Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico.
BACKGROUND
Injection drug use is a growing public health crisis along the U.S.-Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. We explored the acceptability and feasibility of such interventions in Tijuana, a city adjacent to San Diego, California.


METHODS
Using in-depth qualitative interviews conducted from August 2006-March 2007 with 40 key stakeholders - pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel - we explored the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included barriers, structural limitations, and suggestions for implementation.


RESULTS
Topics included acceptance and feasibility of needle exchange programmes (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. Of these interventions, NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding.


CONCLUSIONS
Increasing HIV infection rates among injection drug users in Tijuana have prompted interest in public health responses. Our results may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana.
Philbin
Morgan M
MM
School of Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA.
Mantsios
Andrea
A
Lozada
Remedios
R
Case
Patricia
P
Pollini
Robin A
RA
Alvelais
Jorge
J
Latkin
Carl A
CA
Magis-Rodriguez
Carlos
C
Strathdee
Steffanie A
SA
D000328:Adult; D000368:Aged; D001290:Attitude; D005240:Feasibility Studies; D005260:Female; D040261:Harm Reduction; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D035846:Law Enforcement; D008297:Male; D008800:Mexico; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010595:Pharmacists / Q000523:psychology; D011057:Politics; D012067:Religion; D015819:Substance Abuse, Intravenous / Q000523:psychology*