title: Barriers and missed opportunities to HIV testing among injection drug users in two Mexico--US border cities.
abstract: OBJECTIVE
  Despite increasing HIV prevalence in cities along the Mexico--US border, HIV testing among high-risk populations remains low. We sought to identify barriers associated with HIV testing among injection drug users (IDUs) in Tijuana and Ciudad Juarez, the two largest Mexican border cities located across from San Diego, California and El Paso, Texas, respectively.
  
  
  METHODS
  In 2005, 222 IDUs in Tijuana and 205 IDUs in Ciudad Juarez were recruited by respondent-driven sampling and administered a questionnaire to collect socio-demographic, behavioural and HIV testing history data. Blood samples were provided for serological testing of HIV, hepatitis C virus (HCV) and syphilis.
  
  
  RESULTS
  Only 38% and 30% of respondents in Tijuana and Ciudad Juarez, respectively, had ever had an HIV test. The factors independently associated with never having been tested for HIV differed between the two sites, except for lack of knowledge on HIV transmission, which was independently associated in both locales. Importantly, 65% of those who had never been tested for HIV in both cities experienced at least one missed opportunity for voluntary testing, including medical visits, drug treatment and spending time in jail.
  
  
  CONCLUSIONS
  Among this high-risk IDU population we found HIV testing to be low, with voluntary testing in public and private settings utilised inadequately. These findings underscore the need to expand voluntary HIV education and testing and to integrate it into services and locales frequented by IDUs in these Mexico--US border cities.
authors.affiliation: Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, CA 93093-0622, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Moyer
authors.forename: Kimberley C
authors.initials: KC
authors.lastname: Brouwer
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Brodine
authors.forename: Rebeca
authors.initials: R
authors.lastname: Ramos
authors.forename: Remedios
authors.initials: R
authors.lastname: Lozada
authors.forename: Michelle Firestone
authors.initials: MF
authors.lastname: Cruz
authors.forename: Carlos
authors.initials: C
authors.lastname: Magis-Rodriguez
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008800:Mexico / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012494:Sampling Studies; D016036:Seroepidemiologic Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology; D014171:Transients and Migrants; D014481:United States / Q000453:epidemiology; D014505:Urban Population
chemical_list: D015483:HIV Antibodies