“I would rather do it myself”: injection initiation and current injection patterns among women who inject drugs in Tijuana, Mexico

Background Women who inject drugs (WWID) experience unique risks and adverse health outcomes related to injection initiation and patterns of injection drug use. However, there is limited information on injection initiation experiences and injection patterns among women and the protective strategies employed to limit injection-related harms, especially in low- and middle-income settings. Therefore, this study sought to explore injection initiation and current injection patterns (e.g., relying on someone else to inject) among women who inject drugs and engage in sex work in Tijuana, Mexico. Methods Semistructured in-depth interviews were conducted with 30 WWID on the following topics: injection initiation, current injection patterns, places where women inject, and protective strategies (i.e., risk reduction). All interviews were audio-recorded, transcribed, and de-identified. An inductive thematic analysis was conducted to identify and compare common themes and patterns across participants. Results The interviews revealed that the vast majority of study participants were first initiated by another person who injects drugs (PWID), often a male sexual partner. However, the majority of the women transitioned to become self-injectors in order to avoid risks associated with relying on others for injection, including overdose, interpersonal violence, sexual abuse, and wounds. Those who relied on others indicated that they would prefer to inject themselves without assistance from others if they were able to. Conclusions The narratives uncovered in this study reveal the importance of multiple risk environments in shaping perceived risks associated with injection drug use among women in Tijuana, Mexico. Specifically, the interviews elucidate the connection between interpersonal relationships with other PWID and protective strategies used to minimize risk and harm. These findings highlight the need for women-centered harm reduction programs to facilitate the development of safer drug use environments among WWID in Tijuana, Mexico

Análisis neuropsicológico de las asimetrías cognitivas en estudiantes de psicología de la UDLA, P

Este trabajo tuvo como propósito analizar el estilo cognitivo (manera de procesar y representar la información) de los estudiantes de psicología de la UDLA,P por medio de la prueba BIT-EAC (Ruiz y cols., 2004). La muestra constó de 157 estudiantes de entre 18 y 46 años, 132 mujeres y 25 hombres, quienes también respondieron una ficha de identificación. Los datos obtenidos por medio de la batería y la ficha, así como las calificaciones escolares, se analizaron cuantitativamente por medio de Microsoft Excel y SPSS. Se encontró que el estilo cognitivo predominante es el analítico (ECA) (µ= 3.85), no habiendo diferencias significativas entre sexos, ni por la dominancia manual. Respecto a los datos de la ficha, no hubo correlación significativa con factores prenatales, áreas de preferencia además de psicología, ni autopercepción de aptitudes. En cuanto a las calificaciones, hubo correlación significativa débil entre el promedio acumulado (PA) e índice de eficiencia cognitiva (IEC) (r=0.28; p=0.0001), asimetría cognitiva (IAC) (r=0.18; p=0.01) y estilos cognitivos (r=0.28; p=0.0003 analítico; r= 0.21; p=0.05 holístico). Asimismo, se correlacionaron positivamente el IEC y conocimientos fundamentales (r= 0.37; p=0.0003), psicología clínica (r= 0.29; p=0.004) y el promedio acumulado (PA) r=0.32; p=0.002). Se recomiendan maneras de estimular el estilo cognitivo holístico (ECH) junto con un análisis del proceso de enseñanza-aprendizaje

The impact of involuntary drug treatment on overdose, subsequent drug use and drug use treatment-seeking among people who inject drugs in Tijuana, Mexico

Background: The treatment of substance use disorders, as any other form of medical care, is a human right and must comply with quality standards of health care, including the right to refuse use of services. Involuntary drug treatment has been reported ineffective in decreasing drug use but its effects on health and subsequent treatment-seeking have not been longitudinally assessed.Aims: (1) To examine the dynamics of involuntary drug treatment from the perspectives of people who inject drugs (PWID); (2) to assess the effect of involuntary drug treatment on non-fatal overdose; and (3) to determine whether past experiences of involuntary drug treatment influence subsequent voluntary treatment-seeking behavior in Tijuana, Baja California, Mexico.Methods: PWID who were at least 18-years old and reported injecting drugs in the prior month were enrolled in a prospective study. Participants completed interviewer-administered surveys at baseline and every six months (2011-2017). For Chapters 2 and 4, a subsample of PWID reporting involuntary drug treatment in the context of a federally-funded policing program was interviewed and thematic analysis was performed. In Chapter 3, generalized estimating equation analyses were conducted on recent (i.e., past 6 months) non-fatal overdose event and its relationship to involuntary drug treatment. In Chapter 4, Cox regression was also conducted to identify factors related to voluntary drug treatment subsequent to involuntary drug treatment experience among those with no prior drug treatment history.Results: In Chapter 2, 25 PWID described punitive characteristics of a local policing program and lack of State oversight and healthcare at drug centers. In Chapter 3, among 670 PWID, 31.5% reported a recent non-fatal overdose, which was independently associated with recent involuntary drug treatment. In Chapter 4, among 359 PWID, a possible pathway through which involuntary drug treatment limits future treatment-seeking was identified through mistreatment, stigmatization and discrimination at drug centers.Conclusions: Findings highlight the use of involuntary treatment as a mechanism of control that may have life-threatening risks as well as a complexity of factors that drive drug treatment-seeking among PWID in Tijuana. Policy implications include the need to protect PWIDs’ right to choose the circumstances of treatment, for adequate professionalization and training of drug treatment staff, and for treatment centers’ oversight

Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs.

AIM: To assess the effect of involuntary drug treatment (IDT) on non-fatal overdose among people who inject drugs (PWID). DESIGN: Longitudinal study. SETTING: Tijuana, Mexico. PARTICIPANTS: Baseline sample of 671 PWID included 258 (38.4%) women and 413 (61.6%) men. MEASUREMENTS: Primary independent variables were reported recent (i.e. past 6 months) non-fatal overdose event (dependent variable) and IDT. Substance use the day of the non-fatal overdose was also examined. FINDINGS: From 2011 to 2017, 213 participants (31.7%) reported a recent non-fatal overdose and 103 (15.4%) reported recent IDT. Heroin, in combination with methamphetamine and tranquilizers, were the drugs most reported at the day of the event. IDT significantly increased the odds of reporting a non-fatal overdose event [adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI) = 1.04-2.96]. Odds of non-fatal overdose also increased independently for each additional injection per day (aOR = 1.05; 95% CI = 1.02-1.08), recent tranquilizer use (aOR = 1.92; 95% CI = 1.41-2.61) and using hit doctors (aOR = 1.68; 95% CI = 1.29-2.18) and decreased with age (aOR = 0.97 per year, 95% CI = 0.95-0.99). CONCLUSIONS: Recent involuntary drug treatment in Mexico is a risk factor for non-fatal drug overdose

Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs.

AIM:To assess the effect of involuntary drug treatment (IDT) on non-fatal overdose among people who inject drugs (PWID). DESIGN:Longitudinal study. SETTING:Tijuana, Mexico. PARTICIPANTS:Baseline sample of 671 PWID included 258 (38.4%) women and 413 (61.6%) men. MEASUREMENTS:Primary independent variables were reported recent (i.e. past 6 months) non-fatal overdose event (dependent variable) and IDT. Substance use the day of the non-fatal overdose was also examined. FINDINGS:From 2011 to 2017, 213 participants (31.7%) reported a recent non-fatal overdose and 103 (15.4%) reported recent IDT. Heroin, in combination with methamphetamine and tranquilizers, were the drugs most reported at the day of the event. IDT significantly increased the odds of reporting a non-fatal overdose event [adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI) = 1.04-2.96]. Odds of non-fatal overdose also increased independently for each additional injection per day (aOR = 1.05; 95% CI = 1.02-1.08), recent tranquilizer use (aOR = 1.92; 95% CI = 1.41-2.61) and using hit doctors (aOR = 1.68; 95% CI = 1.29-2.18) and decreased with age (aOR = 0.97 per year, 95% CI = 0.95-0.99). CONCLUSIONS:Recent involuntary drug treatment in Mexico is a risk factor for non-fatal drug overdose

Implementing Evidence-Based HIV Prevention for Female Sex Workers in Mexico: Provider Assessments of Feasibility and Acceptability.

This study examined service provider perceptions of feasibility and acceptability of implementing evidence-based practices for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico. Semi-structured interviews were conducted with 124 directors, supervisors and counselors from 12 reproductive health clinics located throughout Mexico participating in a large randomized controlled trial to scale-up the use of a psychoeducational intervention designed to promote FSW condom use and enhance safer sex negotiation skills. Feasibility was based on assessment of personal, organizational and social costs, benefits, and capacity. Costs included anxiety over intervention competency, purchase of condoms and other supplies, expenses of laboratory tests for HIV/STIs, and stigma associated with FSWs. Benefits included increase in personal knowledge and experience, enhanced clinic reputation and service delivery capacity, and increased public health. Capacity was expressed in terms of provider skills to deliver the intervention and additional workload. Acceptability was expressed in terms of provider enthusiasm in delivering these services and FSWs willingness to receive the services. Service provider evaluations of feasibility and acceptability of implementing evidence-based prevention interventions are grounded in local contexts that define costs and benefits of and capacity for implementation and determine features of the intervention and its implementation that are acceptable