Calderón-Villarreal Alhelí, Avelar Portillo Lourdes Johanna, Abramovitz Daniela, Goldenberg Shira, Flanigan Shawn, Quintana Penelope J E, Harvey-Vera Alicia, Vera Carlos F, Rangel Gudelia, Strathdee Steffanie A, Kayser Georgia L
Department of Family and Preventive Medicine, University of California San Diego (UCSD), San Diego, California, USA.
School of Public Health, San Diego State University (SDSU), San Diego, California, USA.
Int J Equity Health. 2024 Apr 22;23(1):79. doi: 10.1186/s12939-024-02163-x.
Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area.
In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates.
Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing.
WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.
获得水、环境卫生和个人卫生服务（WASH）对于公众健康和人类尊严至关重要。注射吸毒者面临耻辱感和结构性暴力，这可能会限制他们获得WASH服务。很少有研究评估注射吸毒者的WASH服务可及性、不安全状况和不平等情况。我们描述了蒂华纳 - 圣地亚哥大都市区注射吸毒者的WASH服务可及性、社会和地理不平等以及与WASH不安全相关的因素。
在这项跨国民的横断面研究中，我们在2020 - 2021年采访了18岁及以上的注射吸毒者，了解他们的WASH服务可及性和不安全状况。将居住城市（蒂华纳/圣地亚哥）和住房状况作为自变量，以描述关键的WASH服务可及性结果，并评估其作为与WASH不安全结果相关的因素。使用对数修正泊松回归模型评估结果与自变量之间的关联度量，并对协变量进行调整。
在586名注射吸毒者中（202名来自蒂华纳；384名来自圣地亚哥），89%的人报告基本能获得饮用水，38%的人有基本的手部卫生条件，28%的人有基本的卫生设施，46%的人能洗澡，38%的人报告最近有露天排便情况。居住在蒂华纳的参与者报告在获得基本饮用水（调整后风险比：1.68，95%置信区间：1.02 - 2.76）、基本卫生条件（调整后风险比：1.45，95%置信区间：1.28 - 1.64）和洗澡（调整后风险比：1.21，95%置信区间：1.06 - 1.39）方面的不安全程度显著高于居住在圣地亚哥的人。无家可归者在获得基本饮用水（调整后风险比：2.03，95%置信区间：1.07 - 3.86）、基本卫生设施（调整后风险比：1.68，95%置信区间：1.48，1.92）、洗澡（调整后风险比：1.84，95%置信区间：1.52 - 2.22）以及用于清洁伤口（调整后风险比：3.12，95%置信区间：1.55 - 6.29）和准备毒品（调整后风险比：2.58，95%置信区间：1.36 - 4.89）的改善水源方面的不安全程度显著高于居住在永久性住房中的参与者。
按照国际标准，蒂华纳 - 圣地亚哥大都市区注射吸毒者的WASH服务可及性较低，且低于两国的全国平均水平。在这一人群中，无家可归与WASH不安全显著相关。需要集中努力，为注射吸毒者，尤其是无家可归者，确保持续可用的WASH服务。
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