title: High prevalence of abscesses and self-treatment among injection drug users in Tijuana, Mexico.
abstract: BACKGROUND
  Soft tissue infections are common among injection drug users (IDUs), but information on correlates and treatment in this highly marginalized population is lacking.
  
  
  METHODS
  Six hundred twenty-three community-recruited IDUs in Tijuana, Mexico, completed a detailed interview on abscess history and treatment. Univariate and multiple logistic regressions were used to identify factors independently associated with having an abscess in the prior 6 months.
  
  
  RESULTS
  Overall, 46% had ever had an abscess and 20% had had an abscess in the past 6 months. Only 12% had sought medical care for their most recent abscess; 60% treated the abscess themselves. The most common self-treatment method was to apply heated (24%) or unheated (23%) Aloe vera leaf. Other methods included draining the wound with a syringe (19%) or knife (11%). Factors independently associated with recent abscess were having income from sex work (adjusted odds ratio (aOR) 4.56, 95% confidence interval (CI) 2.08-10.00), smoking methamphetamine (aOR 1.65, 95% CI 1.05-2.62), seeking someone to help with injection (aOR 2.06, 95% CI 1.18-3.61), and reporting that police affected where they used drugs (aOR 2.14, 95% CI 1.15-3.96).
  
  
  CONCLUSIONS
  Abscesses are common among IDUs in this setting, but appropriate treatment is rare. Interventions to reduce barriers to medical care in this population are needed. Research on the effectiveness of Aloe vera application in this setting is also needed, as are interventions to provide IDU sex workers, methamphetamine smokers, and those who assist with injection with the information and equipment necessary to reduce abscess risk.
authors.affiliation: Department of Medicine, University of California-San Diego, La Jolla, CA 92093, USA. rpollini@ucsd.edu
authors.forename: Robin A
authors.initials: RA
authors.lastname: Pollini
authors.forename: Manuel
authors.initials: M
authors.lastname: Gallardo
authors.forename: Samreen
authors.initials: S
authors.lastname: Hasan
authors.forename: Joshua
authors.initials: J
authors.lastname: Minuto
authors.forename: Remedios
authors.initials: R
authors.lastname: Lozada
authors.forename: Alicia
authors.initials: A
authors.lastname: Vera
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Zúñiga
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000628:therapy*; D000328:Adult; D000504:Aloe; D019969:Amphetamine-Related Disorders / Q000150:complications; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008517:Phytotherapy; D011446:Prospective Studies; D012307:Risk Factors; D012648:Self Care; D011477:Sex Work; D018461:Soft Tissue Infections / Q000209:etiology* / Q000628:therapy*; D015819:Substance Abuse, Intravenous / Q000150:complications*
references.citation: JAMA. 1998 Mar 18;279(11):859-63
references.pmid: 9516001
references.citation: Aust N Z J Public Health. 2008 Feb;32(1):34-7
references.pmid: 18290911
references.citation: N Engl J Med. 2005 Apr 7;352(14):1436-44
references.pmid: 15814879
references.citation: J Acquir Immune Defic Syndr. 2008 Mar 1;47(3):369-76
references.pmid: 18176320
references.citation: J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2006 Apr;24(1):103-54
references.pmid: 16690538
references.citation: Soc Sci Med. 2003 Jul;57(1):39-54
references.pmid: 12753815
references.citation: Addiction. 2008 Jan;103(1):101-8
references.pmid: 18028520
references.citation: Clin Infect Dis. 2005 May 15;40(10):1529-34
references.pmid: 15844078
references.citation: J Urban Health. 2003 Mar;80(1):127-36
references.pmid: 12612102
references.citation: Clin Infect Dis. 2003 Jan 15;36(2):131-9
references.pmid: 12522744
references.citation: Arch Intern Med. 1998 Apr 27;158(8):895-9
references.pmid: 9570176
references.citation: Clin Infect Dis. 2001 Jul 1;33(1):35-40
references.pmid: 11389492
references.citation: Harm Reduct J. 2005 Nov 10;2:24
references.pmid: 16281979
references.citation: Clin Infect Dis. 2002 Feb 15;34(4):425-33
references.pmid: 11797167
references.citation: Drug Alcohol Depend. 2009 Feb 1;100(1-2):9-16
references.pmid: 19013725
references.citation: J Infect Dis. 2004 Nov 15;190(10):1730-8
references.pmid: 15499526
references.citation: Clin Infect Dis. 2000 Mar;30(3):579-81
references.pmid: 10722447
references.citation: J Urban Health. 2005 Sep;82(3 Suppl 4):iv58-73
references.pmid: 16107441
references.citation: Ann Emerg Med. 2007 Jan;49(1):116-7
references.pmid: 17197298
references.citation: Emerg Infect Dis. 2007 Nov;13(11):1707-13
references.pmid: 18217555
references.citation: Liver Int. 2008 Jul;28(6):781-6
references.pmid: 18312289
references.citation: Antimicrob Agents Chemother. 2003 Mar;47(3):1137-9
references.pmid: 12604556
references.citation: Soc Sci Med. 2005 Aug;61(3):673-84
references.pmid: 15899325
references.citation: J Clin Epidemiol. 1996 Oct;49(10):1149-54
references.pmid: 8826995
references.citation: N Engl J Med. 2006 Aug 17;355(7):666-74
references.pmid: 16914702
references.citation: Eur J Gastroenterol Hepatol. 2008 Jan;20(1):29-32
references.pmid: 18090987
references.citation: Molecules. 2008 Aug 08;13(8):1599-616
references.pmid: 18794775
references.citation: N Engl J Med. 2005 Feb 3;352(5):468-75
references.pmid: 15689585
references.citation: Am J Addict. 2008 Mar-Apr;17(2):111-5
references.pmid: 18393053
references.citation: Am J Public Health. 2002 Dec;92(12):1915-7
references.pmid: 12453808
references.citation: CMAJ. 2001 Aug 21;165(4):415-20
references.pmid: 11531049
references.citation: Public Health Rep. 1992 Sep-Oct;107(5):595-8
references.pmid: 1410243
references.citation: JAMA. 2001 Jun 6;285(21):2707-9
references.pmid: 11419421
references.citation: Health Place. 2001 Dec;7(4):319-31
references.pmid: 11682331
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Sep;13(1):87-92
references.pmid: 8797690
references.citation: BMC Public Health. 2008 Dec 09;8:405
references.pmid: 19068133