Impact of Drug Policy Reform on the HIV Risk Environment Among IDUs in Tijuana (El Cuete, Phase III)

Funded by NIDA grant R01 DA 019829; PI: Steffanie Strathdee

The overall goal of this project is to characterize the epidemiology of HIV, syphilis and TB among injecting drug users (IDUs) in Tijuana, Mexico. Recent data suggest a dynamic HIV sub-epidemic among IDUs on the northwestern Mexico-US border where injection drug use is now a major public health problem.

The aims of this proposal are:

  1. To determine HIV, TB and syphilis prevalence and incidence among IDUs in Tijuana.
  2. To determine the extent to which potentially modifiable individual, social and environmental factors influence the following outcomes among IDUs in Tijuana: i) prevalent and incident HIV and TB infections; ii) risk behaviors for blood borne infections (e.g., direct and indirect syringe sharing, shooting gallery attendance); iii) barriers to access and use of sterile syringes and injection paraphernalia within the context of legal syringe access through pharmacies. Individual level factors of interest include knowledge of HIV and HCV serostatus, recent onset injection and use of specific injection drug combinations (e.g., heroin and methamphetamine) and formulations (e.g., heroin tar versus powder); Social factors include emigration and personal network characteristics; Environmental factors include geospatial factors (e.g., distance from the border, frequency of border crossings, density of shooting galleries, pharmacies and drug treatment programs), and experiences with law enforcement.
  3. To examine the social acceptability of interventions to reduce drug-related harm among the following stakeholders in Tijuana.

To meet Aims 1 and 2, 1000 IDUs who have injected at least once in the prior 6 months will be recruited using respondent driven sampling, which will facilitate an unbiased estimate of HIV and HCV prevalence and associated risk behaviors. Face-to-face interviews will collect sociodemographic and behavioral data over 18 months of follow-up. To assess geospatial factors, we will use hand-held global positioning system devices to map cross-street locations of shooting galleries, pharmacies and drug treatment programs. To meet Aim 3, we will conduct in-depth interviews with three types of key informants (e.g., systems, interactor and street-level key informants). Although Mexico is considered a country of low HIV/AIDS prevalence with a concentrated epidemic, the window of opportunity for prevention is believed to be closing rapidly since IDU-associated HIV epidemics are often explosive and can quickly become generalized. This study will inform the development of culturally-appropriate interventions in one of the largest Mexican-U.S. cities, which has implications for policy making.


  • Bucardo J, Brouwer KC, Magis-Rodriguez C, et al. Historical trends in the production and consumption of illicit drugs in Mexico: implications for the prevention of blood borne infections. Drug Alcohol Depend 2005 September 1; 79(3): 281-93. PMCID: PMC2196212
  • Strathdee SA, Fraga WD, Case P, et al. "Vivo para consumirla y la consumo para vivir" ["I live to inject and inject to live"]: high-risk injection behaviors in Tijuana, Mexico. J Urban Health 2005 September; 82(3 Suppl 4): iv58-iv73. PMCID: PMC2196210
  • Brouwer KC, Strathdee SA, Magis-Rodriguez C, et al. Estimated numbers of men and women infected with HIV/AIDS in Tijuana, Mexico. J Urban Health 2006 March; 83(2): 299-307. PMCID: PMC2527171
  • Brouwer KC, Case P, Ramos R, et al. Trends in production, trafficking, and consumption of methamphetamine and cocaine in Mexico. Subst Use Misuse 2006; 41(5): 707-27. PMCID: PMC2757051
  • Frost SD, Brouwer KC, Firestone Cruz MA, et al. Respondent-driven sampling of injection drug users in two U.S.-Mexico border cities: recruitment dynamics and impact on estimates of HIV and syphilis prevalence. J Urban Health 2006 November; 83(6 Suppl): i83-i97. PMCID: PMC1705507
  • Cruz MF, Mantsios A, Ramos R, et al. A qualitative exploration of gender in the context of injection drug use in two US-Mexico border cities. AIDS Behav 2007 March; 11(2): 253-62. PMCID: PMC2733528
  • White EF, Garfein RS, Brouwer KC, et al. Prevalence of hepatitis C virus and HIV infection among injection drug users in two Mexican cities bordering the U.S. Salud Publica Mex 2007 May; 49(3): 165-72. PMCID: PMC2743977
  • Case P, Ramos R, Brouwer KC, et al. At the borders, on the edge: use of injected methamphetamine in Tijuana and Ciudad Juarez, Mexico. J Immigr Minor Health 2008 February; 10(1): 23-33. PMCID: PMC2716800
  • Deiss RG, Brouwer KC, Loza O, et al. High-risk sexual and drug using behaviors among male injection drug users who have sex with men in 2 Mexico-US border cities. Sex Transm Dis 2008 March; 35(3): 243-9. PMCID: PMC2391275
  • Miller CL, Firestone M, Ramos R, et al. Injecting drug users' experiences of policing practices in two Mexican-U.S. border cities: public health perspectives. Int J Drug Policy 2008 August; 19(4): 324-31. PMCID: PMC2546504
  • Moyer LB, Brouwer KC, Brodine SK, et al. Barriers and missed opportunities to HIV testing among injection drug users in two Mexico--US border cities. Drug Alcohol Rev 2008 January; 27(1): 39-45. PMCID: PMC2196215
  • Philbin M, Pollini RA, Ramos R, et al. Shooting gallery attendance among IDUs in Tijuana and Ciudad Juarez, Mexico: correlates, prevention opportunities, and the role of the environment. AIDS Behav 2008 July; 12(4): 552-60. PMCID: PMC2733534
  • Pollini RA, Brouwer KC, Lozada RM, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction 2008 January; 103(1): 101-8. PMCID: PMC2214830
  • Strathdee SA, Magis-Rodriguez C. Mexico's evolving HIV epidemic. JAMA 2008 August 6; 300(5): 571-3. PMCID: PMC2717701
  • Strathdee SA, Case P, Lozada R, et al. The color of meth: is it related to adverse health outcomes? An exploratory study in Tijuana, Mexico. Am J Addict 2008 March; 17(2): 111-5.
  • Strathdee SA, Philbin MM, Semple SJ, et al. Correlates of injection drug use among female sex workers in two Mexico-U.S. border cities. Drug Alcohol Depend 2008 January 1; 92(1-3): 132-40. PMCID: PMC2213538
  • Strathdee SA, Lozada R, Ojeda VD, et al. Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico. PLoS One 2008; 3(7): e2690. PMCID: PMC2467493
  • Strathdee SA, Lozada R, Pollini RA, et al. Individual, social, and environmental influences associated with HIV infection among injection drug users in Tijuana, Mexico. JAIDS 2008 March 1; 47(3): 369-76. PMCID: PMC2752692
  • Abramovitz D, Volz EM, Strathdee SA, et al. Using respondent-driven sampling in a hidden population at risk of HIV infection: who do HIV-positive recruiters recruit? Sex Transm Dis 2009 December; 36(12): 750-6. PMCID: PMC2788103
  • Brouwer KC, Lozada R, Cornelius WA, et al. Deportation along the U.S.-Mexico border: its relation to drug use patterns and accessing care. J Immigr Minor Health 2009 February; 11(1): 1-6.
  • Deiss R, Garfein RS, Lozada R, et al. Influences of cross-border mobility on tuberculosis diagnoses and treatment interruption among injection drug users in Tijuana, Mexico. Am J Public Health 2009 August; 99(8): 1491-5.
  • Garfein RS, Lozada R, Liu L, et al. High prevalence of latent tuberculosis infection among injection drug users in Tijuana, Mexico. Int J Tuberc Lung Dis 2009 May; 13(5): 626-32. PMCID: PMC2744313
  • Iniguez-Stevens E, Brouwer KC, Hogg RS, et al. Estimating the 2006 prevalence of HIV by gender and risk groups in Tijuana, Mexico. Gac Med Mex 2009 May; 145(3): 189-95.
  • Philbin MM, Mantsios A, Lozada R, et al. Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico. Int J Drug Policy 2009 July; 20(4): 329-35. PMCID: PMC2727467
  • Pollini RA, Alvelais J, Gallardo M, et al. The harm inside: injection during incarceration among male injection drug users in Tijuana, Mexico. Drug Alcohol Depend 2009 July 1; 103(1-2): 52-8. PMCID: PMC2693031
  • Poon AF, Brouwer KC, Strathdee SA, et al. Parsing social network survey data from hidden populations using stochastic context-free grammars. PLoS One 2009; 4(9): e6777. PMCID: PMC2734164
  • Ramos R, Ferreira-Pinto JB, Brouwer KC, et al. A tale of two cities: Social and environmental influences shaping risk factors and protective behaviors in two Mexico-US border cities. Health Place 2009 December; 15(4): 999-1005. PMCID: PMC2735581
  • Rusch ML, Lozada R, Pollini RA, et al. Polydrug use among IDUs in Tijuana, Mexico: correlates of methamphetamine use and route of administration by gender. J Urban Health 2009 September; 86(5): 760-75. PMCID: PMC2729865
  • Volkow P, Brouwer KC, Loza O, et al. Cross-border paid plasma donation among injection drug users in two Mexico-U.S. border cities. Int J Drug Policy 2009 September; 20(5): 409-12.