HIV Prevalence and Correlates of Receptive Needle Sharing Among Injection Drug Users in the Mexican-U.S. Border City of Tijuana

Abstract

Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to identify correlates of receptive needle sharing at the last injection episode. Of 402 IDUs, 87.6% were male; the median age was 34. HIV prevalence was 4.01% (95% CI: 2.29-6.51). One third reported receptive needle sharing at last injection. Factors independently associated with receptive needle sharing were years living in Tijuana (Adjusted Odds Ratio [AdjOR]= 0.97 per year, 95% CI: 0.96-0.99), being bisexual/homosexual (AdjOR=2.12; 95% CI: 1.30 - 3.44), unemployed (AdjOR=2.5; 95% CI: 1.52-4.10), never having an HIV test (AOR: 4.02; 95% CI: 2.44-6.60), having friends who placed importance on avoiding HIV (AdjOR: 0.36; 95% CI: 0.19-0.68) and last injecting in a shooting gallery (AdjOR=1.98; 95% CI: 1.21-3.24). These results underscore the need to increase access to voluntary HIV testing and counseling to IDUs and migrants in Tijuana, as well as expand access to sterile syringes in an effort to avert widespread HIV transmission.

The Effect of Migration to the United States on Substance Use Disorders Among Returned Mexican Migrants and Families of Migrants

“…Similar patterns of change have been observed among migrants with respect to sexual risk behaviors [22][23][24] and needle sharing. 25 Our findings are also consistent with the finding of a study of Mexican Americans in Fresno County, Calif, that longer residence in the United States is associated with higher risk for substance use disorders. 3 One factor responsible for this change is likely direct exposure of migrants to a wider availability of illicit drugs in the United States.…”

Individual, Social, and Environmental Influences Associated With HIV Infection Among Injection Drug Users in Tijuana, Mexico

“…An earlier study by our group found that IDUs who were more recent migrants to Tijuana were more likely to report receptive needle sharing. 20 In a study of 600 male Mexican migrant workers in California, 1% tested newly HIV-positive. 59 Because mobile populations may play a critical role in "seeding" a nascent HIV epidemic, prevention efforts should occur on both sides of the US-Mexico border (eg, migrant camps, immigration and deportation centers).…”

“…56 The border crossing between Tijuana and San Diego is the busiest land crossing in the world, with >53 million northbound crossings between Tijuana and San Diego County in 2006. 57 In 2003, approximately 6000 IDUs attended shooting galleries in Tijuana, 20 although the total IDU population is likely closer to 10,000. 33 It is legal to purchase or carry syringes without a prescription in Mexico.…”

“…16 Such factors as poverty, violence, and fear of withdrawal symptoms or police may reduce the salience of risk reduction norms among IDUs. 17 Specific physical settings, such as shooting galleries, other injecting environments, 4,14,15,[18][19][20][21] and prisons, 22 have been associated with elevated levels of needle sharing and HIV infection. In such environments, HIV risk behaviors are shaped by the interplay of structural constraints placed on the availability of HIV prevention materials or the capacity of IDUs to enact risk reduction and what can be termed spatial practices arising from placed-based behavioral routines, norms, and risk perceptions.…”

Grand challenges in chronic non-communicable diseases

“…HIV prevalence of 4% has been found among injecting drug users in Tijuana (Magis-Rodriguez et al, 2005), and there are some indications that HIV infections may be increasing in some cities along with the United States of America border where sex work and injecting drug use are widespread. In Tijuana and Vera Cruz, 6% of female sex workers were found to be HIV-infected in a 2003 study (Magis et al, 2006a), while in Tijuana and Ciudad Juarez, a 2004-2006 study found HIV prevalence of 6% among female sex workers-and 16% among those who injected drugs (Patterson et al, 2006).…”