1. Sex differences in the multilevel determinants of injection risk behaviours among people who inject drugs in Tijuana, Mexico
- Author
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Jain, Jennifer P, Strathdee, Steffanie A, West, Brooke S, Gonzalez‐Zuniga, Patricia, Rangel, Gudelia, and Pitpitan, Eileen V
- Subjects
Public Health ,Health Sciences ,Digestive Diseases ,Substance Misuse ,Hepatitis ,Clinical Research ,Behavioral and Social Science ,Drug Abuse (NIDA only) ,Prevention ,Liver Disease ,HIV/AIDS ,Infectious Diseases ,2.2 Factors relating to the physical environment ,Aetiology ,Infection ,Good Health and Well Being ,Female ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Mexico ,Risk-Taking ,Sex Factors ,Sexual and Gender Minorities ,Substance Abuse ,Intravenous ,people who inject drug ,injection risk behaviour ,sex difference ,HIV and HCV transmission ,Medical and Health Sciences ,Studies in Human Society ,Psychology and Cognitive Sciences ,Substance Abuse ,Health sciences ,Human society ,Psychology - Abstract
Introduction and aimsHIV and hepatitis C virus transmission among people who inject drugs (PWID) is fuelled by personal and environmental factors that vary by sex. We studied PWID in Mexico to identify sex differences in multilevel determinants of injection risk.Design and methodsFrom 2011 to 2013, 734 PWID (female: 277, male: 457) were enrolled into an observational cohort study in Tijuana. Participants completed interviews on injection and sexual risks. Utilising baseline data, we conducted multiple generalised linear models stratified by sex to identify factors associated with injection risk scores (e.g. frequency of injection risk behaviours).ResultsFor both sexes, difficult access to sterile syringes was associated with elevated injection risk (b = 1.24, 95% confidence interval [CI] 1.16-1.33), using syringes from a safe source (e.g. needle exchange programs) was associated with lower injection risk (b = 0.87, 95% CI 0.82-0.94), and for every one-unit increase in safe injection self-efficacy we observed a 20% decrease in injection risk (b = 0.80, 95% CI 0.76-0.84). Females had a higher safe injection self-efficacy score compared to males (median 2.83, interquartile range 2.2-3 vs. median 2.83, interquartile range 2-3; P = 0.01). Among females, incarceration (b = 1.22, 95% CI 1.09-1.36) and police confiscation of syringes in the past 6 months (b = 1.16, 95% CI 1.01-1.33) were associated with elevated injection risk. Among males, sex work (b = 1.16, 95% CI 1.04-1.30) and polysubstance use in the past 6 months (b = 1.22, 95% CI 1.13-1.31) were associated with elevated injection risk.Discussion and conclusionsInterventions to reduce HIV and hepatitis C virus transmission among PWID in Tijuana should be sex-specific and consider multilevel determinants of injection risk to create safer drug use environments.
- Published
- 2020