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No man’s land: deportation and migration as risk factors versus protective factors for HIV infection among male and female injection drug users in Tijuana, Mexico
Presented by Steffanie Strathdee, United States.
S. Strathdee1, R. Lozada2, V. Ojeda1, A. Vera1, R. Pollini1, K. Brouwer1, W. Cornelius3, L. Nguyen1, C. Magis-Rodriguez4, T.L. Patterson5, Proyecto El Cuete
1University of California San Diego, Family and Preventive Medicine, San Diego, United States, 2PRO-COMUSIDA, Tijuana, Mexico, 3University of California San Diego, Sociology, San Diego, United States, 4CENSIDA, Mexico City, Mexico, 5University of California San Diego, Psychiatry, San Diego, United States
Background: We examined gender-specific correlates of HIV infection among injection drug users (IDUs) in Tijuana, Baja California, a Mexico-US border city experiencing rising HIV rates.
Methods: IDUs aged ³18 years were recruited using respondent driven sampling. Participants underwent antibody testing for HIV, syphilis and structured interviews. Weighted logistic regression identified correlates of HIV infection, stratified by gender.
Results: Among 1056 IDUs, 67% were born outside Baja California. The most important reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (20% for males, 42% for females). Compared to males, females had higher HIV prevalence (10.5% vs. 3.4%, p<.001). Among females (N=158), factors independently associated with HIV included younger age (AdjOR:0.84 per year; p<0.0001), lifetime syphilis infection (AdjOR:4.8; p=0.01) and living in Tijuana for longer durations (AdjOR:1.9 per 10 years, p=0.01). Among males (N=898), factors independently associated with HIV were syphilis titers ³1:8 (AdjOR:6.2; p=0.0001), being arrested for having injection stigmata i.e,´track-marks´ (AdjOR:1.1 per 5 arrests; p=0.05), having larger numbers of recent injection partners (AdjOR:1.3 per 5 people, p=0.01) and living in Tijuana for shorter durations (AdjOR:0.66 per 10 years, p=0.02). Upon further analysis, deportation from the US displaced duration of time lived in Tijuana as a factor independently associated with HIV infection among males (AdjOR:4.0; p=0.002).
Conclusions: Deportation was associated with four-fold increased odds of HIV infection among male IDUs, whereas recent migration was protective among females. Although interpretation warrants caution since data were cross-sectional, these findings suggest that US immigration policies have a bearing on HIV vulnerability. Further study on the important role of displacement and mobility as risk factors for HIV infection is needed to inform prevention programs. Since syphilis was the only common HIV risk factor among male and female IDUs, STD prevention and treatment should be integrated into HIV prevention.
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