co-infections with STIs among MSM in Tijuana, Mexico
Funding Source: University
of California, San Diego Center for AIDS Research (CFAR)
Co-PIs: Gudelia Rangel
and Heather Pines
(CT), Neisseria gonorrhoeae
(NG), and syphilis are among the most
prevalent sexually transmitted infections (STIs). HIV co-infection with these STIs is common and may play an important
role in driving HIV transmission. Men who have sex with men (MSM) are at substantial risk of HIV/STIs worldwide,
including those in low- and middle-income countries (LMIC). In Tijuana, Mexico, the prevalence of HIV among MSM is high
at ~20%. Elevated rates of sexual and substance use behaviors associated with HIV/STIs have also been documented within
this population suggesting that STI control strategies could significantly reduce the spread of HIV among MSM in this
The overall goal of the co-infections among MSM project (CAMP) is to determine the
potential impact of HIV co-infection with STIs on HIV transmission dynamics among MSM in Tijuana. CAMP is embedded in
two ongoing studies among MSM in Tijuana (Enlaces or Links [R01DA037811; PI: Patterson] and Redes or Networks
[K01DA040543; PI: Pines]). CAMP aims to enroll approximately 600 MSM (~300 newly diagnosed HIV-positive and ~300
HIV-negative) to determine: (1) the prevalence of CT, NG, and syphilis, as well as HIV co-infection with these STIs and
(2) whether HIV co-infection with STIs is associated with HIV transmission network characteristics among MSM in
Tijuana. Findings will inform future work evaluating the impact of STI control strategies designed to interrupt HIV
transmission among MSM in Tijuana, which may be applicable to MSM populations in other similar LMIC.
Cultural Perceptions of Adolescent Mental Health and Patterns of Help-Seeking in Northern Mexico
“Cultural Perceptions of Adolescent Mental Health and Patterns of Help-Seeking in
Northern Mexico,” PI: Janis H.
, Ph.D.Project Description:
In this study, our interdisciplinary team
is currently collecting data to identify cultural conceptions of mental health and patterns of help-seeking in the
northern Mexico region. The research seeks an empirical understanding of contemporary knowledge and practices
surrounding emotional distress and behaviors regarded as problematic. Working with parents, teachers, and service
providers, we are investigating (1) the conceptualization of wellbeing and the identification of problems of
emotional/mental health; (2) decision-making for seeking services; and (3) the social-emotional features that
contribute to vulnerability and resilience in processes of recovery. That empirical data obtained will serve as
the basis for interactive, community-designed interventions for adolescent health that are effective and sustainable
Sexual Networks and HIV Transmission Clusters among Substance Using MSM Funding
NIDA K01 DA040543;
PI: Heather Pines
disparities in resource allocation to HIV prevention services may limit the promise of recent breakthroughs in HIV
prevention science, particularly among vulnerable substance using populations, such as men who have sex with men (MSM),
in low- and middle-income countries (LMIC). Innovative research that integrates social network analysis and genetic
sequence analysis methods to direct the delivery of biomedical HIV prevention strategies to individuals at greatest
risk may help maximize their impact, control costs, and facilitate their implementation in the context of limited
Proyecto Redes (Networks Project) is a 5-year project funded by a Mentored Research
Scientist Development Award (K01) from the National Institute on Drug Abuse (NIDA). It contains both a training and
research component. The aims of the training component are to develop expertise in social network analysis and genetic
sequence analysis methods to identify HIV transmission clusters (i.e., individuals with genetically related HIV
infections). The overall goal of the research component is to characterize the sexual networks and sexual network-based
drivers of HIV transmission among MSM in Tijuana, Mexico.
More specifically, the research component
1) Examine the influence of mean degree (i.e., number of male anal intercourse partners), the
degree distribution, and sexual mixing patterns on overall sexual network structure among MSM in Tijuana
Identify individual, sexual network compositional, and socio-contextual factors associated with degree by HIV status
3) Determine whether sexual mixing patterns are associated with HIV transmission cluster
membership among HIV-positive MSM
To address these aims, Proyecto Redes will partner with a NIDA study
(R01DA037811; PI: Patterson) examining the effectiveness of two HIV case identification methods (HIV testing in
high-risk venues vs. partner contact tracing) among MSM in Tijuana. Proyecto Redes will utilize behavioral,
psychosocial, egocentric sexual network, and HIV-1 pol sequence data collected from 200 newly diagnosed HIV-positive
MSM identified via partner contact tracing as part of the parent study and collect additional data from 200 of their
HIV-negative and previously diagnosed HIV-positive male sexual partners. Findings from this project will inform the
development of comprehensive HIV prevention programs that leverage information on sexual network characteristics to
interrupt HIV transmission among MSM in Mexico and other LMIC.
Proyecto Futura: Modeling Structural HIV Determinants in Substance Users and Related populations
NIDA grant R01 DA0 37773;PIs: Natasha
, Steffanie Strathdee
We are conducting secondary data analyses to model potential effects of structural
determinants and combination interventions and cost-effectiveness to optimize HIV prevention in Tijuana. Our team
of prevention scientists and modelers from the U.S., Mexico and the U.K. will utilize data from 8 NIH-funded R01s
and related sub-studies in Tijuana.
Our aims are:
- To model overlapping HIV and syphilis epidemics occurring among different high risk groups in Tijuana
(PWID, MSM, MSM-IDU, FSW, FSW-IDU, and their clients) to ascertain the extent to which HIV transmission is
driven by specific risk groups and sexual or injecting risk behaviors.
- To assess the impact and cost-effectiveness of scaling up coverage of existing and novel interventions
(e.g. SEP, OST, ART, and two existing behavioral interventions), targeted at specific risk subgroups, to
identify the most cost-effective combination intervention package to control HIV transmission.
- To model the potential importance of policing practices and incarceration on HIV transmission among PWID in
Tijuana, and the subsequent impact of a PEP on changing policing practices and HIV transmission.
- To model the potential impact of reducing involuntary (i.e., forced/coerced) entry into sex trade as a
minor or adult on HIV transmission in Tijuana.
Our project will advance efforts to model the potential impacts of structural determinants and combination
prevention interventions on emerging HIV epidemics in lower and middle-income countries.
Economic Debt, Drug Use, and HIV Risk among Sex Workers in Tijuana, Mexico
Center for AIDS Research, University of California, San Diego PI: Elizabeth Reed
, ScD, MPH
High rates of
sex trade and drug use, and the intersection of these, exacerbate the spread of HIV in Tijuana, the largest Mexican
city bordering the US. Poor socioeconomic conditions are the primary driver of sex work initiation in Tijuana, as
well as elsewhere. Our previous research in South Asia has established that economic debt is not only significant
in terms of women’s initiating sex trade, but is also associated with elevated HIV/STI risk among female sex
workers (FSW). This work indicated that the vast majority of FSW have debt (80%) and that debt appears to reduce
women’s condom negotiating power with clients and increases women’s experiences of gender-based violence, both
increasing HIV risk. The prevalence, nature, and effects of debt in the US-Mexico border region likely differs
significantly from that of South Asia, as a result of the intersecting influence of drug use and debt on HIV risk.
Thus, this project aims 1) to describe the prevalence, nature, and magnitude of debt, 2) to examine the relation
between debt and HIV risk among FSW in Tijuana, and 3) to assess the contribution of drug use to debt and how this
translates to increased HIV risk.Selected PublicationsReed, E
Gupta, J., Biradavolu, M., Devireddy, V., & Blankenship, K.M. The context of economic insecurity and relation
to violence and risk factors for HIV among female sex workers in Andhra Pradesh, India. Public Health Reports.
2010;125(Suppl 4): 81–89.
Impact of Drug Policy Reform on the HIV Risk Environment Among IDUs in Tijuana (El Cuete, Phase IV)
NIDA grant R01 DA0 19829PI:Steffanie
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:
- 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.
- 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.
- To study factors at the institutional, environmental and policy level that are impeding vs. promoting
implementation of the narcomenudeo legislation.
- 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. Postcard
From The Trenches: Tijuana’s Hidden HIV and Tuberculosis Epidemics
and Tijuana’s AIDS Epidemic with Sir Richard Branson" See
- 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:
- 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:
- 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.
- 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