Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

Abstract

Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/ STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over the counter without a prescription, but police practices are often at odds with the law. FSWIDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48 %. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR]=2.54, 95 % confidence interval [CI]=1.11-5.80), reporting sexual abuse by police (aOR=12.76, 95 % CI=6.58-24.72), engaging in groin injection (aOR=1.84, 95 % CI=1.15-2.93), injecting in public (aOR=1.64; 95 % CI=1.14-2.36), and obtaining syringes from pharmacies (aOR=1.54; 95 % CI=1.06-2.23). Higher education level was negatively associated with syringe confiscation (aOR= 0.92, 95 % CI=0.87-0.98) as was frequent injection with clients within the last month (aOR=0.64,). This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.

Police Victimization Among Persons Who Inject Drugs Along the U.S.–Mexico Border

“…Understanding factors that increase susceptibility to police victimization is imperative to designing effective interventions aimed at mitigating HIV risk in this region. Problematic policing practices are an important environmental driver that may significantly increase the risk of acquiring HIV among PWID in Tijuana (Beletsky et al, 2013;Pollini et al, 2008;Robertson et al, 2010;Volkmann et al, 2011). Independent associations between increased numbers of arrests and being HIV positive have been documented in Tijuana (Strathdee et al, 2008a(Strathdee et al, , 2008b.…”

“…These variables were chosen based on previous findings linking these problematic policing practices and HIV risk in Tijuana and other international settings (Beletsky et al, 2013;Philbin et al, 2008;Pollini et al, 2008;Robertson et al, 2010;Strathdee et al, 2008bStrathdee et al, , 2010Volkmann et al, 2011).…”

“…In Tijuana, a Mexican city that borders the United States, accounts of police victimization are widespread among PWID and have been linked to behaviors that increase susceptibility to HIV infection (Beletsky et al, 2012(Beletsky et al, , 2013Infante et al, 2012;Miller et al, 2008;Pinedo et al, 2014aPinedo et al, , 2015Pollini et al, 2008Pollini et al, , 2009Pollini et al, , 2010Strathdee et al, 2005Strathdee et al, , 2008bVolkmann et al, 2011). Community and problematic policing practices can operate as social-structural drivers of HIV infection (Blankenship & Koester, 2002;Miller et al, 2008;Sarang et al, 2010;Strathdee et al, 2008bStrathdee et al, , 2010.…”

“…To decrease their exposure to police, PWID in this region who have experienced police victimization are more likely to take additional risks that increase their risk for HIV. Such risks include engaging in receptive needle sharing, injecting in high-risk environments (i.e., shooting galleries), seeking injection assistance (i.e., use of a "hit doctor"), and rushing injections (Beletsky et al, 2012(Beletsky et al, , 2013Philbin et al, 2008;Pollini et al, 2008Pollini et al, , 2009Pollini et al, , 2010Strathdee et al, 2005;Volkmann et al, 2011). Community and problematic policing practices can adversely affect the adoption of preventive behaviors of PWID and increase their odds of acquiring HIV.…”

“…PWID are common police targets given their engagement in drug-related activities (Beletsky et al, 2011b(Beletsky et al, , 2013Burris et al, 2004;Miller et al, 2008;Strathdee et al, 2010;Werb et al, 2008). Physical and visual markers may play an important role in police victimization.…”