Harvey-Vera Alicia Yolanda, González-Zúñiga Patricia, Vargas-Ojeda Adriana Carolina, Medina-Mora Maria Elena, Magis-Rodríguez Carlos Leonardo, Wagner Karla, Strathdee Steffanie Anne, Werb Daniel
Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA.
Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico.
Subst Abuse Treat Prev Policy. 2016 Jan 26;11:5. doi: 10.1186/s13011-015-0044-z.
In 2009, Mexico reformed its health law to partially decriminalize drug possession considered for personal use and to increase mandatory referrals to certified drug rehabilitation centers in lieu of incarceration. Concurrently, news media reported violent attacks perpetrated by drug cartels against Mexican drug rehabilitation centers and instances of human rights violations by staff against people who inject drugs (PWID) in treatment. In many cases, these violent situations took place at "Peer Support" (Ayuda Mutua) drug rehabilitation centers that house a large number of drug-dependent PWID. In an effort to understand barriers to treatment uptake, we examined prevalence and correlates of perceived risk of violence at drug rehabilitation centers among PWID in Tijuana, Mexico.
Secondary analysis of baseline data collected between March 2011 and May 2013 of PWID recruited into a prospective cohort study in Tijuana. Interviewer-administered surveys measured perceived risk of violence at drug rehabilitation centers by asking participants to indicate their level of agreement with the statement "going to rehabilitation puts me at risk of violence". Logistic regression was used to examine factors associated with perceived risk of violence.
Of 733 PWID, 34.5 % perceived risk of violence at drug rehabilitation centers. In multivariate analysis, reporting ever having used crystal methamphetamine and cocaine (separately), having a great or urgent need to get help for drug use, and ever receiving professional help for drug/alcohol use were negatively associated with perceived risk of violence at drug rehabilitation centers, while having been told by law enforcement that drug rehabilitation attendance is mandatory was positively associated with perceived risk of violence. All associations were significant at a 0.05 alpha level.
The perception of violence at drug rehabilitation centers among PWID does not represent the lived experience of those PWID who attended professionalized services, reported a great or urgent need to get help for their drug use and had a history of using crystal and cocaine. Professionalizing service delivery and engaging law enforcement in their new role of decriminalization and service referral for PWID could address the perceptions of violence at drug rehabilitation centers. Similarly, health authorities should expand periodic inspections at drug rehabilitation centers to guarantee quality service provision and minimize PWIDs' concerns about violence.
2009年，墨西哥对其卫生法进行了改革，将被视为个人使用的毒品持有行为部分合法化，并增加了强制转介至经认证的戒毒中心而非监禁的规定。与此同时，新闻媒体报道了贩毒集团对墨西哥戒毒中心实施的暴力袭击，以及工作人员对接受治疗的注射吸毒者（PWID）侵犯人权的事件。在许多情况下，这些暴力事件发生在收容大量药物依赖型PWID的“同伴支持”（互助）戒毒中心。为了了解治疗利用的障碍，我们调查了墨西哥蒂华纳PWID中对戒毒中心暴力风险的认知流行情况及其相关因素。
对2011年3月至2013年5月期间在蒂华纳招募到一项前瞻性队列研究中的PWID的基线数据进行二次分析。由访谈员实施的调查通过询问参与者对“去戒毒会让我面临暴力风险”这一陈述的同意程度来衡量对戒毒中心暴力风险的认知。采用逻辑回归分析来研究与暴力风险认知相关的因素。
在733名PWID中，34.5%的人认为戒毒中心存在暴力风险。在多变量分析中，报告曾使用过冰毒和可卡因（分别）、有很大或迫切需要获得药物使用帮助以及曾接受过药物/酒精使用专业帮助与对戒毒中心暴力风险的认知呈负相关，而被执法部门告知必须参加戒毒则与暴力风险认知呈正相关。所有关联在0.05的α水平上均具有统计学意义。
PWID对戒毒中心暴力的认知并不代表那些接受过专业化服务、报告有很大或迫切需要获得药物使用帮助且有使用冰毒和可卡因历史的PWID的实际经历。使服务专业化并让执法部门在PWID合法化和服务转介的新角色中发挥作用，可以解决对戒毒中心暴力的认知问题。同样，卫生当局应扩大对戒毒中心的定期检查，以保证提供高质量服务并尽量减少PWID对暴力的担忧。
