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.
Table 1
Descriptive statistics by syringe confiscation by police (during the previous 6 months) (N = 624)
| Variable | Had syringe confiscated by police (n = 301) | Did not have syringe confiscated by police (n = 323) | Total (n = 624) | P |
|---|---|---|---|---|
| Interview location | ||||
| Tijuana | 118 (39.2 %) | 194 (60.1 %) | 312 (50.0 %) | <.001 |
| Ciudad Juárez | 183 (60.8 %) | 129 (39.9 %) | 312 (50.0 %) | |
| Sociodemographics | ||||
| Age, median (IQR) | 32 (27–39) | 34 (28–41) | 33 (27–40) | .18 |
| Lived in the city of interview for the entire life | 142 (47.2 %) | 131 (40.6 %) | 273 (43.8 %) | .11 |
| Married | 119 (39.5 %) | 117 (36.2 %) | 236 (37.8 %) | .41 |
| Number of years of education completed, median (IQR) | 6 (4–8) | 7 (5–9) | 6 (5–9) | <.001 |
| Speaks English | 71 (23.6 %) | 94 (29.1 %) | 165 (26.4 %) | .12 |
| Financially responsible for children | 129 (42.9 %) | 133 (41.2 %) | 262 (42.0 %) | .67 |
| Injection and sexual risk behavior | ||||
| Age when first injected drugs, median (IQR) | 19 (16–24) | 20 (17–27) | 20 (17–25) | <.001 |
| Age when first traded sex for money, median (IQR) | 18 (15–20.5) | 19.5 (16–25) | 19 (15–23) | <.001 |
| First drug used: meth | 5 (1.9 %) | 25 (9.0 %) | 30 (5.6 %) | <.001 |
| Receptive syringe sharing (half of the time or more)a | 171 (57.0 %) | 190 (58.8 %) | 361 (57.9 %) | .68 |
| Normally injected drugs in public placesa | 201 (66.8 %) | 173 (53.6 %) | 374 (59.9 %) | <.001 |
| Duration (years) of injection, median (IQR) | 12 (5–18) | 11 (4–18) | 11 (5–18) | .09 |
| Groin injectiona | 65 (21.6 %) | 40 (12.4 %) | 105 (16.9 %) | .003 |
| Sought the help of a hit doctora | 123 (40.9 %) | 121 (37.5 %) | 244 (39.1 %) | .41 |
| Number of people usually injected with, median (IQR)a | 4 (2–7) | 2 (1–5) | 3 (1–5) | . < 001 |
| Number of male clients, median (IQR)a | 40 (15–90) | 24 (10–56) | 30 (10–80) | <.001 |
| Ratio of unprotected/total number of sex acts with clients, median (IQR)a | 0.34 (0.00–0.68) | 0.00 (0.00–0.45) | 0.15 (0.00–0.56) | <.001 |
| Total number of unprotected vaginal and/or anal sex acts, median (IQR)a | 23 (2–62) | 6 (0–32) | 13.5 (0–45) | <.001 |
| Health and psychological assessment | ||||
| HIV infection, based on confirmatory positive test result | 22 (7.3 %) | 12 (3.7 %) | 34 (5.5 %) | .05 |
| Syphilis infection (based on titer > =1:8) | 29 (9.8 %) | 35 (11 %) | 64 (10.4 %) | .69 |
| Any STI, based on confirmatory test results (excluding BV) | 186 (61.8 %) | 175 (54.2 %) | 361 (57.9 %) | .06 |
| Self-esteem (Rosenberg Score), median (IQR) | 2.38 (2.13–2.50) | 2.5 (2.25–2.5) | 2.46 (2.25–2.5) | .60 |
| Depression (CES-D score of 10 = depression), median (IQR) | 12 (6–17) | 12 (7–18) | 12 (7–18) | .14 |
| Physical, social, and economic risk environment | ||||
| Number of hours spent on the streets, on typical day, median (IQR)b | 11.5 (8–16) | 10 (7–15) | 10 (7–15) | .07 |
| Spouse/steady partner ever injected illegal drugs, among those with spouse | 89 (69.5 %) | 74 (63.2 %) | 163 (66.5 %) | .34 |
| Income (in US dollars) earned from sex, median (IQR)a | 1,056.5 (405–1,915) | 820 (380–1,525) | 935 (400–1,800) | .02 |
| Often/always injected drugs with a client arounda | 88 (29.2 %) | 120 (37.2 %) | 208 (33.3 %) | .04 |
| Worked as a prostitute in the streeta | 244 (81.3 %) | 256 (79.5 %) | 500 (80.4 %) | .61 |
| Worked as a prostitute in hotel or motela | 68 (22.7 %) | 75 (23.3 %) | 143 (23.0 %) | .92 |
| Service utilization | ||||
| Ever had an HIV test | 171 (57.0 %) | 152 (47.1 %) | 323 (51.8 %) | .02 |
| Ever had a gynecological checkup | 58 (19.3 %) | 61 (19.1 %) | 119 (19.2 %) | 1.0 |
| Ever received methadone or buprenorphine treatment (among heroin users) | 61 (20.5 %) | 63 (20.1 %) | 124 (20.3 %) | .92 |
| Obtained syringes from pharmacya | 197 (65.7 %) | 182 (56.3 %) | 379 (60.8 %) | .02 |
| Obtained syringes from syringe exchange programa | 39 (13.0 %) | 28 (8.7 %) | 67 (10.8 %) | .09 |
| Experiences with police | ||||
| Ever been arrested | 284 (94.4 %) | 186 (57.6 %) | 470 (75.3 %) | <.001 |
| Police officer has asked you for sexual favorsb | 154 (51.2 %) | 49 (15.2 %) | 203 (32.5 %) | <.001 |
| Sexually abused by a police officerb | 94 (31.2 %) | 12 (3.7 %) | 106 (17.0 %) | <.001 |
| Police officer has asked you for moneyb | 273 (90.7 %) | 111 (34.4 %) | 384 (61.5 %) | <.001 |
| Police officer has forcibly taken your moneyb | 213 (70.8 %) | 55 (17.0 %) | 268 (42.9 %) | <.001 |
aLast month
bPast 6 months
Table 3
Multivariate analysis of factors associated with syringe confiscation among FSW-IDUs in Tijuana and Ciudad Juarez (N = 621)
| Predictor | Adjusted odds ratio estimate | Lower 95 % confidence limit | Upper 95 % confidence limit |
|---|---|---|---|
| Sexually abused by a police officera | 12.76 | 6.58 | 24.72 |
| HIV infection, based on confirmatory positive test result | 2.54 | 1.11 | 5.80 |
| Groin injectionb | 1.84 | 1.15 | 2.93 |
| Normally injected in public spacesb | 1.64 | 1.14 | 2.36 |
| Obtained syringes from pharmacyb | 1.54 | 1.06 | 2.23 |
| Years of education completed (per year) | 0.92 | 0.87 | 0.98 |
| Often/always injected drugs with a client aroundb | 0.64 | 0.44 | 0.94 |
aPast 6 months
bPast month
Full article
at: http://goo.gl/TQ43gX
By:
1Division of Global Public Health, University of California-San Diego, La Jolla, CA, USA.
More at: https://twitter.com/hiv_insight
No comments:
Post a Comment