described modifying how, where, and with whom they injected drugs in response; and experienced feelings of stress, anxiety, and powerlessness. This was less common among San Diego-based participants, who mostly attempted to avoid contact with LEOs in Mexico while engaging in risky injection behavior. Conclusion Experiences of discrimination and stigma were reported by a larger proportion of PWIDs living in Mexico, suggesting that they may be subject to greater health harms related to policing practices compared with those residing in the USA. Our findings reinforce the importance of efforts to curb abuse and align policing practices with public health goals in both the US and Mexico.

Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review

“…Experience of homelessness, 13 arrest, 14 incarceration, 15 , 16 and sex work 17 can increase exposure of PWID to HIV, HCV, and HBV, and increase their risks of physical and mental health harms. Age, 18 gender, 19 and the types of drugs injected 20 , 21 , 22 are associated with blood-borne virus risk among PWID, and could require quite different treatment and harm reduction responses.…”

Cross-border injection drug use and HIV and hepatitis C virus seropositivity among people who inject drugs in San Diego, California

“…First, recent evidence suggests that U.S. PWID injecting in Mexico take precautions to avoid drawing attention to themselves in order to minimise likelihood of police encounters (Wood et al, 2017); in particular this type of behaviour may explain the low prevalence of public injection and injecting at shooting galleries that we observed. Second, they may be aware of the high prevalence of HIV and HCV among local PWID populations and be fearful of becoming infected, so take extra precautions during injecting events that they do not take at home, either due to choice or barriers to syringe access.…”

“…It is also possible, however, that changes in law and policing practice are unlikely to influence U.S. PWIDs’ decisions about whether or not to engage in cross-border drug use. A recent analysis exploring our study participants’ experiences with law enforcement in Mexico found that although they perceived it was likely they would be stopped by law enforcement and may be targeted for bribes, they felt they were unlikely to be arrested or detained (Wood et al, 2017). As the relationship between the Mexican drug law reform and cross-border IDU remains unclear, continued monitoring of patterns of cross-border IDU among U.S. PWID including future analysis of longitudinal data from the current study, will be important.…”

Comparing risk environments for HIV among people who inject drugs from three cities in Northern Mexico

“…Specifically, the presence of military forces likely exposes PWID to higher levels of harassment and the possibility of human rights violations, including the right to free mobilization and access to sterile syringes. Previous studies had shown the importance of police practices on HIV prevalence and other poor health outcomes among PWID [ 6 , 7 , 30 , 31 ].…”