Journal of Urban Health

, Volume 90, Issue 2, pp 284–298 | Cite as

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

  • Leo Beletsky
  • Remedios Lozada
  • Tommi Gaines
  • Daniela Abramovitz
  • Hugo Staines
  • Alicia Vera
  • Gudelia Rangel
  • Jaime Arredondo
  • Steffanie A. Strathdee
Article

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. FSW-IDUs 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, 95 % CI = 0.44–0.94). 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.

Keywords

Injection drug use Sex work Police HIV risk factors Risk environment 

References

  1. 1.
    Bucardo J, Brouwer K, Magis-Rodriguez C, et al. Historical trends in the production and consumption of illicit drugs in Mexico: implications for the prevention of blood borne infections. Drug Alcohol Depend. 2005;79(3):281-293.PubMedCrossRefGoogle Scholar
  2. 2.
    Ramos R, Ferreira-Pinto J, Brouwer K, et al. A tale of two cities: social and environmental influences shaping risk factors and protective behaviors in two Mexico–US border cities. Health Place. 2009;15(4):999-1005.PubMedCrossRefGoogle Scholar
  3. 3.
    Strathdee S, Magis-Rodriguez C. Mexico's evolving HIV epidemic. JAMA. 2008;300(5):571-573.PubMedCrossRefGoogle Scholar
  4. 4.
    Meyer M. Abused and afraid in Ciudad Juarez: an analysis of human rights violations by the military in Mexico. Ciudad Juarez, Mexico: Centro de Derechos Humanos; 2010.Google Scholar
  5. 5.
    Miller CL, Firestone M, Ramos R, et al. Injecting drug users’ experiences of policing practices in two Mexican–U.S. border cities: public health perspectives. Int J Drug Policy. 2008;19(4):324-331.PubMedCrossRefGoogle Scholar
  6. 6.
    Beittel JS. Mexico’s drug-related violence. Washington, DC: Congressional Research Service; 2009. May 15.Google Scholar
  7. 7.
    Biradavolu MR, Burris S, George A, Jena A, Blakenship K. Can sex workers regulate police? Learning from an HIV prevention project for sex workers in Southern India. Soc Sci Med. 2009;68(8):1541-1547.PubMedCrossRefGoogle Scholar
  8. 8.
    Basu I, Jana S, Rotheram-Borus MJ, et al. HIV prevention among sex workers in India. J Acquir Immune Defic Syndr. 2004;36(3):845-852.PubMedCrossRefGoogle Scholar
  9. 9.
    Blankenship K, Koester S. Criminal law, policing policy, and HIV risk in female street sex workers and injection drug users. J Law Med Ethics. 2002;30:548-559.PubMedCrossRefGoogle Scholar
  10. 10.
    Harcourt C, Egger S, Donovan B. Sex work and the law. Sex Heal. 2005;2:121-128.CrossRefGoogle Scholar
  11. 11.
    Law SA. Commercial sex: beyond decriminalization. Calif Law Rev. 2000;73:523-608.Google Scholar
  12. 12.
    Mayhew S, Collumbien M, Qureshi A, et al. Protecting the unprotected: mixed-method research on drug use, sex work and rights in Pakistan’s fight against HIV/AIDS. Sex Transm Infect. 2009;85(Suppl 2):ii31-ii36.PubMedCrossRefGoogle Scholar
  13. 13.
    Decker MR, McCauley HL, Phuengsamran D, Janyam S, Seage G, Silverman J. Violence victimisation, sexual risk and sexually transmitted infection symptoms among female sex workers in Thailand. Sex Transm Infect. 2010;86(3):236-240.PubMedCrossRefGoogle Scholar
  14. 14.
    Raj A, Gupta J. Women, Migration, conflict and risk for HIV. In: Martin SF, Tirman J, eds. Women, migration, and conflict: breaking a deadly cycle. Washington, DC: Springer; 2009:107.CrossRefGoogle Scholar
  15. 15.
    Sarang A, Rhodes T, Sheon N, Page K. Policing drug users in Russia: risk, fear, and structural violence. Subst Use Misuse. 2010;45(6):813-864.PubMedCrossRefGoogle Scholar
  16. 16.
    Beletsky L, Martinez G, Gaines T, et al. Mexico’s Northern Border conflict: collateral damage to health and human rights of vulnerable groups. Pan Am J Public Health. 2012;in press.Google Scholar
  17. 17.
    Mann J, Gruskin S, Grodin MA, eds. Health and human rights: a reader. New York: Routledge; 1999.Google Scholar
  18. 18.
    Strathdee SA, Lozada R, Martinez G, et al. Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico–US Border Region. PLoS ONE. 2011;6(4).Google Scholar
  19. 19.
    Hamers FF, Downs AM. HIV in central and eastern Europe. Lancet. 2003;361(9362):1035-1044.PubMedCrossRefGoogle Scholar
  20. 20.
    Liu H, Grusky O, Li X, Ma E. Drug users: a potentially important bridge population in the transmission of sexually transmitted diseases, including AIDS, in China. Sex Transm Dis. 2006;33(2):111-117.PubMedCrossRefGoogle Scholar
  21. 21.
    Rich JD, Dickenson BP, Lie K-L, Case P. Strict syringe laws in Rhode Island are associated with high rates of reusing syringes and HIV risks among injection drug users (letter). J Acquir Immune Defic Syndr. 1998;18(Suppl 1):S140.Google Scholar
  22. 22.
    Beletsky L, Grau LE, White E, Bowman S, Heimer R. The roles of law, client race, and program visibility in shaping police interference with the operation of US syringe exchange programs. Addiction. 2011;106(2):357-365.PubMedCrossRefGoogle Scholar
  23. 23.
    Rhodes T, Platt L, Sarang A, Vlasov A, Mikhailova L, Monaghan G. Street policing, injecting drug use and harm reduction in a Russian city: a qualitative study of police perspectives. J Urban Health. 2006;83(5):911-925.PubMedCrossRefGoogle Scholar
  24. 24.
    Werb D, Wood E, Small W, et al. Effects of police confiscation of illicit drugs and syringes among injection drug users in Vancouver. Int J Drug Policy. 2008;19(4):332-338.PubMedCrossRefGoogle Scholar
  25. 25.
    Rhodes T. The 'risk environment': a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002;13(2):85-94.CrossRefGoogle Scholar
  26. 26.
    Burris S, Blankenship KM, Donoghoe M, et al. Addressing the "risk environment" for injection drug users: the mysterious case of the missing cop. Milbank Q. 2004;82(1):125-126.PubMedCrossRefGoogle Scholar
  27. 27.
    Wood E, Spittal P, Small W, et al. Displacement of Canada's largest public illicit drug market in response to a police crackdown. Can Med Assoc J. 2004;170:1551-1556.CrossRefGoogle Scholar
  28. 28.
    Tello N. Police reforms: the voice of police and residents in Mexico City. Polic Soc Int J Res Policy. 2011;22(1):14-27.Google Scholar
  29. 29.
    Pollini RA, Brouwer KC, Lozada RM, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico–US border cities. Addiction. 2008;103(1):101-108.PubMedCrossRefGoogle Scholar
  30. 30.
    Strathdee SA, Fraga WD, Case P, et al. "Vivo para consumirla y la consumo para vivir" ["I live to inject and inject to live"]: high-risk injection behaviors in Tijuana, Mexico. J Urban Health. 2005;82(3 Suppl 4):iv58-iv73.PubMedCrossRefGoogle Scholar
  31. 31.
    Beletsky L, Macalino G, Burris S. Attitudes of police officers towards syringe access, occupational needle-sticks, and drug use: a qualitative study of one city police department in the United States. Int J Drug Policy. 2005;16:267-274.CrossRefGoogle Scholar
  32. 32.
    Human Rights Watch. Abusing the user: police misconduct, harm reduction and HIV/AIDS in Vancouver. New York: Human Rights Watch; 2003:Vol 15, No. 2(B).Google Scholar
  33. 33.
    Philbin M, Pollini R, Ramos R, et al. Shooting gallery attendance among IDUs in Tijuana and Ciudad Juarez, Mexico: correlates, prevention opportunities, and the role of the environment. AIDS Behav. 2008;12(4):552-560.PubMedCrossRefGoogle Scholar
  34. 34.
    Cooper H, Moore L, Gruskin S, Krieger N. The impact of a police drug crackdown on drug injectors' ability to practice harm reduction: a qualitative study. Soc Sci Med. 2005;61:673-684.PubMedCrossRefGoogle Scholar
  35. 35.
    Davis C, Burris S, Metzger D, Becher J, Lynch K. Effects of an intensive street-level police intervention on syringe exchange program utilization: Philadelphia, Pennsylvania. Am J Public Health. 2005;95:233-236.PubMedCrossRefGoogle Scholar
  36. 36.
    Strathdee SA, Lozada R, Pollini RA, et al. Individual, social, and environmental influences associated with HIV infection among injection drug users in Tijuana, Mexico. JAIDS. 2008;47(3):369-376.PubMedCrossRefGoogle Scholar
  37. 37.
    Rhodes T, Simic M. Transition and the HIV risk environment. Br Med J. 2005;331:220-223.CrossRefGoogle Scholar
  38. 38.
    Springer S, Chen S, Altice F. Depression and symptomatic response among HIV-infected drug users enrolled in a randomized controlled trial of directly administered antiretroviral therapy. AIDS Care. 2009;21(8):976-983.PubMedCrossRefGoogle Scholar
  39. 39.
    Santor DA, Coyne JC. Shortening the CES-D to improve its ability to detect cases of depression. Psychol Assess. 1997;9(3):233-243.CrossRefGoogle Scholar
  40. 40.
    Rosenberg M. Society and the adolescent self image. Princeton (NJ): Princeton University Press; 1965.Google Scholar
  41. 41.
    Human Rights Watch. Locked doors: the human rights of people living with HIV/AIDS in China. New York: Human Rights Watch; 2003:Vol. 14, No. 7(C).Google Scholar
  42. 42.
    Human Rights Watch. Injecting reason: human rights and HIV prevention for injection drug users. New York: Human Rights Watch; 2003:Vol 15, No, 2(G).Google Scholar
  43. 43.
    Human Rights Watch. Fanning the flames: how human rights abuses are fueling the AIDS epidemic in Kazakhstan. New York: Human Rights Watch; 2003:Vol. 15, No. 3(D).Google Scholar
  44. 44.
    Human Rights Watch. Lessons not learned: human rights abuses and HIV/AIDS in the Russian Federation. New York: Human Rights Watch; 2004:April 2004, Vol. 16, No. 5(D).Google Scholar
  45. 45.
    Human Rights Watch. Not enough graves: the war on drugs, HIV/AIDS and violations of human rights. New York: Human Rights Watch; 2004:Vol.16, No. 8(C).Google Scholar
  46. 46.
    Beyrer C, Jittiwutikarn J, Teokul W, et al. Drug use, increasing incarceration rates, and prison-associated HIV risks in Thailand. AIDS Behav. 2003;7(2):153-161.PubMedCrossRefGoogle Scholar
  47. 47.
    Vongchak T, Kawichai S, Sherman S, et al. The influence of Thailand's 2003 'war on drugs' policy on self-reported drug use among injection drug users in Chiang Mai, Thailand. Int J Drug Policy. 2005;16(2):115.CrossRefGoogle Scholar
  48. 48.
    Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Soc Sci Med. 2005;61(5):1026-1044.PubMedCrossRefGoogle Scholar
  49. 49.
    Lazzarini Z, Klitzman R. HIV and the law: integrating law, policy, and social epidemiology. J Law Med Ethics. 2002;30(4):533-547.PubMedCrossRefGoogle Scholar
  50. 50.
    Pollini R, Gallardo M, Hasan S, et al. High prevalence of abscesses and self-treatment among injection drug users in Tijuana, Mexico. Int J Infect Dis. 2010;14(Suppl 3):117-122.CrossRefGoogle Scholar
  51. 51.
    Volkmann T, Lozada R, Anderson CM, Patterson TL, Vera A, Strathdee SA. Factors associated with drug-related harms related to policing in Tijuana, Mexico. Harm Reduct J. 2011;8(7).Google Scholar
  52. 52.
    Pollini R, Lozada R, Gallardo M, et al. Barriers to pharmacy-based syringe purchase among injection drug users in Tijuana, Mexico: a mixed methods study. AIDS Behav. 2010;14(3):679-687.PubMedCrossRefGoogle Scholar
  53. 53.
    Strathdee SA, Lozada R, Ojeda VD, et al. Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico. PLoS One. 2008;3(7):e2690.PubMedCrossRefGoogle Scholar
  54. 54.
    Shannon K, Kerr T, Strathdee SA, Shoveller J, Montaner J, Tyndall M. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ. 2009;339.Google Scholar
  55. 55.
    Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the risk environment among people who inject drugs: past, present, and projections for the future. Lancet. 2010;376(9737):268-284.PubMedCrossRefGoogle Scholar
  56. 56.
    Pirkle C, Soundardjee R, Stella A. Female sex workers in China: vectors of disease? Sex Transm Dis. 2007;34(5).Google Scholar
  57. 57.
    El-Bassel N, Terlikbaeva A, Pinkham S. HIV and women who use drugs: double neglect, double risk. Lancet. 2010;376(9738):312-314.PubMedCrossRefGoogle Scholar
  58. 58.
    Beletsky L, Silverman B, Davis C, Graff J. Harmonizing harm reduction and law enforcement: strategies for prevention, monitoring, and response. American Civil Liberties Union of Delaware. Available at: http://aclu-de.comcastbiz.net/phc/PDF/final.pdf.
  59. 59.
    Beletsky L, Agrawal A, Moreau B, Kumar P, Weiss-Laxer N, Heimer R. Police training to align law enforcement and HIV prevention: preliminary evidence from the field. Am J Public Health. 2011;101(11):2012-2015.PubMedCrossRefGoogle Scholar
  60. 60.
    Beletsky L, Grau LE, White E, Bowman S, Heimer R. Content, correlates and predictors of police training initiatives by syringe exchange programs. Drug Alcohol Depend. 2011;19(1–2):145-149.CrossRefGoogle Scholar
  61. 61.
    Davis C, Beletsky L. Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: evidence from three U.S. cities. Harm Reduct J. 2009;6(16):1-18.Google Scholar
  62. 62.
    Green TC, Martin EG, Bowman SE, Mann MR, Beletsky L. Life after the ban: an assessment of US syringe exchange programs’ attitudes about and early experiences with federal funding. Am J Public Health. In Press.Google Scholar
  63. 63.
    Auditoría Superior de la F. Informe del Resultado de la Revisión y Fiscalización Superior de la Cuenta Pública. Mexico, DF; 2007.Google Scholar

Copyright information

© The New York Academy of Medicine 2012

Authors and Affiliations

  • Leo Beletsky
    • 1
    • 2
    • 7
  • Remedios Lozada
    • 3
    • 4
    • 8
  • Tommi Gaines
    • 1
  • Daniela Abramovitz
    • 1
  • Hugo Staines
    • 5
  • Alicia Vera
    • 1
  • Gudelia Rangel
    • 6
  • Jaime Arredondo
    • 1
  • Steffanie A. Strathdee
    • 1
  1. 1.Division of Global Public HealthUniversity of California—San DiegoLa JollaUSA
  2. 2.Northeastern University School of Law and Bouvé College of Health SciencesBostonUSA
  3. 3.Salud y Desarollo Comunitario de Ciudad Juárez A.C. (SADEC)Ciudad JuárezMexico
  4. 4.Prevencasa, A.C.TijuanaMexico
  5. 5.Universidad Autonoma de Ciudad JuarezCiudad JuarezMexico
  6. 6.El Colegio de la Frontera NorteChihuahuaMexico
  7. 7.BostonUSA
  8. 8.Federación Méxicana de Asociaciones Privadas (FEMAP)Ciudad JuárezMexico

Personalised recommendations