Intraurban Mobility and Its Potential Impact on the Spread of Blood-Borne Infections Among Drug Injectors in Tijuana, Mexico

Abstract

We explored intraurban mobility of Tijuana, Mexico, injection drug users (IDUs). In 2005, 222 IDUs underwent behavioral surveys and infectious disease testing. Participants resided in 58 neighborhoods, but regularly injected in 30. From logistic regression, “mobile” IDUs (injecting ≥3 km from their residence) were more likely to cross the Mexico/US border, share needles, and get arrested for carrying syringes—but less likely to identify hepatitis as an injection risk. Mobile participants lived in neighborhoods with less drug activity, treatment centers, or migrants, but higher marriage and home ownership rates. Mobile IDUs should be targeted for outreach and further investigation. The study's limitations are noted.

RÉSUMÉ

La mobilité intra-urbaine et son impact potentiel sur la propagation des infections à diffusion hématogène chez les utilisateurs de drogues injectables à Tijuana, Mexique

Nous avons exploré la mobilité intra-urbaine des utilisateurs de drogues injectables (UDI) de Tijuana et Mexique. En 2005, 222 UDI ont subis des enquêtes de comportement et des preuves des maladies infectieuses. Les participants ont résidés en 58 quartiers, mais se sont régulièrement injectés dans 30. De la régression logistique “Mobile” UDI (injectés ≥ 3 kilomètres de leurs résidences) ont étés plus susceptibles de traverser la frontière Mexique-États Unis, et partager des aiguilles, et être arrêtés pour porter des seringues, mais moins susceptibles à identifier l'hépatite comme un risque d'injection. Les participants de Mobile habitaient dans des quartiers avec moins d'activité de drogue, centres de traitement, ou migrants, mais taux de mariage et d'accession à la propriété plus élevés. Mobile UDI devraient être l'objectif de sensibilisation et une enquête plus profonde.

RESUMEN

Movilidad intraurbana y su posible impacto en la propagación de infecciones sanguíneas en los usuarios de drogas inyectables en Tijuana, México

Exploramos la movilidad intraurbana de los usuarios de drogas inyectables (UDIs) en Tijuana, México. En el 2005, 222 UDIs participaron en encuestas de comportamientos y pruebas de enfermedades infecciosas. Los participantes vivían en 58 colonias, pero regularmente se inyectaban en 30. Una regresión logística demostró quelos UDIs “móviles” (inyectarse a ≥3 km de su vivienda) eran más propensos a cruzar la frontera México/EE.UU., compartir jeringas y ser arrestados por llevar jeringas consigo –pero menos propensos a identificar la hepatitis como un riesgo del inyectarse. Los participantes móviles vivían en colonias con menos actividad relacionada con las drogas, centros de rehabilitación o migrantes, pero con índices más elevados de matrimonio y propiedad de viviendas. Los UDIs móviles deben ser el enfoque de programas de alcance y más investigación.

Keywords :

• injection drug use
• mobility
• distance
• GIS
• neighborhood context

THE AUTHORS

Dr. Kimberly C. Brouwer, Ph.D., is an Associate Professor and infectious disease epidemiologist in the Division of Global Public Health of the University of California San Diego. She is interested in applying novel and mixed methods to develop new approaches to global health issues.

She is currently PI of two 5-year US National Institute on Drug Abuse (NIDA) funded R01 grants and a developmental grant from the UCSD Center for AIDS research. While early studies concentrated on parasitic diseases, recent work has focused on exploring the spatial patterns of disease and migration/mobility issues surrounding HIV and substance use in the Americas and sub-Saharan Africa.

Dr. Remedios Lozada, M.D., Masters in Development, is the state coordinator for the Baja California HIV, AIDS, and STI Program, and is the copresident of COBINA Binational Health Councils for Baja California in Mexico. She is also a consultant with the Binational Border Health Commission, the University of California San Diego, and the consultant of OSC PREVENCASA (which provides assistance and health education to substance users). Dr. Lozada is currently a part-time epidemiology and community development of public health professor at the Universidad Autonoma de Baja California (UABC) School of Medicine and Tijuana's Universidad Iberoamericana. In 2009, Dr. Strathdee and Dr. Lozada, received the National Leadership Award for International Cooperation, which was issued by the US National Institutes of Health (NIH).

Dr. John R. Weeks, Ph.D., is a Distinguished Professor of Geography and Director of the International Population Center at San Diego State University. He is also a Clinical Professor of Global Public Health at the University of California San Diego, School of Medicine, and is a Senior Fellow of the California Council on Science and Technology. He is currently PI/PD of a multiyear, multi-institution grant from US National Institute of Child Health and Human Development (NICHD) studying health, poverty, and place in Accra, Ghana. His doctorate is in demography from the University of California, Berkeley.

Dr. Carlos Magis-Rodríguez, M.D., M.P.H., is a physician and epidemiologist, who has been working on the epidemiology of HIV since 1988 in the Mexican Ministry of Health. From 1988 to 1994, he was in charge of the National AlDS Case Registry surveillance. From 1996 to 2010, Dr. Magis-Rodríguez was the head of research and monitoring at CONASIDA (Centro Nacional para la Prevención y Control del VIH/SIDA—The National Center for the Prevention and Control of HIV/AIDS). In 1996, he began different risk intervention projects on the US/Mexico border. The projects were conducted in various cities with incarcerated substance users and individuals who sought treatment at NGOs (nongovernmental organizations). Since 1993, Dr. Magis-Rodríguez has been doing research and prevention programs in injected drug use and HIV, and beginning in 2011, he is directing a center for HIV and sexually transmitted infections for Mexico City. Dr. Magis-Rodríguez has presented in many diverse national and international HIV/AIDS meetings, and has published numerous papers and books on HIV/AIDS in Mexico.

Michelle Firestone, M.H.S. In 2003, Michelle Firestone-Cruz obtained a Masters degree in Health Sciences from The Johns Hopkins School of Public Health. Presently, she is pursuing a doctoral degree at the Dalla Lana School of Public Health at the University of Toronto. Michelle works closely with Dr. Janet Smylie at the Centre for Research on Inner City Health at St. Michael's Hospital, where her research is grounded in community partnerships and participatory methods, with a specific focus on mental health and healing among urban Aboriginal people in Canada. Ms. Firestone's previous work experience includes 2 years as a project director at the University of California San Diego (UCSD), where she coordinated a multisite research project on risks for HIV and hepatitis C virus among Mexican drug users along the Mexican/US border. From 2005 to 2007, Ms. Firestone worked as a research coordinator at the Centre for Addiction and Mental Health (CAMH) in Toronto, where her research centered primarily on illicit drug use, infectious disease transmission, and social determinants of addiction.

Dr. Steffanie A. Strathdee, Ph.D., is an infectious disease epidemiologist who has spent the last two decades focusing on underserved, marginalized populations in developed and developing countries. She is the Associate Dean of Global Health Sciences, and Harold Simon Professor and Chief of the Division of Global Public Health in the Department of Medicine at the University of California San Diego (UCSD) School of Medicine. In the last decade, Dr. Strathdee has published over 350 peer-reviewed publications on HIV prevention and the natural history of HIV infection. Currently, she is engaged in a number of HIV prevention projects in international settings and leads three NIH-funded studies of HIV risk behaviors among drug users and sex workers. Dr. Strathdee directs the Fogarty-funded AIDS Training Program between academic institutions in San Diego and Tijuana, the UCSD Global Health Initiative, and the UC Global Health Institute's Center for Migration and Health.