Drug tourism to Mexico: Impact of Mexicos new drug law on HIV-HCV-TB in US IDUs

墨西哥毒品旅游：墨西哥新毒品法对美国注射吸毒者 HIV-HCV-TB 的影响

• 批准号: 8141202
• 负责人: Richard S Garfein
• 金额: $ 60.45万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8141202
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Area; Attitude; Behavior; Behavior assessment; Biological Assay; Border Crossings; California; Cannabis; Charge; Cities; Cocaine; Cohort Studies; Collaborations; Communities; Comorbidity; Complement; Country; Crime; Data; Data Collection; Diffusion of Innovation; Disease; Disease Progression; Drug Legislation; Drug usage; Drug user; Epidemic; Epidemiologic Studies; Evaluation; Frequencies; Fright; Funding; Future; Goals; Gold; HIV; HIV Antibodies; HIV Infections; Health Status; Health behavior; Health behavior outcomes; Hepatitis C; Hepatitis C Antibodies; Hepatitis C Prevalence; Hepatitis C virus; Heroin; High Prevalence; Home environment; Illicit Drugs; Incidence; Infection; Injecting drug user; Intervention; Interview; Knowledge; Laws; Lead; Legal; Location; Marijuana; Measures; Methamphetamine; Methods; Mexican; Mexico; Modeling; Mycobacterium tuberculosis; Narcotics; National Institute of Drug Abuse; Natural experiment; New Mexico; Participant; Perception; Persons; Pharmaceutical Preparations; Policies; Prevalence; Process; Production; Qualitative Methods; Recruitment Activity; Reporting; Research; Respondent; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Serologic tests; Serum; Sister; Specific qualifier value; Statutes and Laws; Testing; Time; Travel; Tuberculosis; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; base; behavioral health; cohort; design; disorder risk; effective intervention; experience; follow-up; insight; instrument; male; meetings; novel; peer; response; risk perception; theories; transmission process

DESCRIPTION (provided by applicant): The goal of the proposed 5-year epidemiologic study is to assess the impact of Mexico's new drug laws on behaviors and disease incidence among injection drug users (IDUs) in the U.S. In August, 2009, Mexico enacted a controversial law decriminalizing possession of personal-sized quantities of drugs including heroin, cocaine, methamphetamine and cannabis. The sister-cities of San Diego, CA, USA and Tijuana, BC, Mexico share the world's busiest land border crossing and are home to nearly 4 million residents. Through research collaborations with the University of California, San Diego and partners in Tijuana, we found: i) increasing drug use and HIV prevalence in Tijuana; ii) dramatically higher prevalence of hepatitis C virus (HCV) and M. tuberculosis (Mtb) infections among IDUs in Tijuana versus San Diego; and, iii) injecting in Mexico reported by 21% of IDUs in San Diego. "Drug tourism" to Mexico among San Diegan IDUs may be an unintended consequence of Mexico's relaxed drug laws and could increase their risk for HCV, Mtb and HIV infections. This epidemiologic study aims to: 1) identify sociodemographic, behavioral, and health status differences between IDUs in San Diego who do and do not inject in Mexico; 2) describe changes in San Diegan IDUs' knowledge, attitudes, and experiences related to Mexican drug policies and assess their influences on decisions about injecting in Mexico; and 3) determine whether San Diegan IDUs who inject in Mexico are at increased risk for incident HCV and Mtb infection and identify risk factors for infection. To achieve these aims, we will use a mixed-methods design involving quantitative and qualitative data collection. Quantitative methods include recruiting a cohort of 750 IDUs in San Diego via respondent driven sampling for semi-annual behavioral assessments and serologic testing for HIV, HCV, and Mtb infections over 24 months of follow-up. HIV and HCV antibody testing will be performed on serum using standard practices; Mtb infection will be detected by QuantiFERON TB-Gold assay. Qualitative methods involve selecting 20 participants after each assessment visit (total=100) for in-depth interviews that will be used to: i) explore novel findings that emerge in preliminary analysis of the quantitative data; ii) identify new areas of inquiry for addition to the quantitative assessments; and iii) assess the validity of quantitative findings by presenting them for interpretation to study participants in qualitative interviews. The iterative process of using qualitative and quantitative data to inform methods and interpret findings of each approach facilitates a comprehensive understanding of the conceptual model describing how Mexico's new law will impact the behaviors and health outcomes of IDUs in San Diego. This study meets NIDA priorities supporting epidemiologic research on HIV/AIDS co-morbidities including HCV and tuberculosis, and the prevention of HIV among vulnerable populations. This study exploits a rare natural experiment to evaluate the impact of opposing drug policies on interconnected, bordering communities, and will provide important insights for future policies. PUBLIC HEALTH RELEVANCE: Injection drug users (IDUs) are disproportionately affected by HIV, hepatitis C, and tuberculosis, and, the recently recognized convergence of these diseases in Tijuana, Mexico-sister city to San Diego, CA- suggests that progression of disease and rates of transmission will increase without effective interventions. In August, 2010 Mexico enacted new legislation decriminalizing possession of personal-size quantities of narcotic drugs (e.g., methamphetamine, heroin, cocaine, and cannabis), which it is feared will encourage more U.S. IDUs to visit Mexico to buy and use drugs. In parallel with a NIDA-funded study that will assess the law's impact on IDUs in Tijuana, we will conduct a longitudinal cohort study to examine the law's impact on the behaviors and disease risks among IDUs in San Diego who can readily cross the border to and from Mexico.

描述（由申请人提供）：这项拟议的5年流行病学研究的目标是评估墨西哥新毒品法对美国注射吸毒者（IDUs）行为和疾病发病率的影响。2009年8月，墨西哥颁布了一项有争议的法律，将持有个人数量的毒品（包括海洛因、可卡因、甲基苯丙胺和大麻）合法化。美国加州圣地亚哥和墨西哥不列颠哥伦比亚省蒂华纳是姊妹城市，拥有世界上最繁忙的陆路口岸，居住着近400万居民。通过与加州大学圣地亚哥分校和蒂华纳的合作伙伴的研究合作，我们发现：i)蒂华纳的毒品使用和艾滋病毒流行率不断上升；ii)与圣地亚哥相比，蒂华纳注射吸毒者中丙型肝炎病毒（HCV）和结核分枝杆菌（Mtb）感染的流行率明显更高；第三，据报告，圣地亚哥21%的注射吸毒者在墨西哥进行注射。圣地亚哥注射吸毒者前往墨西哥的“毒品旅游”可能是墨西哥放宽毒品法律的意外后果，可能会增加他们感染丙型肝炎病毒、结核杆菌和艾滋病毒的风险。这项流行病学研究的目的是：1)确定圣地亚哥注射吸毒者在墨西哥注射和不注射之间的社会人口学、行为和健康状况差异；2)描述圣地亚哥注射吸毒者对墨西哥毒品政策的知识、态度和经验的变化，并评估其对墨西哥注射决策的影响；3)确定在墨西哥注射的圣地亚哥注射吸毒者发生丙型肝炎病毒和结核分枝杆菌感染的风险是否增加，并确定感染的危险因素。为了实现这些目标，我们将使用混合方法设计，包括定量和定性数据收集。定量方法包括在圣地亚哥招募750名注射吸毒者，通过受访者驱动的抽样进行半年一次的行为评估和在24个月的随访期间进行艾滋病毒、丙型肝炎病毒和结核杆菌感染的血清学检测。将按照标准做法对血清进行艾滋病毒和丙型肝炎病毒抗体检测；采用QuantiFERON TB-Gold试验检测结核分枝杆菌感染。定性方法包括在每次评估访问后选择20名参与者（总数=100）进行深入访谈，这些访谈将用于：i)探索定量数据初步分析中出现的新发现；Ii)确定除定量评估之外的新的调查领域；iii)通过向定性访谈的研究参与者提供解释来评估定量研究结果的有效性。利用定性和定量数据为各种方法提供信息并解释每种方法的结果的反复过程，有助于全面理解描述墨西哥新法律将如何影响圣地亚哥注射吸毒者的行为和健康结果的概念模型。这项研究符合NIDA的优先事项，支持艾滋病毒/艾滋病合并症的流行病学研究，包括丙型肝炎病毒和结核病，以及在弱势群体中预防艾滋病毒。这项研究利用一种罕见的自然实验来评估反对毒品政策对相互联系的边界社区的影响，并将为未来的政策提供重要的见解。