Correlates of Sexual Violence among Men Who Have Sex with Men in Tijuana, Mexico

Sexual violence among men who have sex with men (MSM) is prevalent in developing countries and is associated with increased HIV/STI risk. Despite high HIV prevalence (20 %) among MSM in Tijuana, Mexico, little attention has been paid to the occurrence of sexual violence in this high-risk group. 

The present study used a syndemic conditions framework to examine correlates of sexual violence victimization in a sample of 201 MSM surveyed in Tijuana, Mexico during 2012 and 2013. Participants were recruited through respondent-driven sampling and underwent a 2-h baseline interview and testing for HIV and syphilis. Sexual violence was defined as any incident during the past year in which the participant had been raped, sexually molested, or sexually harassed. 

The majority of participants self-identified as gay or bisexual, had never married, were employed, and had a high school education or greater. The average age was 29.7 years. Thirty-nine percent reported sexual violence in the past year. A hierarchical multiple linear regression model predicting more experiences of sexual violence was tested. In a final model, a higher number of experiences of sexual violence was associated with a history of childhood sexual abuse, more adult experiences of homophobia, more depression and hostility symptoms, and not living with a spouse or steady partner. 

The findings from this study support a model of co-occurring psychosocial factors that increase the likelihood of sexual violence experiences among MSM. Multi-level approaches to the prevention of childhood and adult experiences of sexual violence and homophobia are needed to avert the development of adverse mental and physical health outcomes associated with sexual violence victimization.

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By:  Semple SJ1, Stockman JK2, Goodman-Meza D3, Pitpitan EV2, Strathdee SA2, Chavarin CV1, Rangel G4, Torres K5, Patterson TL6.

• 1Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA.
• 2Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
• 3Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
• 4US-Mexico Border Health Commission, Tijuana, Mexico.
• 5Agencia Familiar Binacional, A.C., Tijuana, Mexico.
• 6Department of Psychiatry, University of California San Diego, Mail Code 0680, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA. tpatterson@ucsd.edu. 
• Arch Sex Behav. 2016 May 13. 

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Sex Work Regulation and Sexually Transmitted Infections in Tijuana, Mexico

While reducing the transmission of sexually transmitted infections is a common argument for regulating sex work, relatively little empirical evidence is available regarding the effectiveness of these policies. 

We investigate the effects of highly publicized sex work regulations introduced in 2005 in Tijuana, Mexico on the incidence of trichomoniasis. State-level, annual data for the 1995-2012 period are employed that include the incidence rates of trichomoniasis by age group and predictor variables. We find that the regulations led to a decrease in the incidence rate of trichomoniasis. Specifically, while our estimates are somewhat noisy, the all-ages incidence rate in the 2005-2012 period is roughly 37% lower than what is predicted by our synthetic control estimates and corresponds to approximately 800 fewer reported cases of trichomoniasis per year. 

We find that the decreases are especially pronounced for 15-24 and 25-44 age cohorts.

Purchase full article at:   http://goo.gl/CXN1CE

By:  Quast T1, Gonzalez F2.

• 1Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL, USA.
• 2Economics and International Business, Sam Houston State University, Huntsville, TX, USA. 
• Health Econ. 2016 Mar 16. doi: 10.1002/hec.3339

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Cost-Effectiveness of Combined Sexual and Injection Risk Reduction Interventions among Female Sex Workers Who Inject Drugs in Two Very Distinct Mexican Border Cities

Background

We evaluated the cost-effectiveness of combined single session brief behavioral intervention, either didactic or interactive (Mujer Mas Segura, MMS) to promote safer-sex and safer-injection practices among female sex workers who inject drugs (FSW-IDUs) in Tijuana (TJ) and Ciudad-Juarez (CJ) Mexico. Data for this analysis was obtained from a factorial RCT in 2008–2010 coinciding with expansion of needle exchange programs (NEP) in TJ, but not in CJ.

Methods

A Markov model was developed to estimate the incremental cost per quality adjusted life year gained (QALY) over a lifetime time frame among a hypothetical cohort of 1,000 FSW-IDUs comparing a less intensive didactic vs. a more intensive interactive format of the MMS, separately for safer sex and safer injection combined behavioral interventions. The costs for antiretroviral therapy was not included in the model. We applied a societal perspective, a discount rate of 3% per year and currency adjusted to US$2014. A multivariate sensitivity analysis was performed. The combined and individual components of the MMS interactive behavioral intervention were compared with the didactic formats by calculating the incremental cost-effectiveness ratios (ICER), defined as incremental unit of cost per additional health benefit (e.g., HIV/STI cases averted, QALYs) compared to the next least costly strategy. Following guidelines from the World Health Organization, a combined strategy was considered highly cost-effective if the incremental cost per QALY gained fell below the gross domestic product per capita (GDP) in Mexico (equivalent to US$10,300).

Findings

For CJ, the mixed intervention approach of interactive safer sex/didactic safer injection had an incremental cost-effectiveness ratio (ICER) of US$4,360 ($310–$7,200) per QALY gained compared with a dually didactic strategy. Using the dually interactive strategy had an ICER of US$5,874 ($310–$7,200) compared with the mixed approach. For TJ, the combination of interactive safer sex/didactic safer injection had an ICER of US$5,921 ($104–$9,500) per QALY compared with dually didactic. Strategies using the interactive safe injection intervention were dominated due to lack of efficacy advantage. The multivariate sensitivity analysis showed a 95% certainty that in both CJ and TJ the ICER for the mixed approach (interactive safer sex didactic safer injection intervention) was less than the GDP per capita for Mexico. The dual interactive approach met this threshold consistently in CJ, but not in TJ.

Interpretation

In the absence of an expanded NEP in CJ, the combined-interactive formats of the MMS behavioral intervention is highly cost-effective. In contrast, in TJ where NEP expansion suggests that improved access to sterile syringes significantly reduced injection-related risks, the interactive safer-sex combined didactic safer-injection was highly cost-effective compared with the combined didactic versions of the safer-sex and safer-injection formats of the MMS, with no added benefit from the interactive safer-injection component.

Below:  Cost-effectiveness acceptability curve for the combined interactive safer sex-didactic safer injection intervention in Cd. Juarez

Below:  Cost-effectiveness acceptability curve for the combined interactive safer sex/Safer injection intervention for Ciudad Juarez

Below:  Cost-effectiveness acceptability curve for the combined interactive safer sex and didactic safer injection components of the Mujer Mas Segura intervention in Tijuana

Full article at:   http://goo.gl/RBQD6m

By:  

Jose L. Burgos, Steffanie A. Strathdee

University of California San Diego, Department of Medicine, Division of Global Public Health, La Jolla, California, United States of America

Jose L. Burgos

Universidad Autonoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, México

Thomas L. Patterson

University of California San Diego, Department of Psychiatry, La Jolla, California, United States of America

Joshua S. Graff-Zivin

University of California San Diego, School of Global Policy and Strategy, La Jolla, California, United States of America

James G. Kahn

University of California San Francisco, Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, Global Health Sciences, San Francisco, California, United States of America

M. Gudelia Rangel

Secretaria de Salud de México, Comision de Salud Fronteriza Mexico-Estados Unidos Sección México, Tijuana, Baja California, México

M. Remedios Lozada

Instituto de Servicios de Salud Pública del Estado de Baja California, Mexicali, Baja California, Mexico

Hugo Staines

Universidad Autonoma de Ciudad Juarez, Facultad de Medicina, Ciudad Juárez, Chihuahua, México

  

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Intravaginal Practices among HIV-Negative Female Sex Workers Along the US-Mexico Border & Their Implications for Emerging HIV Prevention Interventions

OBJECTIVE:

To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities-Tijuana and Ciudad Juarez-on the border between the USA and Mexico.

METHODS:

Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18 years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs.

RESULTS:

Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6 months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6 months, three or more pregnancies, and having clients who became violent when proposing condom use, which are all factors related to inconsistent condom use.

CONCLUSION:

Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.

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By:  Seidman D1, Rusch M2, Abramovitz D3, Stockman JK3, Martinez G4, Rangel G5, Vera A3, Ulibarri MD6, Strathdee SA7.

• 1Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
• 2Population Health and Epidemiology, Island Health, Victoria, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
• 3Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA.
• 4Community Health and Development of Ciudad Juarez and the Mexican Federation of Private Associations, Ciudad Juarez, Mexico.
• 5El Colegio de la Frontera del Norte, Tijuana, Mexico.
• 6Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
• 7Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA. Electronic address: sstrathdee@ucsd.edu. 
• Int J Gynaecol Obstet. 2016 Jan 28. pii: S0020-7292(16)00037-0. doi: 10.1016/j.ijgo.2015.09.025.

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HIV Testing among Men Who Have Sex with Men in Tijuana, Mexico

OBJECTIVES:

HIV testing is critical to the delivery of comprehensive HIV prevention and care services, yet coverage of sexual minorities by HIV testing programmes remains insufficient in many low- and middle-income countries, including Mexico. The objective of this study was to identify the prevalence and correlates of HIV testing among men who have sex with men (MSM) in Tijuana, Mexico.

METHODS:

We conducted a cross-sectional study (2012-2013) among 189 MSM recruited via respondent-driven sampling (RDS). RDS-weighted logistic regression was used to identify correlates of prior HIV testing.

RESULTS:

RDS-adjusted prevalence of prior and recent (≤12 months) HIV testing was 63.5% and 36.8%, respectively. Prior HIV testing was positively associated with older age, being born in Tijuana, higher levels of education, identifying as homosexual or gay, being more 'out' about having sex with men, and a history of sexual abuse. Prior HIV testing was negatively associated with reporting more condomless anal intercourse acts (past 2 months) and greater internalised homophobia.

CONCLUSIONS:

Our findings indicate an urgent need for expanded HIV testing services for MSM in Tijuana. Innovative, non-stigmatising, confidential HIV testing interventions targeted at young, less educated, migrant and non-gay identifying MSM may facilitate HIV testing and timely linkage to HIV care and treatment within this population.

Full article at:   http://goo.gl/ga986c

By:  Pines HA1, Goodman-Meza D1, Pitpitan EV1, Torres K2, Semple SJ3, Patterson TL3.

• 1Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA.
• 2Agencia Familiar Binacional, AC, Tijuana, Mexico.
• 3Department of Psychiatry, University of California, San Diego, La Jolla, USA. 
• BMJ Open. 2016 Feb 4;6(2):e010388. doi: 10.1136/bmjopen-2015-010388.

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Risk of Violence in Drug Rehabilitation Centers: Perceptions of People Who Inject Drugs in Tijuana, Mexico

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.

CONCLUSION:

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.

Demographic characteristics (n=733)

Variable name	Total	Feared violence	Didn't fear violence	p-valuea
	(n=733)	(n=253, 34.5%)	(n=480, 65.5%)
Ageb	37 (31, 44)	36 (30, 42)	37 (31, 45)	0.08
Female (n, %)	279 (38.1%)	102 (40.3%)	177 (36.9%)	0.38
Married (n, %)	332 (45.3%)	113 (44.7%)	219 (45.6%)	0.82
Education
Years of education completedb	8 (6,10)	8 (6,11)	8 (6,10)	0.15
Main source of income
No income (n, %)	25 (3.4%)	8 (3.2%)	17 (3.5%)	0.82
Formal source of income (n, %)	502 (68.5%)	177 (70.0%)	325 (67.7%)
Informal source of income (n, %)	203 (27.7%)	67 (26.5%)	136 (28.3%)
Homeless (where slept most often last 6 mos)
Homeless (n, %)	146 (19.9%)	60 (23.7%)	86 (17.9%)	0.06
Mobility
Lived in Tijuana whole life (n, %)	278 (37.9%)	107 (42.3%)	171 (35.6%)	0.08
Years lived in Tijuana (n= 454) b	21 (10, 34)	20 (10, 34)	21 (10, 33)	0.54
Drug Use History
Age of first time use of illegal drugb	14 (12,16)	14 (12,16)	14 (12,16)	0.30
Age of first injected drugsb	19 (17,24)	20 (17,25)	19 (17,24)	0.58
Ever used heroin	730 (99.6%)	252 (99.6%)	478 (99.6%)	0.99
Ever used cocaine	559 (76.3%)	171 (67.6%)	388 (80.8%)	<0.01
Ever used crystal/methamphetamine	647 (88.3%)	206 (81.4%)	441 (91.9%)	<0.01
Interactions with Law Enforcement
Ever stopped by law enforcement	661 (90.2%)	220 (87.0%)	441 (91.9%)	0.04
Ever been told by law enforcement that you would be required to go to drug treatment	17 (2.3%)	10 (4.0%)	7 (1.5%)	0.04
Drug Rehabilitation History
Great or urgent need to get help for drug use (n, %)	375 (51.2%)	144 (56.9%)	231 (48.1%)	0.02
Ever received professional help for drug usec	417 (56.9%)	124 (49.0%)	293 (61.0%)	0.01
Lifetime # of times received professional help for drug use (n=417) b	1 (0, 3)	0 (0, 3)	1 (0, 4)	0.01
Ever enrolled in drug rehabilitation center (n, %)	375 (51.2%)	109 (43.1%)	266 (55.4%)	0.37
# of times enrolled in drug rehabilitation center(n=375) b	1 (0, 3)	0 (0, 2)	1 (0, 3)	0.01

acomparisons of means made using Student t-test, comparisons of proportions made using chi-squared test, all p-values are two-sided

bMedian, interquartile range

cEver received professional help refers to outpatient counseling services and might include drug rehabilitation services

Full article at:  http://goo.gl/vLPhjh

By:  Harvey-Vera AY1,2, González-Zúñiga P3, Vargas-Ojeda AC4, Medina-Mora ME5, Magis-Rodríguez CL6, Wagner K7, Strathdee SA8, Werb D9.

• 1Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. alvera@ucsd.edu.
• 2Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico. alvera@ucsd.edu.
• 3Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. pgonzalez@ucsd.edu.
• 4Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico. caro_vargas@uabc.edu.mx.
• 5Instituto Nacional de Psiquiatría de México, Ciudad de Mexico, Distrito Federal, Mexico. mmedina@hsph.harvard.edu.
• 6Centro Nacional para la Prevención y Control del VIH/SIDA, Ciudad de Mexico, Distrito Federal, Mexico. carlos.magis@gmail.com.
• 7Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. kdwagner@ucsd.edu.
• 8Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. sstrathdee@ucsd.edu.
• 9Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. dwerb@ucsd.edu. 

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