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Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana, Mexico
Journal article   Open access   Peer reviewed

Correlates of injecting in an HIV incidence hotspot among substance users in Tijuana, Mexico

Nana Kori, Alexis M. Roth, Remedios Lozada, Alicia Vera and Kimberly C. Brouwer
The International journal of drug policy, v 25(3), pp 525-532
01 May 2014
DOI: https://doi.org/10.1016/j.drugpo.2013.12.005
PMID: 24418632
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://escholarship.org/uc/item/22v0v3qvView
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Female sex work HIV Injection drug use Mobility Tijuana Transmission hotspot
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. From 4/06 to 6/07, IDUs aged ≥18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and interviewer-administered surveys eliciting information on demographics, drug use, sexual behaviors, and socio-environmental influences. Participants 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’. 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 independently 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), various 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). 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, interventions addressing STIs and structural vulnerabilities may be needed to effectively address HIV risk.

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Domestic collaboration
International collaboration
Web of Science research areas
Substance Abuse
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