Abstract
Cross-border infectious disease transmission is a concern related to drug tourism from the U.S. to Mexico. We assessed this risk among people who inject drugs (PWID) in Tijuana, Mexico. We measured the prevalence and identified correlates of injecting with PWID visiting from the U.S. among PWID in Tijuana using univariable and multivariable logistic regression. Of 727 participants, 18.5% injected during the past 6 months in Mexico with U.S. PWID described mostly as friends (63%) or acquaintances (26%). Injecting with U.S. PWID was independently associated with higher education [adjusted odds ratio (aOR) = 1.13/year], deportation from the U.S. (aOR = 1.70), younger age at first injection (aOR = 0.96/year), more lifetime overdoses (aOR = 1.08), and, in the past 6 months, backloading (aOR = 4.00), syringe confiscation by the police (aOR = 3.02) and paying for sex (aOR = 2.98; all p-values < 0.05). Nearly one-fifth of PWID in Tijuana recently injected with U.S. PWID, and their reported risk behaviors could facilitate cross-border disease transmission.
Similar content being viewed by others
References
Weine SM, Kashuba AB. Labor migration and HIV risk: a systematic review of the literature. AIDS Behav. 2012;16 (6):1605–21.
Delany-Moretlwe S, Bello B, Kinross P, Oliff M, Chersich M, Kleinschmidt I, et al. HIV prevalence and risk in long-distance truck drivers in South Africa: a national cross-sectional survey. Int J Std AIDS. 2014;25 (6):428–38.
Garcia PJ, Fazio B, Bayer AM, Lizarraga AG, Chiappe M, La Rosa S, et al. Sexual health knowledge and practices and STI/HIV prevalence among long-distance truck drivers in Peru. SAGE Open Med. 2017;5:2050312117746308.
Lacerda R, Gravato N, McFarland W, Rutherford G, Iskrant K, Stall R, et al. Truck drivers in Brazil: prevalence of HIV and other sexually transmitted diseases, risk behavior and potential for spread of infection. AIDS. 1997;11 (Suppl 1):15-9.
Lee D, Bell DC, Hinojosa M. Drug use, travel and HIV risk. AIDS Care. 2002;14 (4):443–53.
Marshall BD, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health Place. 2009;15 (3):753–60.
Elifson KW, Sterk CE, Theall KP. Safe living: the impact of unstable housing conditions on HIV risk reduction among female drug users. AIDS Behav. 2007;11 (6 Suppl):45–55.
Corneil TA, Kuyper LM, Shoveller J, Hogg RS, Li K, Spittal PM, et al. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place. 2006;12 (1):79–85.
Rachlis B, Brouwer KC, Mills EJ, Hayes M, Kerr T, Hogg RS. Migration and transmission of blood-borne infections among injection drug users: understanding the epidemiologic bridge. Drug Alcohol Depend. 2007;90 (2–3):107–19.
U.S. General Services Administration. The San Ysidro Land Port of Entry Project Facts. 2018. https://www.gsa.gov/about-us/regions/welcome-to-the-pacific-rim-region-9/land-ports-of-entry/san-ysidro-land-port-of-entry/san-ysidro-lpoe-project-facts. Accessed 24 Sept 2018.
PI. Steffanie Strathdee. Proyecto el Cuete phase IV. NIDA grant R01 DA0 19829; 2010–2020.
White EF, Garfein RS, Brouwer KC, Lozada R, Ramos R, Firestone-Cruz M, et al. Prevalence of hepatitis C virus and HIV infection among injection drug users in two Mexican cities bordering the U.S. Salud Publica Mex. 2007;49 (3):165–72.
Centers for Disease Control and Prevention. Infection HIV, Prevention R and testing behaviors among persons who inject drugs—National HIV Behavioral Surveillance: Injection Drug Use, 20 U.S. Cities. 2015. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-hssr-nhbs-pwid-2015.pdf. Accessed 19 Sept 2018.
Horyniak D, Wagner KD, Armenta RF, Cuevas-Mota J, Hendrickson E, Garfein RS. Cross-border injection drug use and HIV and hepatitis C virus seropositivity among people who inject drugs in San Diego, California. Int J Drug Policy. 2017;47:9–17.
Wagner KD, Pollini RA, Patterson TL, Lozada R, Ojeda VD, Brouwer KC, et al. Cross-border drug injection relationships among injection drug users in Tijuana, Mexico. Drug Alcohol Depend. 2011;113 (2–3):236–41.
Pinedo M, Burgos JL, Zuniga ML, Perez R, Macera CA, Ojeda VD. Police victimization among persons who inject drugs along the U.S.–Mexico border. J Stud Alcohol Drugs. 2015;76 (5):758–63.
Pollini RA, Brouwer KC, Lozada RM, Ramos R, Cruz MF, Magis-Rodriguez C, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction. 2008;103 (1):101–8.
Beletsky L, Lozada R, Gaines T, Abramovitz D, Staines H, Vera A, et al. Syringe confiscation as an HIV risk factor: the public health implications of arbitrary policing in Tijuana and Ciudad Juarez. Mexico J Urban Health. 2013;90 (2):284–98.
U.S. Department of Homeland Security. Yearbook of immigration statistics, aliens removed or returned: fiscal years 1892 to 2016. 2017. https://www.dhs.gov/immigration-statistics/yearbook/2016/table39. Accessed 9 Sept 2018.
DECRETO por el que se reforman. Adicionan y derogan diversas disposiciones de la Ley General de Salud, del Código Penal Federal y del Código Federal de Procedimientos Penales. Diario oficial de la federación. 2009.
Mackey TK, Werb D, Beletsky L, Rangel G, Arredondo J, Strathdee SA. Mexico’s “ley de narcomenudeo” drug policy reform and the international drug control regime. Harm Reduct J. 2014;11 (1):31.
Robertson AM, Garfein RS, Wagner KD, Mehta SR, Magis-Rodriguez C, Cuevas-Mota J, et al. Evaluating the impact of Mexico’s drug policy reforms on people who inject drugs in Tijuana, B.C., Mexico, and San Diego, CA, United States: a binational mixed methods research agenda. Harm Reduct J. 2014;11:4.
Liang KY, Zeger S. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73 (1):13–22.
Hardin J, Hilbe J. Generalized estimating equations. London: Chapman and Hall/CRC; 2003.
Bendal RB, Afifi AA. Comparison of stopping rules in forward regression. J Am Stat Assoc. 1977;72:46–53.
Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129 (1):125–37.
Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley; 2000.
Hosmer DW, Lemeshow S. Applied survival analysis: regression modeling of time to event data. New York: Wiley; 1999.
Robertson AM, Rangel MG, Lozada R, Vera A, Ojeda VD. Male injection drug users try new drugs following U.S. deportation to Tijuana, Mexico. Drug Alcohol Depend. 2012;120 (1–3):142–8.
Ojeda VD, Robertson AM, Hiller SP, Lozada R, Cornelius W, Palinkas LA, et al. A qualitative view of drug use behaviors of Mexican male injection drug users deported from the United States. J Urban Health. 2011;88 (1):104–17.
Moyer LB, Brouwer KC, Brodine SK, Ramos R, Lozada R, Cruz MF, et al. Barriers and missed opportunities to HIV testing among injection drug users in two Mexico–US border cities. Drug Alcohol Rev. 2008;27 (1):39–45.
Smith LR, Patterson TL, Magis-Rodriguez C, Ojeda VD, Burgos JL, Rojas SA, et al. Engagement in the HIV care continuum among key populations in Tijuana, Mexico. AIDS Behav. 2016;20 (5):1017–25.
Werb D, Wagner KD, Beletsky L, Gonzalez-Zuniga P, Rangel G, Strathdee SA. Police bribery and access to methadone maintenance therapy within the context of drug policy reform in Tijuana, Mexico. Drug Alcohol Depend. 2015;148:221–5.
Smith DM, Werb D, Abramovitz D, Magis-Rodriguez C, Vera A, Patterson TL, et al. Predictors of needle exchange program utilization during its implementation and expansion in Tijuana, Mexico. Am J Addict. 2016;25 (2):118–24.
Patterson TL, Semple SJ, Fraga M, Bucardo J, de la Torre A, Salazar J, et al. Comparison of sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, Mexico. Subst Use Misuse. 2006;41 (10–12):1535–49.
Pollini RA, Alvelais J, Gallardo M, Vera A, Lozada R, Magis-Rodriquez C, et al. The harm inside: injection during incarceration among male injection drug users in Tijuana, Mexico. Drug Alcohol Depend. 2009;103 (1–2):52–8.
Mazhnaya A, Tobin KE, Owczarzak J. Association between injection in public places and HIV/HCV risk behavior among people who use drugs in Ukraine. Drug Alcohol Depend. 2018;189:125–30.
Ickowicz S, Wood E, Dong H, Nguyen P, Small W, Kerr T, et al. Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: a longitudinal analysis. Drug Alcohol Depend. 2017;180:33–8.
Acknowledgements
The authors wish to thank the study participants for sharing their detailed histories, without which this research would not have been possible. We also wish to thank the Tijuana and San Diego research staff members whose compassion for the study population and dedication to the research objectives helped to acquire high quality data for this analysis.
Funding
This study was funded by the National Institutes of Health (R37 DA019829). RSG also received funding from the National Institutes for Health (R01 DA031074).
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bórquez, A., Garfein, R.S., Abramovitz, D. et al. Prevalence and Correlates of Injecting with Visitors from the United States Among People Who Inject Drugs in Tijuana, Mexico. J Immigrant Minority Health 21, 1200–1207 (2019). https://doi.org/10.1007/s10903-019-00868-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10903-019-00868-8