title: Risk of violence in drug rehabilitation centers: perceptions of people who inject drugs in Tijuana, Mexico.
abstract: BACKGROUND
  In 2009, Mexico reformed its health law to partially decriminalize drug possession considered for personal use and to increase mandatory referrals to certified drug rehabilitation centers in lieu of incarceration. Concurrently, news media reported violent attacks perpetrated by drug cartels against Mexican drug rehabilitation centers and instances of human rights violations by staff against people who inject drugs (PWID) in treatment. In many cases, these violent situations took place at "Peer Support" (Ayuda Mutua) drug rehabilitation centers that house a large number of drug-dependent PWID. In an effort to understand barriers to treatment uptake, we examined prevalence and correlates of perceived risk of violence at drug rehabilitation centers among PWID in Tijuana, Mexico.
  
  
  METHODS
  Secondary analysis of baseline data collected between March 2011 and May 2013 of PWID recruited into a prospective cohort study in Tijuana. Interviewer-administered surveys measured perceived risk of violence at drug rehabilitation centers by asking participants to indicate their level of agreement with the statement "going to rehabilitation puts me at risk of violence". Logistic regression was used to examine factors associated with perceived risk of violence.
  
  
  RESULTS
  Of 733 PWID, 34.5 % perceived risk of violence at drug rehabilitation centers. In multivariate analysis, reporting ever having used crystal methamphetamine and cocaine (separately), having a great or urgent need to get help for drug use, and ever receiving professional help for drug/alcohol use were negatively associated with perceived risk of violence at drug rehabilitation centers, while having been told by law enforcement that drug rehabilitation attendance is mandatory was positively associated with perceived risk of violence. All associations were significant at a 0.05 alpha level.
  
  
  CONCLUSIONS
  The perception of violence at drug rehabilitation centers among PWID does not represent the lived experience of those PWID who attended professionalized services, reported a great or urgent need to get help for their drug use and had a history of using crystal and cocaine. Professionalizing service delivery and engaging law enforcement in their new role of decriminalization and service referral for PWID could address the perceptions of violence at drug rehabilitation centers. Similarly, health authorities should expand periodic inspections at drug rehabilitation centers to guarantee quality service provision and minimize PWIDs' concerns about violence.
authors.affiliation: Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. alvera@ucsd.edu.|Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico. alvera@ucsd.edu.
authors.forename: Alicia Yolanda
authors.initials: AY
authors.lastname: Harvey-Vera
authors.affiliation: Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. pgonzalez@ucsd.edu.
authors.forename: Patricia
authors.initials: P
authors.lastname: González-Zúñiga
authors.affiliation: Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico. caro_vargas@uabc.edu.mx.
authors.forename: Adriana Carolina
authors.initials: AC
authors.lastname: Vargas-Ojeda
authors.affiliation: Instituto Nacional de Psiquiatría de México, Ciudad de Mexico, Distrito Federal, Mexico. mmedina@hsph.harvard.edu.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: Centro Nacional para la Prevención y Control del VIH/SIDA, Ciudad de Mexico, Distrito Federal, Mexico. carlos.magis@gmail.com.
authors.forename: Carlos Leonardo
authors.initials: CL
authors.lastname: Magis-Rodríguez
authors.affiliation: Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. kdwagner@ucsd.edu.
authors.forename: Karla
authors.initials: K
authors.lastname: Wagner
authors.affiliation: Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. sstrathdee@ucsd.edu.
authors.forename: Steffanie Anne
authors.initials: SA
authors.lastname: Strathdee
authors.affiliation: Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. dwerb@ucsd.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Werb
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011446:Prospective Studies; D016320:Substance Abuse Treatment Centers / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000523:psychology* / Q000534:rehabilitation*; D014754:Violence / Q000706:statistics & numerical data*
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