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Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

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Abstract

We know little about predictors of injection drug cessation and relapse among female sex workers who inject drugs (FSW-PWID) at the US-Mexico border. Among HIV-negative FSW-PWID taking part in a behavioral intervention study in Tijuana and Ciudad Juárez, Cox regression was used to identify predictors of time to first cessation of injection, which was defined as reporting not having injected drugs for a period of 4 months or longer, and among that subset, we examined predictors of time to injection relapse. Among 440 women, 84 (19 %) reported ceasing injection during follow-up (median time to cessation = 9.3 months); of these, 30 (35 %) reported relapse to injection (median time to relapse = 3.5 months). The rate of injection cessation was lower for women reporting trading sex prior to age 18 (adj. hazard ratio (HR) = 0.64, 95 % confidence interval (CI) = 0.41–1.01), ever being sexually abused (adj. HR = 0.44, 95 % CI = 0.27–0.71), and a higher number of vaginal sex acts with casual clients (adj. HR = 0.99 per transaction, 95 % CI = 0.98–1.00). The rate of cessation was higher for women who spent more hours on the streets on a typical day (adj. HR = 1.04/h, 95 % CI = 1.01–1.08) and who lived in Tijuana vs. Ciudad Juárez (adj. HR = 2.15, 95 % CI = 1.14–4.07). The rate of relapse was higher among women reporting regular drug use with clients (adj. HR = 2.17, 95 % CI = 0.96–4.89) and those scoring higher on a risk injection index (adj. HR = 2.04, 95 % CI = 1.15–3.61). The rate of relapse was lower for FSW-PWID with higher than average incomes (adj. HR = 0.40, 95 % CI = 0.18–0.89). These findings have important implications for the scale-up of methadone maintenance treatment programs (MMTPs) in Mexico and indicate a need for gender-specific programs that address sexual abuse experiences and economic vulnerabilities faced by FSW-PWID.

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Acknowledgments

The authors gratefully acknowledge the contributions of study participants and staff, including Prevencasa A.C., and Federacion Mexicana de Asociaciones Privadas (FEMAP), UACJ, COLEF and UCSD for assistance with data collection, as well as the Instituto de Servicios de Salud de Estado de Baja California (ISESALUD). This study was funded through NIDA grant R01 DA023877. Dr. West is funded by a NIDA T32 (T32DA023356) and Ms. Vera is funded as a predoctoral scholar by the Fogarty International Center (D43TW008633).

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Authors and Affiliations

  1. Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA

    Brooke S. West, Daniela Abramovitz, Alicia Vera & Steffanie A. Strathdee

  2. Department of Psychiatry, University of California San Diego, La Jolla, CA, USA

    Hugo Staines

  3. Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Chihuahua, Mexico

    Thomas L. Patterson

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  1. Brooke S. West
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  6. Steffanie A. Strathdee
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Correspondence to Brooke S. West.

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West, B.S., Abramovitz, D., Staines, H. et al. Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities. J Urban Health 93, 141–154 (2016). https://doi.org/10.1007/s11524-015-9995-7

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