Syringe confiscation as an HIV risk factor: the public health implications of arbitrary policing in Tijuana and Ciudad Juarez, Mexico

Leo Beletsky, Northeastern University School of Law
Remedios M. Lozada, Salud y Desarollo Comunitario de Ciudad Juárez A.C. (SADEC)
Tommi Gaines, University of California, San Diego, Division of Global Public Health
Daniela Abramovitz, University of California, San Diego, Division of Global Public Health,
Hugo Staines, Universidad Autonoma de Ciudad Juarez, MX
Alicia Vera, University of California, San Diego, Division of Global Public Health
Gudelia Rangel, El Colegio de la Frontera Norte; Salud del Migrante, Secretaria de Salud-Mexico, MX
Steffanie Strathdee, University of California, San Diego, Division of Global Public Health
Jaime Arredondo, University of California, San Diego, Division of Global Public Health

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Originally published in the Journal of Urban Health, Vol. 90, No. 2, pp. 284-298, 2013. The final publication is available at www.springerlink.com.

Funding for this study was provided by the National Institute on Drug Abuse (NIDA; R01 DA023877), R25DA025771, and D43TW008633.

Abstract

Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over-the-counter without a prescription, but police practices are often at odds with the law. FSW-IDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48%. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR]=2.54, 95% confidence interval [CI]=1.11-5.80), reporting sexual abuse by police (aOR=12.76, 95%CI=6.58-24.72), engaging in groin injection (aOR=1.84, 95%CI=1.15-2.93), injecting in public (aOR=1.64; 95%CI=1.14-2.36), and obtaining syringes from pharmacies (aOR:1.54; 95%CI=1.06-2.23). Higher education level was negatively associated with syringe confiscation (aOR=0.92, 95%CI=0.87-0.98) as was frequent injection with clients within the last month (aOR=0.64, 95%CI=0.44-0.94). This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.