The overall goal of this project is to characterize the epidemiology of HIV and HCV among injecting drugusers (IDUs) in Tijuana, Mexico. Recent data suggest a dynamic HIV.sub-epidemic among IDUs on thenorthwestern Mexico-US border where injection drug use is now a major public health problem.
The aims ofthis proposal are:1) To determine HIV, HCV and syphilis prevalence and estimate HIV incidence based onthe detuned assay among IDUs in Tijuana; 2) To determine the extent to. which potentially modifiableindividual, social and environmental factors influence the following outcomes among IDUs in Tijuana: i)prevalent HIV and HCV and incident HIV infections; ii) risk behaviors for blood borne infections (e.g, directand indirect syringe sharing, shooting gallery attendance); iii) barriers to access and use of sterile syringesand injection paraphernalia within the context of legal syringe access through pharmacies. Individual levelfactors of interest include knowledge of HIV and HCV serostatus, recent onset injection and use of specificinjection drug combinations (e.g., heroin and methamphetamine) and formulations (e.g., heroin tar versuspowder); Social factors include emigration and personal network characteristics; Environmental factorsinclude geospatial factors (e.g., distance from the border, frequency of border crossings, density of shootinggalleries, pharmacies and drug treatment programs), and experiences with law enforcement. 3) To examinethe social acceptability of interventions to reduce drug-related harm among the following stakeholders inTijuana. To meet Aims 1 and 2, 2000 IDUs who have injected at least once in the prior 6 months will berecruited using respondent driven sampling, which will facilitate an unbiased estimate of HIV and HCVprevalence and associated risk behaviors. Face-to-face interviews will collect sociodemographic andbehavioral data. To assess geospatial factors, we will use hand-held global positioning system devices tomap cross-street locations of shooting galleries, pharmacies and drug treatment programs. To meet Aim 3,we will conduct in-depth interviews with three types of key informants (e.g., systems, interactor and street-level key informants). Although Mexico is considered a country of low HIV/AIDS prevalence with aconcentrated epidemic, the window of opportunity for prevention is believed to be closing rapidly since IDU-associated HIV epidemics are often explosive and can quickly become generalized. This study will informthe development of culturally-appropriate interventions in one of the largest Mexican-U.S. cities, which hasimplications for policy making and program planning for both countries.
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