The Social and Environmental Context of Cross-Border Drug Use in Mexico: Findings from a Mixed Methods Study of Young Injection Drug Users Living in San Diego, CA

Abstract

We report the results of qualitative (n=19) and quantitative (n=545) interviews with young injection drug users (IDUs) in San Diego, California, USA about their experiences using drugs in Tijuana, Mexico, and associated risks for HIV infection. Young IDUs who have ever traveled to Mexico (n=365) used a variety of injection (54%) and non-injection (30%) drugs there, and appear to be heavier users than those who have never traveled to Mexico. Sociocultural themes influencing drug use in Mexico included: interactions amongst the purpose of travel, drug preference, and route of administration; familiarity with the border region; evolving relationships with the US and Mexican drug markets; and the experience of crossing the US/Mexico border. Interventions for IDUs in border regions need to be sensitive to the ethnicity, familiarity with the border region, and life history of participants, as well as differences in national policies that could influence drug use and risk for HIV on both sides of the border.

Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego

“…This could impact their risk for acquiring these infectious diseases (Rothenberg et al, 2000, 1998). PWIDs’ travel to Mexico because of a perception that it is easier to evade criminal penalties in the US, as demonstrated in the current study, or to obtain lower-cost or more available drug supplies, as shown in previous work (Wagner et al, 2012), demonstrates the continued need for laws in the US that provide alternatives to incarceration and that connect people to services (e.g., evidence based drug treatment) while keeping them connected to their support networks.…”

“…Both cities are located on a major international drug trafficking route that runs from the Andean region in South America to the United States, making drugs such as heroin, methamphetamine, and cocaine abundant in both cities (Bucardo et al, 2005). Approximately 10,000 people who inject drugs (PWIDs) reside in Tijuana, with many more crossing the border from San Diego, reportedly to use and buy illicit drugs because of lower prices, easier access, and to avoid facing legal penalties in the United States (Morales, Lozada, Magis, & Saaverda, 2004; Volkmann et al, 2011; Wagner et al, 2012). …”

“…Law enforcement practices, both official laws and enforcement of those laws, are one of the structural aspects that shape PWIDs’ risk environment (Burris et al., 2004; Rhodes, 2002), including individuals’ ability to access sterile needle/syringes and their capacity to avoid risky injection behaviors (Bluthenthal, Kral, Erringer, & Edlin, 1999; Bluthenthal, Lorvick, Kral, Erringer, & Kahn, 1999; Miller et al, 2009; Strathdee, Beletsky, & Kerr, 2015). Research among PWIDs in the Tijuana–San Diego border region has shown that individuals frequently travel between these two cities and have social relationships that transcend the international border (Volkmann et al, 2011; Wagner et al, 2010, 2012; Zúñiga et al, 2006). Given the connectedness of these two communities and the recent legal change in Mexico that has the potential to impact drug use risk environments in San Diego and Tijuana, we sought to investigate how policing practices in Tijuana may affect Mexican and American PWIDs differentially, in order to inform public health intervention and policies to reduce health and social risks associated with injection drug use.…”

Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status

“…The high risk of drug use among transnational Mexicans, defined as individuals who have resided in both Mexico and the United States, may have negative effects on the health and well-being of residents in both countries [5-7]. Emerging evidence has suggested that Mexican migrants who come to the United States increase their drug use while in the United States and those who return to Mexico have higher rates of substance problems [4,5] that often go untreated, compared to the nonmigrant population [6,8,9].…”

Place of Residence Moderates the Relationship Between Emotional Closeness and Syringe Sharing Among Injection Drug Using Clients of Sex Workers in the US-Mexico Border Region

“…Concern about bi-directional transmission of HIV and other infectious diseases at the US-Mexico border has inspired research to elucidate the social and environmental factors contributing to increased risk for HIV in this and other border regions [29, 30, 33, 34]. Social network-based approaches, which examine the composition and function of social relationships (including drug using relationships), are ideal for helping to uncover the mechanisms underlying HIV transmission in environments characterized by high levels of mobility and population mixing [35].…”