High prevalence of abscesses and self-treatment among injection drug users in Tijuana, Mexico

Abstract

Summary Background Soft tissue infections are common among injection drug users (IDUs), but information on correlates and treatment in this highly marginalized population is lacking. Methods Six hundred twenty-three community-recruited IDUs in Tijuana, Mexico, completed a detailed interview on abscess history and treatment. Univariate and multiple logistic regressions were used to identify factors independently associated with having an abscess in the prior 6 months. Results Overall, 46% had ever had an abscess and 20% had had an abscess in the past 6 months. Only 12% had sought medical care for their most recent abscess; 60% treated the abscess themselves. The most common self-treatment method was to apply heated (24%) or unheated (23%) Aloe vera leaf. Other methods included draining the wound with a syringe (19%) or knife (11%). Factors independently associated with recent abscess were having income from sex work (adjusted odds ratio (aOR) 4.56, 95% confidence interval (CI) 2.08–10.00), smoking methamphetamine (aOR 1.65, 95% CI 1.05–2.62), seeking someone to help with injection (aOR 2.06, 95% CI 1.18–3.61), and reporting that police affected where they used drugs (aOR 2.14, 95% CI 1.15–3.96). Conclusions Abscesses are common among IDUs in this setting, but appropriate treatment is rare. Interventions to reduce barriers to medical care in this population are needed. Research on the effectiveness of Aloe vera application in this setting is also needed, as are interventions to provide IDU sex workers, methamphetamine smokers, and those who assist with injection with the information and equipment necessary to reduce abscess risk.

Healthcare seeking and hospital admissions by people who inject drugs in response to symptoms of injection site infections or injuries in three urban areas of England

“…The use of these approaches could have resulted in the over-sampling of higher-risk individuals. Similar levels of symptoms to those reported here have been found in studies from other countries [12,26]. Overall a quarter of the PWID participating in this study had sought advice from a doctor or nurse about one of the three symptoms enquired about in the study.…”

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

“…[7][8][9][10][11][12][13][14]23,26,46,48,49 Previous studies along Mexico's North Border have contributed to this international consensus by identifying a panoply of associations between criminal justice experiences and behavioral risk factors, including syringe sharing. 29,50,51 We have also observed independent associations between arrest and HIV status. 30 This study extends previous research on the links between experiencing extra-judicial police practices with HIV infection 18 by demonstrating a full range of behavioral and health factors associated with syringe confiscation and thus strengthening the evidence base on the health-human rights nexus.…”

“…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.…”

Healthcare avoidance by people who inject drugs in Bangkok, Thailand

“…A Yes have assessed healthcare-seeking behaviour: in Mexico, only 12% of IDU sought formal treatment for skin abscesses 31 ; in Miami, many chronic drug users reported 'attitudinal and behavioural barriers' to health care, such as not wanting treatment or self-treating 32 ; and in India, 33% of IDU did not seek formal healthcare services. 33 The latter, however, was to our knowledge the only study to analyse social and structural factors and found that low utilization of healthcare services was associated with exposure to policing, social exclusion and negative healthcare experiences.…”