Programmatic Support for Peer Specialists that Serve Transition Age Youth Living with Serious Mental Illness: Perspectives of Program Managers from Two Southern California Counties.

Peer Specialists (PS) often work in outpatient mental health programs serving transition age youth (TAY). This study examines program managers' perspectives on efforts to strengthen PS' professional development. In 2019, we interviewed program managers (n = 11) from two Southern California Counties employed by public outpatient mental health programs (n = 8) serving TAY and conducted thematic analyses. We present themes and illustrative quotes. PS' roles are highly flexible; thus, PM support PS to strengthen skills to address organization-facing and client-facing responsibilities. PM addressed time management, documentation, PS integration into the organization, and workplace relationships. Trainings to better support clients included addressing cultural competency to serve LGBTQ TAY and racial/ethnic subgroups. Diverse supervision modalities address PS' diverse needs. Supporting PS' technical and administrative skills (e.g., planning, interpersonal communication skills) may aid their implementation of a complex role. Longitudinal research can examine the impact of organizational supports on PS' job satisfaction, career trajectories, and TAY clients' engagement with services.

Tattoo discrimination in Mexico motivates interest in tattoo removal among structurally vulnerable adults.

Tattoos are less prevalent in Mexico and tattooed persons are frequently stigmatized. We examine the prevalence and correlates of interest in receiving tattoo removal services among 278 tattooed Mexican adults living in Tijuana, Mexico who responded to interviewer-administered surveys, including open-ended questions. Overall, 69% of participants were interested in receiving free tattoo removal services, 31% reported facing employment barriers due to their tattoos, and 43% of respondents regretted or disliked some of their tattoos. Having a voter identification card, reporting moderate/severe depression symptoms and believing that tattoo removal would remove employment barriers were independently associated with interest in tattoo removal. Our findings suggest that there is substantial interest in tattoo removal services. Publicly financed tattoo removal services may help disadvantaged persons gain access to Mexico's labor market and it may positively impact other life domains such as mental well-being and interactions with law enforcement.

Interest in Receiving HIV PrEP Among Biological Male Latinx Migrants at High-Risk of HIV Living in Mexico.

OBJECTIVE: We examined the prevalence and correlates of interest in receiving HIV pre-exposure prophylaxis (PrEP) in Latinx migrants at high-risk of HIV infection in Tijuana, Mexico, a migrant sending/receiving community bordering California. METHODS: In 2016, 870 HIV-seronegative biologically male Latinx migrants ages 18 and older responded to interviewer-administered surveys. Univariate statistics and multivariable analyses were estimated. RESULTS: In multivariable logistic regression analyses, emerging adults (18-24 years) were significantly less likely than participants ages 45 and older to be interested in PrEP (AOR: 0.35; 95% CI: 0.13, 0.89). Those who ever had sex with another male (AOR: 1.78; 95% CI: 1.13, 2.80), and who recently used illicit drugs (AOR: 1.74, 95% 1.09, 2.75) were significantly more likely to be interested in receiving PrEP. CONCLUSIONS: Provision of PrEP to migrant males at high-risk of HIV is needed. In Mexico, expanding access to federal health insurance and reducing the costs of PrEP are urgently needed.

Cost-effectiveness of hepatitis C virus (HCV) elimination strategies among people who inject drugs (PWID) in Tijuana, Mexico.

BACKGROUND AND AIMS: In Latin America, Mexico was first to launch a hepatitis C virus (HCV) elimination strategy, where people who inject drugs (PWID) are a main risk group for transmission. In Tijuana, HCV seroprevalence among PWID is > 90%, with minimal harm reduction (HR). We evaluated cost-effectiveness of strategies to achieve the incidence elimination target among PWID in Tijuana. METHODS: Modeling study using a dynamic, cost-effectiveness model of HCV transmission and progression among active and former PWID in Tijuana, to assess the cost-effectiveness of incidence elimination strategies from a health-care provider perspective. The model incorporated PWID transitions between HR stages (no HR, only opioid agonist therapy, only high coverage needle-syringe programs, both). Four strategies that could achieve the incidence target (80% reduction by 2030) were compared with the status quo (no intervention). The strategies incorporated the number of direct-acting anti-viral (DAA) treatments required with: (1) no HR scale-up, (2) HR scale-up from 2019 to 20% coverage among PWID, (3) HR to 40% coverage and (4) HR to 50% coverage. Costs (2019 US$) and health outcomes [disability-adjusted life years (DALYs)] were discounted 3% per year. Mean incremental cost-effectiveness ratios (ICER, $/DALY averted) were compared with one-time per capita gross domestic product (GDP) ($9698 in 2019) and purchasing power parity-adjusted per capita GDP ($4842-13 557) willingness-to-pay (WTP) thresholds. RESULTS: DAAs alone were the least costly elimination strategy [$173 million, 95% confidence interval (CI) = 126-238 million], but accrued fewer health benefits compared with strategies with HR. DAAs + 50% HR coverage among PWID averted the most DALYs but cost $265 million, 95% CI = 210-335 million). The optimal strategy was DAAs + 50% HR (ICER $6743/DALY averted compared to DAAs only) under the one-time per-capita GDP WTP ($9698). CONCLUSIONS: A combination of high-coverage harm reduction and hepatitis C virus treatment is the optimal cost-effective strategy to achieve the HCV incidence elimination goal in Mexico.

HIV and Sexual Health Services Available to Sexual and Gender Minority Youth Seeking Care at Outpatient Public Mental Health Programs in Two California Counties.

Purpose: Sexual and gender minority youth (SGMY, ages 16-24 years) face disparities in sexually transmitted infections (STIs) and HIV, in part, due to exposure to settings and behaviors that may harm youth's physical and mental health. This study examines the scope of sexual health and HIV services available to youth living with serious mental illness (SMI), including SGMY, seeking care at publicly funded outpatient mental health programs. Methods: Between 2018 and 2019, we surveyed 183 managers of mental health programs serving youth living with SMI of ages 16-24 years, including SGMY, in San Diego and Los Angeles counties. Participants reported on programs' target populations, sexual health/HIV service provision, and the use of peer providers. Descriptive statistics and Pearson chi-square tests were used to describe sexual health/HIV services and identify programmatic characteristics associated with providing these services. Results: Overall, 46% of all programs surveyed provided sexual health/HIV services. Of these, 62% provided HIV education, 81% provided sexual/reproductive health education, and 69% provided sexual/reproductive health education tailored for lesbian, gay, bisexual, queer, intersex (LGBQI) youth. Peers often provided these services. Chi-squared tests showed that programs employing peer specialists (p=0.009) and targeting LGBQI youth (p=0.045) were significantly more likely to provide sexual health/HIV services. Conclusion: The use of peer providers may reduce stigma around sexual/HIV service utilization and promote SGMY's trust. Publicly funded outpatient mental health programs serving youth and especially those actively engaging SGMY may consider also offering onsite HIV, STI, and sexual health services, creating a one-stop-shop approach.

Deported Men's and Father's Perspective: The Impacts of Family Separation on Children and Families in the U.S.

Background: Family separation due to the deportation of a migrant is pervasive, yet less is known about its potential impacts on the social, economic and mental well-being of families remaining in the United States. Methods: We conducted a mixed-methods study. In 2013, 303 Mexican male nationals completed an interviewer-administered questionnaire at a free clinic in Tijuana, Mexico. For this analysis, participants were: (1) ≥18 years; (2) seeking services; (3) Spanish or English speakers and (4) reported a U.S. deportation. Participants answered migration history items and open-ended questions regarding the impact of their deportation on U.S.-based family members. We present descriptive statistics and illustrative quotes for themes identified in the qualitative text data. Using a grounded-theory approach, we considered all data to develop a conceptual framework that others may use to study the consequences of family separation due to deportation. Results: Nearly two-thirds of participants reported living in the U.S. for 11+ years, a similar proportion reported 2+ deportations, and 31% reported being banned from re-entering the U.S. for 11+ years. More than one-half of participants were separated from their nuclear families (spouse/partner and/or children). Deportees who were separated from any family members reported that their families lost income for basic needs (rent/utilities: 50%, food: 44%, clothing: 39%, daycare: 16%, health insurance: 15%); school participation was also negatively impacted (31%). Qualitative data revealed that children ≤18 years remaining in the U.S. experienced mental health symptoms post-parental deportation (i.e., persistent crying, depression, sadness, anger, resentment). Deported fathers consistently expressed frustration at being unable to provide love, care, support, mentorship for their children. Based on our mixed-methods approach, we propose a framework to systematically study the consequences of family separation due to the deportation of fathers. Conclusion: Findings are consistent with the extant research. Binational interventions to support families that experience forced-separation are needed to mitigate short and long-term adverse mental health outcomes, especially among youth in the U.S., and other unfavorable family and household-level outcomes. Funding to understand the implications of maternal deportation and for longitudinal qualitative and quantitative research on migrant-focused interventions and related outcomes is needed.

Tattoo Removal as a Resettlement Service to Reduce Incarceration Among Mexican Migrants.

In Mexico, tattooed migrants face discrimination and are at high-risk of incarceration, thus, we assessed whether receiving laser tattoo removal affected the likelihood of incarceration. In 2015-2016, 89 adults ages ≥ 18 years with visible tattoos were recruited at a free-clinic to receive laser tattoo removal or assigned to the wait-list; all completed baseline and 6-month questionnaires. Overall, 97.8% of participants ever migrated to the USA. In multivariate analyses restricted to migrants (n = 87), those receiving laser tattoo removal [Adjusted Odds Ratio (AOR) 0.27, 95% CI 0.07-0.89] and possessing a Mexican Voting card (AOR 0.14; 95% CI 0.03-0.58) were significantly less likely than wait-list participants to be incarcerated at 6-months. Previously incarcerated participants were significantly more likely to be incarcerated at follow-up. Tattoo removal may reduce incarceration among Mexican migrants. Future studies can assess other health and social benefits of tattoo removal for migrants/deportees returning to Mexico.

Stability of "No-Pair Ferromagnetic" Lithium Clusters.

High-spin lithium clusters, n+1Lin (n = 2-21), have been systematically studied by using density functional theory. Although these high-spin clusters have no bonding electron pairs, they are stable with respect to isolated atoms. A set of 42 density functional theory functionals were benchmarked against CCSD(T)/cc-pVQZ results for clusters from the dimer to the hexamer. For these clusters, the strong non-additivity on the binding energy is analyzed employing a many-body energy decomposition scheme, concluding that most of the binding energy is due to a balance between the three- and four-body contributions. After a quality parameter had been defined, the LC-BP86 functional was identified as the most promising one for the description of high-spin lithium clusters. We employ the dependence of the second energy difference on cluster size to predict the formation of a higher-stability cluster.

Cost-Effectiveness of a Technology-Enhanced Diabetes Care Management Program in Mexico.

BACKGROUND: The prevalence of diabetes has increased substantially in Mexico over the last 40 years, leading to significant impacts on population health and the healthcare system. Technology-based solutions may improve diabetes outcomes in areas where lack of efficient transportation creates barriers to care. OBJECTIVES: To estimate the lifetime cost-effectiveness of a technology-based diabetes care management program from the perspective of the Mexican healthcare system. METHODS: Clinical outcomes and cost data from a 3-arm randomized clinical trial of Dulce Wireless Tijuana, a diabetes care management program incorporating short-term mobile technology, were used as inputs in a validated simulation model for type 2 diabetes. Study arms included a control group (CG), Project Dulce diabetes care management (PD), and Project Dulce with technology enhancement (PD-TE). RESULTS: Intervention costs were $1448 for PD and $1740 for PD-TE compared with $740 for CG. Both intervention arms increased quality-adjusted life-years and costs. The incremental cost-effectiveness ratio for PD was $1635 and for PD-TE was $2220, both compared with CG. The incremental cost-effectiveness ratio for PD-TE versus PD was $4299. The results were sensitive to the time horizon. The PE and PD-TE interventions were cost-effective under time horizons of 15 to 20 years, but were not cost-effective under time horizons of 5 to 10 years. CONCLUSIONS: Both the PD and PD-TE were highly cost-effective from a Mexican health system perspective. Considering the economic impact of the diabetes epidemic and the widespread use of cellular technology in Mexico, implementation of PD-TE is warranted.

Evaluating the impact of global fund withdrawal on needle and syringe provision, cost and use among people who inject drugs in Tijuana, Mexico: a costing analysis.

OBJECTIVE: From 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision. DESIGN: Costing study and longitudinal cohort study. SETTING: Tijuana, Mexico. PARTICIPANTS: Personnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study. PRIMARY OUTCOME MEASURES: Provision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal. RESULTS: During the GF period, the needle and syringe programme distributed 55 920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After GF withdrew, the needle and syringe programme distributed 10 700 syringes to 2140 contacts (five syringes/contact) across three geographical locations. During the GF period, the cost per harm reduction contact was approximately 10-fold higher compared with after GF ($44.72 vs $3.81); however, the cost per syringe distributed was nearly equal ($0.75 vs $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe programme in the post-GF period was significantly lower than during the GF period (p=0.02). CONCLUSIONS: Withdrawal of GF support for needle and syringe programme provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage and recent clean syringe utilisation among people who inject drugs. Better planning is required to ensure harm reduction programme sustainability is at scale after donor withdrawal.

Association of Adverse Childhood Experiences with Depression in Latino Migrants Residing in Tijuana, Mexico.

CONTEXT: Physical, sexual, and emotional abuse in childhood-adverse childhood experiences (ACEs)-are associated with poor mental and physical health. OBJECTIVE: To determine the prevalence of ACEs and their relationship to depression among Latino migrants in Mexico, which has not been previously examined. METHODS: A total of 110 Latinos aged 18 years and older residing in Tijuana, Mexico, completed interviewer-administered questionnaires, including the ACE scale (range = 0 to 10 items), at baseline in 2015. We studied the prevalence of ACEs (score on the ACE scale) and the presence of depressive symptoms (Patient Health Questionnaire-9). Multivariate logistic regression models were used to estimate the association between the ACE score and depressive symptoms. RESULTS: Overall, 82% of participants were men, and 82% reported being deported from the US. At least 1 ACE was reported by 64% of participants, and 33% reported 3 or more ACEs. Those who reported ever being incarcerated were significantly more likely to have 3 or more ACEs compared with no ACEs (56% vs 28%; p = 0.039). Symptoms of mild, moderate, or severe depression were identified in 14% of participants. In multivariate analyses, for each additional ACE item reported, participants were significantly more likely to meet criteria for depressive symptoms (adjusted odds ratio = 1.42; 95% confidence interval = 1.13-1.78; p = 0.002). CONCLUSION: Among Latino migrants residing in the US-Mexico border region, ACEs were pervasive and associated with depression symptoms. Programs and policies targeting migrants in this region should consider addressing both ACEs and depression.

Effects of heat treatment on enzyme activity and expression of key genes controlling cell wall remodeling in strawberry fruit.

Modification of cell wall polymers composition and structure is one of the main factors contributing to textural changes during strawberry (Fragaria x ananassa, Duch.) fruit ripening and storage. The present study aimed to provide new data to understand the molecular basis underlying the postharvest preservation of strawberry cell wall structure by heat treatment. Ripe fruit (cv. Aroma) were heat-treated in air oven (3 h at 45 °C) and then stored 8 days at 4 °C + 2 days at 20 °C, while maintaining a set of non-treated fruit as controls. The effect of heat stress on the expression pattern of key genes controlling strawberry cell wall metabolism, as well as some enzymatic activities was investigated. The expression of genes proved to be relevant for pectin disassembly and fruit softening process (FaPG1, FaPLB, FaPLC, FaAra1, FaßGal4) were down-regulated by heat treatment, while the expression of genes being involved in the reinforcement of cell wall as pectin-methylesterase (FaPME1) and xyloglucan endo-transglycosilase (FaXTH1) was up-regulated. Total cell wall amount as well as cellulose, hemicellulose, neutral sugars and ionically and covalently bounded pectins were higher in heat-stressed fruit compared to controls, which might be related to higher firmness values. Interestingly, heat stress was able to arrest the in vitro cell wall swelling process during postharvest fruit ripening, suggesting a preservation of cell wall structure, which was in agreement with a lower growth rate of Botrytis cinerea on plates containing cell walls from heat-stressed fruit when compared to controls.

Cost of provision of opioid substitution therapy provision in Tijuana, Mexico.

BACKGROUND: Mexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns. METHODS: We adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined "delivery cost" as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates. RESULTS: The total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93-$2.66 per methadone dose. CONCLUSIONS: The cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.

Deportation and mental health among migrants who inject drugs along the US-Mexico border.

This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) screening instrument. Eligible participants were ≥18 years old, injected drugs in the past month, spoke English or Spanish, and resided in Tijuana. Multivariate analyses identified factors associated with depressive symptoms. Among deported PWID, 45% reported current symptoms of depression. Deported PWID who were initially detained in the US for a crime-related reason before being deported (adjusted odds ratio (AOR): 5.27; 95% CI: 1.79-15.52) and who perceived needing help with their drug use (AOR: 2.15; 95% 1.01-4.61) had higher odds of reporting depressive symptoms. Our findings highlight the need for effective strategies targeting deported migrants who inject drugs to treat mental health and drug abuse in Tijuana. Investing in the mental health of deported PWID may also be a viable HIV prevention strategy.

Relationships Between Integration and Drug Use Among Deported Migrants in Tijuana, Mexico.

Deported migrants face numerous challenges which may elevate their risk for drug use. We examined relationships between integration and drug use among deported migrants in Tijuana, Mexico. A cross-sectional survey conducted at a free health clinic included 255 deported Mexican-born migrants residing in Tijuana ≥6 months. Multivariable logistic regression examined associations between variables across four integration domains (public participation, social connections, macro-level facilitators and foundations) and recent (past 6-month) drug use. The prevalence of recent drug use was 46 %. Having sought work in Tijuana in the past 6 months, greater household affluence, lifetime history of incarceration in both US and Mexico, and lacking health insurance were independently associated with recent drug use. Policies that support access to employment, adequate housing and healthcare in Mexico, particularly for justice-involved deportees, may facilitate successful integration and reduce potential stressors that may contribute to drug use.

Depressive symptoms among patients at a clinic in the Red Light District of Tijuana, Mexico.

Little is known about depression among structurally vulnerable groups living in Tijuana (e.g., migrants, deportees, substance users, sex workers, homeless) who may be at high risk for poor mental health. This study investigates the prevalence and correlates of depressive symptoms among vulnerable patients receiving services at a free clinic in Tijuana, Mexico. A convenience sample of 584 adult Mexican patients completed an interviewer-administered questionnaire in English or Spanish that included the 8-item NIH PROMIS depression short form and measures of individual, social, and structural factors affecting health. The prevalence of clinically significant depressive symptoms in our sample was 55%. In the multivariate analysis, female gender, poor/fair self-rated health, recent illicit drug use (past six months), feeling rejected (past six months), history of forced sex, and history of violence were independently associated with increased odds of experiencing depressive symptoms. When stratified by gender, we found important differences in significant factors, including recent illicit drug use in men and deportation in women. Among study participants, prevalence of depressive symptoms exceeds prevalence rates reported elsewhere in the U.S.-Mexico border region. These findings suggest that public health efforts to support mental health services in the border region are needed.

Engagement in the HIV Care Continuum among Key Populations in Tijuana, Mexico.

In Tijuana, Mexico, HIV is concentrated in sub-epidemics of key populations: persons who inject drugs (PWID), sex workers (SW), and men who have sex with men (MSM). To date, data on engagement in the HIV care continuum among these key populations, particularly in resource-constrained settings, are sparse. We pooled available epidemiological data from six studies (N = 3368) to examine HIV testing and treatment uptake in these key populations; finding an overall HIV prevalence of 5.7 %. Of the 191 identified HIV-positive persons, only 11.5 % knew their HIV-positive status and 3.7 % were on ART. Observed differences between these HIV-positive key populations suggest PWID (vs. non-PWID) were least likely to have previously tested or initiate HIV care. MSM (vs. non-MSM) were more likely to have previously tested but not more likely to know their HIV-positive status. Of persons aware of their HIV-positive status, SW (vs. non-SW) were more likely to initiate HIV care. Findings suggest engagement of key populations in HIV treatment is far below estimates observed for similarly resource-constrained generalized epidemics in sub-Saharan Africa. These data provide one of the first empirical-snapshots highlighting the extent of HIV treatment disparities in key populations.

Police Victimization Among Persons Who Inject Drugs Along the U.S.-Mexico Border.

OBJECTIVE: Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.-Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. METHOD: From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). RESULTS: Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a "hit doctor" (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. CONCLUSIONS: Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.-Mexico border region should consider PWID's drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region.

Prevalence and correlates of HIV among men who have sex with men in Tijuana, Mexico.

INTRODUCTION: Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city. METHODS: We conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation. RESULTS: A total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4-46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0-40.0) were estimated to have ever used methamphetamine. Independent correlates of being infected with HIV were methamphetamine use (odds ratio [OR] = 2.24, p = 0.045, 95% CI: 1.02, 4.92) and active syphilis infection (OR = 4.33, p = 0.01, 95% CI: 1.42, 13.19). CONCLUSIONS: Our data indicate that MSM are a key sub-population in Tijuana at higher risk for HIV. Tijuana would also appear to have the highest proportion among upper-middle-income countries of HIV-positive MSM who are unknowingly infected. More HIV prevention research on MSM is urgently needed in Tijuana.

The role of visual markers in police victimization among structurally vulnerable persons in Tijuana, Mexico.

BACKGROUND: Law enforcement can shape HIV risk behaviours and undermine strategies aimed at curbing HIV infection. Little is known about factors that increase vulnerability to police victimization in Mexico. This study identifies correlates of police or army victimization (i.e., harassment or assault) in the past 6 months among patients seeking care at a free clinic in Tijuana, Mexico. METHODS: From January to May 2013, 601 patients attending a binational student-run free clinic completed an interviewer-administered questionnaire. Eligible participants were: (1) ≥18 years old; (2) seeking care at the clinic; and (3) spoke Spanish or English. Multivariate logistic regression analyses identified factors associated with police/army victimization in the past 6 months. RESULTS: More than one-third (38%) of participants reported victimization by police/army officials in the past 6 months in Tijuana. In multivariate logistic regression analyses, males (adjusted odds ratio (AOR): 3.68; 95% CI: 2.19-6.19), tattooed persons (AOR: 1.56; 95% CI: 1.04-2.33) and those who injected drugs in the past 6 months (AOR: 2.11; 95% CI: 1.29-3.43) were significantly more likely to report past 6-month police/army victimization. Recent feelings of rejection (AOR: 3.80; 95% CI: 2.47-5.85) and being denied employment (AOR: 2.23; 95% CI: 1.50-3.32) were also independently associated with police/army victimization. CONCLUSION: Structural interventions aimed at reducing stigma against vulnerable populations and increasing social incorporation may aid in reducing victimization events by police/army in Tijuana. Police education and training to reduce abusive policing practices may be warranted.