Departments of Medicine University of California, La Jolla.
Departments of Pathology, University of California, La Jolla.
Clin Infect Dis. 2018 Feb 10;66(5):758-764. doi: 10.1093/cid/cix884.
North Tijuana, Mexico is home to many individuals at high risk for transmitting and acquiring human immunodeficiency virus (HIV). Recently, policy shifts by local government impacted how these individuals were handled by authorities. Here we examined how this affected regional HIV transmission dynamics.
HIV pol sequences and associated demographic information were collected from 8 research studies enrolling persons in Tijuana and were used to infer viral transmission patterns. To evaluate the impact of recent policy changes on HIV transmission dynamics, qualitative interviews were performed on a subset of recently infected individuals.
Between 2004 and 2016, 288 unique HIV pol sequences were obtained from individuals in Tijuana, including 46.4% from men who have sex with men, 42.1% from individuals reporting transactional sex, and 27.8% from persons who inject drugs (some individuals had >1 risk factor). Forty-two percent of sequences linked to at least 1 other sequence, forming 37 transmission clusters. Thirty-two individuals seroconverted during the observation period, including 8 between April and July 2016. Three of these individuals were putatively linked together. Qualitative interviews suggested changes in policing led individuals to shift locations of residence and injection drug use, leading to increased risk taking (eg, sharing needles).
Near real-time molecular epidemiologic analyses identified a cluster of linked transmissions temporally associated with policy shifts. Interviews suggested these shifts may have led to increased risk taking among individuals at high risk for HIV acquisition. With all public policy shifts, downstream impacts need to be carefully considered, as even well-intentioned policies can have major public health consequences.
墨西哥北蒂华纳是许多感染艾滋病毒（HIV）风险较高的个体的家园。最近，当地政府的政策转变影响了当局对这些人的处理方式。在此，我们研究了这如何影响区域 HIV 传播动态。
从在蒂华纳进行的 8 项研究中收集了 HIV pol 序列和相关人口统计信息，用于推断病毒传播模式。为了评估最近政策变化对 HIV 传播动态的影响，对最近感染的个体进行了定性访谈。
2004 年至 2016 年间，从蒂华纳的个体中获得了 288 个独特的 HIV pol 序列，其中 46.4%来自男男性行为者，42.1%来自报告有交易性行为的个体，27.8%来自注射毒品者（一些个体有>1 个风险因素）。42%的序列与至少 1 个其他序列相关联，形成 37 个传播簇。在观察期间有 32 人血清转换，其中 8 人在 2016 年 4 月至 7 月之间。这 32 个人中有 3 个人被认为是相互关联的。定性访谈表明，警务的变化导致个体改变居住和注射毒品的地点，导致风险增加（例如，共用针头）。
近实时分子流行病学分析确定了一个与政策转变时间相关的关联传播簇。访谈表明，这些转变可能导致高危个体的风险增加。随着所有公共政策的转变，需要仔细考虑其下游影响，因为即使是善意的政策也可能对公共卫生产生重大影响。
