187232 Reduced Infectious Disease Risk among Recent Border Crossing Injection Drug Users along the Mexico/U.S. Border

Tuesday, October 28, 2008

Kimberly C. Brouwer, PhD , Division of International Health & Cross-Cultural Medicine, University of California, San Diego, La Jolla, CA
Maria Remedios Lozada, Dra , Patronato Pro-COMUSIDA, Tijuana, Mexico
Alicia Vera, MPH , Division of International Health & Cross-Cultural Medicine, University of California, San Diego, La Jolla, CA
Carlos Magis-Rodriguez, MD, MPH , SecretarÝa de Salud, Centro Nacional para la Prevenciˇn del VIH/SIDA, Anzures, Mexico D.F., Mexico
Maria Luisa Z˙˝iga, PhD , Division of International Health & Cross-Cultural Medicine, University of California, San Diego, La Jolla, CA
Victoria D. Ojeda, PhD, MPH , Division of International Health & Cross-Cultural Medicine, University of California, San Diego, La Jolla, CA
Steffanie A. Strathdee, PhD , Division of International Health & Cross-Cultural Medicine, University of California, San Diego, La Jolla, CA
Illicit drug use in Mexico is concentrated along the Mexico/U.S. border. San Diego/Tijuana is the busiest land border crossing in the western hemisphere. We sought to characterize behaviors of injection drug users (IDUs) who were recent border crossers. From 4/06-6/07, Tijuana IDUs who injected within the last month were recruited using respondent-driven sampling, administered a survey, and tested for infectious diseases. Logistic regression compared IDUs who crossed to the U.S. in the past year with non-crossers. Of 1056 IDUs, 78% had ever traveled to the U.S., 7% in the past year, with 6% accessing U.S. health services. Half of recent border crossers worked, 21% bought and 4% sold drugs, 10% bought syringes, and 6% bought and 4% sold sex. Recent crossers were more likely to have injected with a U.S. resident (67% vs. 46%) and used drugs in the U.S. (80% vs. 56%). Independent associations with recent crossing were: being female (adjusted odds ratio (AOR)=2.23;95%CI=1.17-4.25); younger (AOR=0.95/year;95%CI:0.92-0.99); and completing secondary school (AOR=2.35;95%CI=1.35-4.11). Crossers had marginally lower prevalence of tuberculosis and HIV, and significantly lower syphilis (AOR=0.10;95%CI=0.02-0.42) and shooting gallery use (16% vs .40%). Although income was similar, recent crossers had higher odds of having someone from whom they could ask advice/borrow cash (2.13;95%CI=1.25-3.61), recent drug treatment (AOR=2.11;95%CI=1.03-4.34), and having family who used illicit drugs (AOR=1.81;95%CI=1.07-3.08). Cross-border interactions are common in Tijuana IDUs, suggesting potential for infectious disease spread, but also prevention and treatment services exposure. Cross-border health programs, investigations of U.S. IDUs cross-border activities, and prospective studies should be expanded.

Learning Objectives:
1. Describe cross-border activities of injection drug users along the Mexico/U.S. border 2. Identify methods to recruit difficult to reach populations 3. Articulate behavioral differences between injection drug users who are border crossers versus those who have not recently traveled internationally

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I participated in many stages of the study, analyzed the data, and wrote the abstract in conjunction with the co-authors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.