Department of Medicine, University of California, San Diego, USA.
School of Social Work, San Diego State University, San Diego, USA.
AIDS Behav. 2024 Nov;28(11):3629-3642. doi: 10.1007/s10461-024-04433-9. Epub 2024 Jul 26.
Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in Tijuana. PWID were recruited via street outreach for a longitudinal cohort study from October 2020-September 2021. We compared SISE scale items by city. Due to low variability in SISE scores among San Diego residents, we restricted analysis of factors associated with SISE to Tijuana residents and identified correlates of SISE score levels (low, medium, high) using ordinal logistic regression. Of 474 participants, most were male (74%), Latinx (78%) and Tijuana residents (73%). Mean age was 44. Mean SISE scores among San Diego residents were high (3.46 of 4 maximum) relative to Tijuana residents (mean: 1.93). Among Tijuana residents, White race and having previously resided in San Diego were associated with higher SISE scores. HCV and HIV seropositivity, homelessness, fentanyl use, polysubstance co-injection, and greater injection frequency were associated with lower SISE scores. We found profound inequalities between Tijuana and San Diego SISE, likely attributable to differential risk environments. Associations with fentanyl and polysubstance co-injection, injection frequency, and both HIV and HCV seropositivity suggest that SISE contribute to blood-borne infection transmission risks in Tijuana. SISE reflects an actionable intervention target to reduce injection risk behaviors, but structural interventions are required to change the risk environment.
安全注射自我效能（SISE）与注射吸毒者（PWID）的注射风险行为呈负相关，但在不同的风险环境中尚未得到检验。我们比较了在加利福尼亚州圣地亚哥和墨西哥蒂华纳的 PWID 对经过验证的 SISE 量表的反应，并研究了蒂华纳 PWID 中 SISE 的相关因素。PWID 是通过街头外展从 2020 年 10 月至 2021 年 9 月招募到一个纵向队列研究中的。我们比较了城市之间的 SISE 量表项目。由于圣地亚哥居民的 SISE 得分差异较小，我们将与 SISE 相关的因素分析仅限于蒂华纳居民，并使用有序逻辑回归确定 SISE 得分水平（低、中、高）的相关因素。在 474 名参与者中，大多数是男性（74%），拉丁裔（78%）和蒂华纳居民（73%）。平均年龄为 44 岁。与蒂华纳居民相比，圣地亚哥居民的 SISE 得分较高（4 分中的 3.46 分）。在蒂华纳居民中，白人种族和以前居住在圣地亚哥与较高的 SISE 得分相关。HCV 和 HIV 血清阳性、无家可归、芬太尼使用、多药物共同注射和更高的注射频率与较低的 SISE 得分相关。我们发现蒂华纳和圣地亚哥的 SISE 之间存在巨大的不平等，这可能归因于不同的风险环境。与芬太尼和多药物共同注射、注射频率以及 HIV 和 HCV 血清阳性相关，表明 SISE 有助于在蒂华纳传播血源性感染的风险。SISE 反映了减少注射风险行为的可采取的干预目标，但需要进行结构性干预以改变风险环境。
