Research paperInjecting drug users’ experiences of policing practices in two Mexican–U.S. border cities: Public health perspectives
Introduction
Mexico is considered by UNAIDS to be a country of low HIV prevalence and ranks third in the Americas in reported AIDS cases behind the United States and Brazil (UNAIDS, 2002). Although the prevalence of HIV infection amongst injection drug users (IDUs) in Mexico appears low (CONASIDA, 2004, Viani et al., 2004), a recent study found that the prevalence of hepatitis C virus (HCV) amongst IDUs was approximately 95% in Tijuana and Ciudad Juarez. The use of injection drugs has been on the rise during the past decade in these border cities, which are considered hot spots for heroin and stimulant use (Brouwer et al., 2006, DEA, 2003).
Tijuana, Mexico, sits across from San Diego, United States, along the busiest border crossing in the world (Lange, Lauer, & Voas, 1999). A major route for trafficking heroin, cocaine and methamphetamine into the United States passes through Tijuana (Brouwer et al., 2006). ‘Spillover’ from drug shipments has created a local drug consumption market in Tijuana, a city reported to have three times the national average of individuals consuming illicit drugs (Magis-Rodriguez, Marques, & Touze, 2002). Tijuana is home to a growing estimated population of 10,000 IDUs and over 200 shooting galleries [‘picaderos’] (Morales, Lozada, Magis, & Saavedra, 2004). Services for drug users are scant; there is no formal needle exchange programme (NEP) and only two methadone clinics, both of which are privately operated.
Ciudad (Cd.) Juarez, Mexico, is situated at the approximate mid-point of the 2000 miles long border between Mexico and the United States and is part of a metroplex with El Paso, Texas and Las Cruces, New Mexico. Cd. Juarez is ranked second only to Tijuana in the prevalence of illicit drug use and is estimated to have twice the national average (SSA, 1998). A mathematical model using capture–recapture methods conducted in 2001 estimated that there were approximately 6000 IDUs including 3000–3500 ‘heavy’ heroin injectors (defined as having used heroin two to three times a day in the previous 6 months) and as many as 186 picaderos in Cd. Juarez (Cravioto, 2003).
Several important factors have been identified in settings worldwide that influence risk for blood-borne transmission amongst IDUs. At the individual level, syringe sharing is an important factor in the transmission of blood-borne viruses, which include HIV, HCV and hepatitis B virus (Diaz, Chu, Weinstein, Mokotoff, & Jones, 1998). At the social level, personal networks form an integral part of the risk environment amongst IDUs because HIV is not homogenously distributed and is present in systematically concentrated social and geographic pockets (Neaigus et al., 1996). Further, law enforcement practices that heighten fear of arrest or other negative interactions with police can discourage IDUs from carrying syringes. This in turn can lead IDUs to share syringes and can facilitate the formation of high-risk needle sharing networks (Burris, Gable, Stone, & Lazzarini, 2003).
Whilst syringe purchase and possession by IDUs is not a crime in Mexico, little is known regarding the practices of police officers in relation to possession of syringes by IDUs. Research elsewhere has shown that laws on the books and practice on the street are not necessarily congruent and that the practices of police officers can greatly affect the self-efficacy of IDUs to reduce the likelihood of blood-borne infection transmission. The economic disparities between cities situated on the U.S.–Mexico border likely provide additional dimensions to the experiences of IDUs in Tijuana and Cd. Juarez, particularly in regards to interactions between police and IDUs (Burris et al., 2004). Studies of structural factors that influence multiple pathways of disease risk are needed to help inform the development of culturally appropriate interventions (Rhodes, Singer, Bourgois, Friedman, & Strathdee, 2005).
The fact that HIV prevalence amongst IDUs in Tijuana and Cd. Juarez is low, despite a high prevalence of HCV infection, suggests conditions that facilitate HIV transmission are present and that a small window of opportunity to intervene exists before a large-scale epidemic occurs. We therefore conducted a series of qualitative interviews with IDUs in Tijuana and Cd. Juarez, Mexico which included questions regarding drug users’ experiences with law enforcement practices in order to better understand the role of front line police officers in reducing or increasing the risks of blood-borne infection amongst IDUs.
Section snippets
Methods
Between April and May 2004, a team of eight trained Mexican interviewers conducted guided in-depth interviews in Spanish with 43 IDUs (25 males, 18 females) in Tijuana and Cd. Juarez, Mexico. Participants were eligible for interviews provided they were aged 18 years or older, resided in Tijuana or Cd. Juarez and reported injecting illicit substances at least once within the prior month, identified through the presence of recent injection stigmata (i.e., track marks). In order to understand the
Results
Socio-demographic characteristics of the 43 respondents are summarized in Table 1, Table 2.
Discussion
Police behaviour has been shown to influence IDUs’ ability to use protective behaviours against blood-borne infection transmission in numerous studies world-wide (Cooper et al., 2004, Cooper et al., 2005; Maher & Dixon, 1999; Wood et al., 2003). In this qualitative study in two Mexican–U.S. border cities, participants reported that policing practices influenced whether they obtain and carry syringes, and where they inject. Some police in this setting appear to exercise broad discretion in
Acknowledgements
The authors gratefully acknowledge support from the National Institute on Drug Abuse (DA09225-S11) and the University of California San Diego Center for AIDS Research (AI36214-06). We also thank Drs. Wendy Davila and Remedios Lozada, Ms. Saida Gracia Perez, study interviewers from Tijuana and Cd. Juarez and the participants who shared their stories. Cari L. Miller is supported by a CIHR post-doctoral fellowship. Kimberly Brouwer is supported by NIDA grant K01DA020364 and an NIH Ruth L.
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