Differential Effects of Migration and Deportation on HIV Infection among Male and Female Injection Drug Users in Tijuana, Mexico

Abstract

HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and female injection drug users (IDUs) in Tijuana in an effort to inform HIV prevention and treatment programs. IDUs aged ≥18 years were recruited using respondent-driven sampling and underwent testing for HIV, syphilis and structured interviews. Logistic regression identified correlates of HIV infection, stratified by gender. Among 1056 IDUs, most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (34% for females, 15% for males). HIV prevalence was higher in females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N = 158), factors independently associated with higher HIV prevalence included younger age, lifetime syphilis infection and living in Tijuana for longer durations. Among males (N = 898), factors independently associated with higher HIV prevalence were syphilis titers consistent with active infection, being arrested for having ‘track-marks’, having larger numbers of recent injection partners and living in Tijuana for shorter durations. An interaction between gender and number of years lived in Tijuana regressed on HIV infection was significant (p = 0.03). Upon further analysis, deportation from the U.S. explained the association between shorter duration lived in Tijuana and HIV infection among males; odds of HIV infection were four-fold higher among male injectors deported from the US, compared to other males, adjusting for all other significant correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's evolving HIV epidemic, and its impact is significantly modified by gender. Future studies are needed to elucidate the context of mobility and HIV acquisition in this region, and whether US immigration policies adversely affect HIV risk.

Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

“…This parallels previous research in this region, highlighting the role of actual and perceived police practices as facilitators of risk behaviors and barriers to protective behaviors, including pharmacy-based syringe access. 18,29,33,36,50,52,53 Women in this sample may encounter additional risks stemming from syringe confiscation in the realm of sexual transmission. Literature suggests that police officers often use drug and syringe possession and commercial sex activity to extort sexual services, 2,5,16,18,51,54 a paradigm clearly accentuated by our finding that syringe confiscation was independently associated with police sexual abuse.…”

Adapting chain referral methods to sample new migrants

“…As a result, migration-related surveys using RDS have multiplied in recent years, including surveys of migrant health (Montealegre et al 2012;Montealegre et al 2011;Strathdee et al 2008;Wagner et al 2011), workplace practices (Alsos and Eldring 2008;Bernhardt et al 2009), and transnational behaviours (Friberg and Horst 2014;Horvath 2012;Napierala and Gorny 2013).…”

A Comparison of Registered and Unregistered Female Sex Workers in Tijuana, Mexico

“…In a study evaluating injection drug users who had recently been deported or who had migrated to Tijuana, the odds of HIV infection among females increased with time spent in Tijuana, but the trend was opposite among males. 44 Our findings may suggest that women who are migrants to Tijuana are routed into sex work through establishments (such as bars) that may encourage them to become registered.…”