El Colegio de Mexico, Mexico City, Mexico.
Centro Nacional para la Prevención y Control del SIDA (CENSIDA), Mexico City, Mexico.
Harm Reduct J. 2018 May 18;15(1):27. doi: 10.1186/s12954-018-0225-y.
A large body of research has investigated the rise of injection drug use and HIV transmission in Tijuana and Ciudad Juarez (CJ). However, little is known about the dynamics of injecting in Hermosillo. This study compares drug-related behaviors and risk environment for HIV of people who inject drugs (PWID) across Tijuana, CJ, and Hermosillo to identify factors that could explain differences in HIV prevalence.
Data from Tijuana belong to a prospective study (El Cuete IV). Data from Hermosillo and Ciudad Juarez belong to a cross-sectional study. Both studies collected data in places where PWID spend time. All participants completed quantitative behavioral and serological testing for HIV. Datasets were merged using only comparable variables. Descriptive statistics tests were used to compare sociodemographic and behavioral characteristics of people who inject drugs PWID sampled in each city. A logistic regression model was built to identify factors independently associated with the likelihood of reporting receptive syringe sharing in the past 6 months.
A total of 1494 PWID provided data between March 2011 and May 2012. HIV prevalence differed significantly between participants in Tijuana (4.2%), CJ (7.7%), and Hermosillo (5.2%; p < 0.05). PWID from Hermosillo reported better living conditions, less frequency of drug injection, and lower prevalence of syringe sharing (p < 0.01). PWID from CJ reported a higher prevalence of syringe sharing and confiscation by police (p < 0.01). In a multivariable logistic regression model, living in Hermosillo compared to Tijuana (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI] 0.29-0.61) and being female (AOR = 0.61, 95% CI 0.45-0.83) were protective against syringe sharing. Having used crystal meth (AOR = 1.62, 95% CI 1.24-2.13, p = 0.001), having experienced syringe confiscation by police in the last 6 months (AOR = 1.78, 95% CI 1.34-2.40), and lower perception of syringe availability (AOR = 2.15, 95% CI 1.59-2.91) were significantly associated with syringe sharing (p < 0.05).
Differences in HIV prevalence across cities reflect mainly differences in risk environments experienced by PWID, shaped by police practices, access to injection equipment, and dynamics of drug markets. Findings highlight the importance of ensuring sterile syringe availability through harm reduction services and a human rights approach to drug harms in northern Mexico and to generate better understanding of local dynamics and contexts of drug use for designing proper harm reduction programs.
大量研究调查了提华纳和华雷斯城（CJ）注射毒品使用和艾滋病毒传播的上升情况。然而，关于埃莫西约的注射动态知之甚少。本研究比较了 across Tijuana、CJ 和 Hermosillo 的注射吸毒者（PWID）的与毒品相关的行为和艾滋病毒风险环境，以确定可能解释艾滋病毒流行率差异的因素。
来自提华纳的数据属于一项前瞻性研究（El Cuete IV）。来自埃莫西约和华雷斯城的数据属于一项横断面研究。这两项研究都在 PWID 花费时间的地方收集数据。所有参与者都完成了定量行为和艾滋病毒血清学检测。使用仅具有可比性的变量合并数据集。使用描述性统计检验比较了每个城市抽样的注射吸毒者的社会人口统计学和行为特征。建立了一个逻辑回归模型，以确定与过去 6 个月报告接受性注射器共享的可能性独立相关的因素。
共有 1494 名 PWID 于 2011 年 3 月至 2012 年 5 月期间提供数据。来自提华纳（4.2%）、CJ（7.7%）和埃莫西约（5.2%）的参与者的艾滋病毒流行率差异显著（p<0.05）。来自埃莫西约的 PWID 报告了更好的生活条件、较低的吸毒频率和较低的注射器共享率（p<0.01）。来自 CJ 的 PWID 报告了更高的注射器共享率和警察没收率（p<0.01）。在多变量逻辑回归模型中，与提华纳相比，生活在埃莫西约（调整后的优势比 [AOR] = 0.42，95%置信区间 [CI] 0.29-0.61）和女性（AOR = 0.61，95%CI 0.45-0.83）是注射器共享的保护因素。使用冰毒（AOR = 1.62，95%CI 1.24-2.13，p=0.001）、在过去 6 个月内经历过警察没收注射器（AOR = 1.78，95%CI 1.34-2.40）和较低的注射器可用性感知（AOR = 2.15，95%CI 1.59-2.91）与注射器共享显著相关（p<0.05）。
城市间艾滋病毒流行率的差异主要反映了 PWID 所经历的风险环境的差异，这些差异受警察行为、注射设备获取和毒品市场动态的影响。研究结果强调了通过减少伤害服务和以人权为基础的方法确保无菌注射器供应的重要性，以减轻毒品危害，并更好地了解当地的毒品使用动态和背景，为制定适当的减少伤害方案提供依据。
