Syringe confiscation as an HIV risk factor: the public health implications of arbitrary policing in Tijuana and Ciudad Juarez, Mexico.
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.
Division of Global Public Health, University of California-San Diego, La Jolla, CA, USA. l.beletsky@neu.edu
Leo
L
Beletsky
Remedios
R
Lozada
Tommi
T
Gaines
Daniela
D
Abramovitz
Hugo
H
Staines
Alicia
A
Vera
Gudelia
G
Rangel
Jaime
J
Arredondo
Steffanie A
SA
Strathdee
D000328:Adult; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D035846:Law Enforcement; D008800:Mexico; D016017:Odds Ratio; D011634:Public Health; D012044:Regression Analysis; D012307:Risk Factors; D060386:Sex Workers; D015819:Substance Abuse, Intravenous; D011795:Surveys and Questionnaires; D013594:Syringes / Q000600:supply & distribution