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

Funded by NIDA grant R01 DA0 19829; PI: Steffanie Strathdee

  • El Bordo -- HIV/SIDA: The Epidemic in Tijuana - Episode 1
  • The overall objective of Proyecto El Cuete is to evaluate the impact of structural interventions in the legal environment that may influence drug use and HIV risk behaviors of people who inject drugs (PWID) in Tijuana, Mexico. Specifically, we will continue to monitor the impact of Mexico’s federal drug policy reform (narcomenudeo) which partially decriminalized possession of small, specified amounts of cocaine, heroin, methamphetamine and marijuana for personal use. We are also collecting data from an implementation science perspective to examine factors at the institutional, environmental and policy level that impede vs. promote operationalization of the narcomenudeo.

    We will also use the El Cuete cohort to prospectively examine the impact of a police education program (PEP) newly designed to align law enforcement and HIV prevention programs in Tijuana. In Mexico and other countries, policing practices are directly and/or indirectly linked to behaviors that increase PWIDs’ vulnerability to HIV, viral hepatitis and STIs. These include syringe confiscation and police misconduct (e.g., physical and sexual abuse). PEPs have been successfully piloted in several locations, but to date, evaluations were limited to brief pre-post assessments of police knowledge, attitudes and/or intentions. Since the impact of PEPs on policing behaviors is unknown, the El Cuete cohort will be utilized to examine the impact of the PEP on PWIDs’ behaviors that influence their risk of acquiring HIV and other blood-borne infections. Our specific aims are:

    1. To continue to monitor the following impacts of the narcomenudeo in Tijuana with respect to: i) temporal trends in drug use behaviors; ii) PWIDs’ health risks and protective behaviors; iii) experiences with drug treatment; iv) interactions with law enforcement.
    2. To prospectively examine extent to which police detention and arrest behaviors adhere to narcomenudeo legislation that institutionalizes diversion of substance users to substance use treatment instead of incarceration.
    3. To study factors at the institutional, environmental and policy level that are impeding vs. promoting implementation of the narcomenudeo legislation.
    4. To evaluate the impact of a PEP on PWIDs’ outcomes with respect to i) temporal trends in high risk injection behaviors (e.g., rushed injections, needle sharing, injecting in shooting galleries); iii) protective behaviors (e.g., attendance at syringe exchange and drug treatment programs); iii) interactions with law enforcement (e.g., experience with police misconduct, syringe confiscation).

    As the narcomenudeo reforms continue to be scaled up, our study will generate important findings that will inform drug policy reforms in Mexico and in other countries. In particular, since the next UN General Assembly Special Session on Drugs will be held in 2016, our study results will be particularly timely. Our study also would be the first to evaluate the impact of a PEP on PWIDs’ risk behaviors, which could serve as a model for other countries. We are also comparing HIV prevalence, incidence and risk behaviors among PWID in Tijuana to a parallel cohort of PWID in San Diego, STAHR II.

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    Selected Publications:

    • Robertson AM, Garfein RS, Wagner KD, Mehta SR, Magis-Rodriguez C, Cuevas-Mota J, Moreno-Zuniga PG, Strathdee SA; Proyecto El Cuete IV and STAHR II. Evaluating the impact of Mexico's drug policy reforms on people who inject drugs in Tijuana, B.C., Mexico, and San Diego, CA, United States: a binational mixed methods research agenda. Harm Reduct J. 2014. 11(1):4. doi: 10.1186/1477-7517-11-4. PMCID: PMC3944401
    • Mackey TK, Werb D, Beletsky L, Rangel G, Arredondo J, Strathdee SA. Mexico’s “ley de narcomenudeo” drug policy reform and the international drug control regime. Harm Reduct J. 2014 Nov 14; 11(1):31. doi: 10.1186/1477-7517-11-31.
    • Werb D, Medina-Mora EL, Arredondo J, Beletsky L, Patterson T, Strathdee SA. Mexico’s drug policy reform: cutting edge success or crisis in the making? Int J Drug Policy. 2014. pii: S0955-3959(14)00145-5. doi: 10.1016/j.drugpo.2014.05.014.
    • Werb D, Wagner KD, Beletsky L, Gonzalez-Zuniga P, Vera A, Strathdee SA. Police bribery and access to methadone maintenance therapy among injection drug users in Tijuana, Mexico. Drug Alc Depend (in press)
    • Meachem M, Rudolph AE, Strathdee SA, Brouwer KC, Rusch M, Roesch S. Polydrug use and HIV risk among people who inject heroin in Tijuana, Mexico: A latent class analysis. Substance Use and Misuse (in press)
    • Beletsky L, Arredondo J, Werb D, et al. Utilization of Google enterprise tools to georeference survey data among hard-to-reach groups: strategic application in international settings. Int. J. Health Geogr. 2016;15(24)e1-4 [link]
    • Beletsky L, Wagner KD, Arredondo J, et al. Implementing Mexico’s “Narcomenudeo” Drug Law Reform: A Mixed-Methods Assessment of Early Experiences among People Who Inject Drugs. Journal of Mixed Methods Research 2015; doi: 10.1177/1558689815575862 [link]