Methamphetamine and cocaine use among Mexican migrants in California: the California-Mexico Epidemiological Surveillance Pilot.

Abstract

Methamphetamine and cocaine use have been associated with a vulnerability to HIV infection among men who have sex with men and among men who have sex with women but not specifically among Mexican migrants in the United States. The California-Mexico Epidemiological Surveillance Pilot was a venue-based targeted survey of male and female Mexican migrants living in rural and urban areas in California. Among men (n = 985), the percentage of methamphetamine/cocaine use in the past year was 21% overall, 20% in male work venues, 19% in community venues, and 25% in high-risk behavior venues. Among women, 17% reported methamphetamine/cocaine use in high-risk behavior venues. Among men, methamphetamine/cocaine use was significantly associated with age less than 35 years, having multiple sex partners, depressive symptoms, alcohol use, sexually transmitted infections (including HIV), and higher acculturation. Prevention interventions in this population should be targeted to specific migrant sites and should address alcohol, methamphetamine, and cocaine use in the context of underlying psychosocial and environmental factors.

Full text

Page 1

AIDS Education and Prevention, 21, Supplement B, 34–44, 2009
© 2009 The Guilford Press
34
María Teresa Hernández, Melissa A. Sanchez, Lorena Ayala, Bart K. Aoki and George F. Lemp are with
the California HIV/AIDS Research Program, University of California, Office of the President, Oakland.
Carlos Magis-Rodríguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA e ITS,
México D.F., México. Juan D. Ruiz is with the Center for Infectious Diseases, Division of Communi-
cable Disease Control, California Department of Public Health, Richmond. Michael C. Samuel is with
the Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond.
Alvaro H. Garza is with the San Mateo County Health Department, San Mateo, CA.
This study is a product of the California-Mexico AIDS Initiative, a collaboration among federal, state,
and local agencies in the United States and in Mexico. Primary partners are the California HIV/AIDS
Research Program, the Office of AIDS, California Department of Public Health, and the Centro Nacional
para la Prevención y Control del VIH/SIDA e ITS, México. Other partner agencies include the Sexu-
ally Transmitted Disease Control Branch, California Department of Public Health, the San Diego Public
Health Laboratory, the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention,
Planned Parenthood MarMonte, Vista Community Clinic, the Bi-national AIDS Advocacy Project (PRO-
CABI), the Health and Human Services Agency of the County of San Diego, the Department of Commu-
nity Health of the County of Fresno, the Latino Center for Medical Education and Research (part of the
University of California, San Francisco, at Fresno), and the Health Initiative of the Americas, University
of California, Berkeley. Support for this study came from the following sources: the California HIV/
AIDS Research Program, University of California, Office of the President; the Office of AIDS, California
Department of Public Health; the Sexually Transmitted Disease Control Branch, California Department
of Public Health; the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention; and
The California Endowment.
Address correspondence to María Teresa Hernández, MPH, Director, Applied Community Research and
Evaluation, Public Health Practice, School of Public Health, University of California, Berkeley, 141 Uni-
versity Hall, Berkeley, CA 94720-7360; maria.hernandez@berkeley.edu
Hernández et al.
Drug Use Among Mexican Migrants
METHAMPHETAMINE AND COCAINE
USE AMONG MExICAN MIGRANTS IN
CALIFORNIA: THE CALIFORNIA-MExICO
EPIDEMIOLOGICAL SURVEILLANCE PILOT
María Teresa Hernández, Melissa A. Sanchez, Lorena Ayala, Carlos
Magis-Rodríguez, Juan D. Ruiz, Michael C. Samuel,
Bart K. Aoki, Alvaro H. Garza, and George F. Lemp
Methamphetamine and cocaine use have been associated with a vulnerabil-
ity to HIV infection among men who have sex with men and among men
who have sex with women but not specifically among Mexican migrants in
the United States. The California-Mexico Epidemiological Surveillance Pilot
was a venue-based targeted survey of male and female Mexican migrants
living in rural and urban areas in California. Among men (n = 985), the
percentage of methamphetamine/cocaine use in the past year was 21%
overall, 20% in male work venues, 19% in community venues, and 25%
in high-risk behavior venues. Among women, 17% reported methamphet-
amine/cocaine use in high-risk behavior venues. Among men, methamphet-
amine/cocaine use was significantly associated with age less than 35 years,
having multiple sex partners, depressive symptoms, alcohol use, sexually

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DRUG USE AMONG MEXICAN MIGRANTS 35
transmitted infections (including HIV), and higher acculturation. Preven-
tion interventions in this population should be targeted to specific migrant
sites and should address alcohol, methamphetamine, and cocaine use in the
context of underlying psychosocial and environmental factors.
Migration has increased the vulnerability of populations to HIV infection in dif-
ferent parts of the world (Coffee, Lurie & Garnett, 2007; Joint United Nations
Programme on HIV/AIDS & International Organization for Migration, 1998; Yang,
Derlega & Luo, 2007). Mexican migration has increased dramatically in recent de-
cades in the U.S., and California continues to be home to the highest concentration
of this population (The Pew Hispanic Center, 2005). Despite strong participation in
the U.S. labor force, especially in California, Mexican migrants and immigrants are
more likely than U.S.-born Latinos or other U.S.-born race/ethnicity groups to live
in poverty, to lack public or private health insurance, and to lack a usual health care
provider (The Pew Hispanic Center & Robert Wood Johnson Foundation, 2008;
Zúniga, Castañeda, Averbach, & Wallace, 2006). Moreover, Mexican-born Latinos
are more likely than U.S.-born Latinos to present a short HIV-to-AIDS interval, im-
plying delayed testing and inadequate care and treatment (Espinoza, Hall, Selik, &
Xiaohong, 2008; Tang, Levy, & Hernandez, 2008). In addition, in two California
studies, it was more likely that Latino immigrants were infected with HIV in the U.S.
than in their home countries (Harawa et al., 2002; Levy et al., 2007).
Although published research on Latino migrants within the U.S. portrays con-
siderable environmental vulnerability promoting unprotected sex with multiple
partners and sex workers, and also unprotected sex under the influence of alcohol,
available data on HIV prevalence among migrants suggest infection rates are low
(Organista & Balls Organista, 1997; Organista, Carrillo, & Ayala, 2004; Painter,
2008; Sanchez et al., 2004). Over time, environmental and behavioral factors may
increase the opportunities for HIV-infected individuals to enter into Latino migrant
sexual networks, and migrant communities could experience higher rates of HIV
infection and transmission (Apostolopoulos et al., 2006; Rangel et al., 2006; Worby
& Organista, 2007). Methamphetamine and cocaine use promotes opportunities for
becoming infected with HIV and sexually transmitted infections (STIs) among men
who have sex with men (MSM) and, more recently, among men who have sex with
women, particularly through unprotected anal and vaginal intercourse and unpro-
tected intercourse with a new partner (Centers for Disease Control and Prevention
[CDC], 2006; Compton, Lamb, & Fletcher, 1995; Mansergh et al., 2006; Moli-
tor, Truax, Ruiz, & Sun, 1998; Zule, Costenbader, Meyer, & Wechsberg, 2007).
Although there is evidence that methamphetamine and crack cocaine smoking is
increasing nationally, especially in the border states in Mexico and in the United
States, in addition to increasing non-injected methamphetamine use among Latinos
diagnosed with AIDS in California, research is scarce addressing these behaviors
among Mexican migrants in relation to HIV (Maxwell et al., 2006; Rock Wohl,
Johnson, & Frye, 2007). This article examines methamphetamine/cocaine use and
its association with STIs, HIV, and other risk behaviors among Mexican migrant
men in California.

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36 HERNÁNDEZ ET AL.
METHODS
The California-Mexico Epidemiological Surveillance Pilot (CMESP) was a bination-
al collaborative project to assess the vulnerabilities and risk behaviors of Mexican
migrants to HIV and STIs. The National Center for HIV/AIDS Control and Preven-
tion, Secretariat of Health, Mexico (CENSIDA) shaped the research design through
background information on migrant demographics, vulnerabilities, and risk behav-
ior and was instrumental in the development of the questionnaire. The CMESP con-
sisted of a venue-based targeted systematic survey of male and female Mexican mi-
grants living in rural and urban areas in San Diego and Fresno counties, California,
conducted from March 2004 through November 2005 by collaborating community-
based organizations (Planned Parenthood MarMonte, Vista Community Clinic, and
the Bi-national AIDS Advocacy Project [PROCABI]).
The target population was defined as persons 18-64 years of age, born in Mexi-
co, who either (a) had been living/working in the United States for 5 years or less or
(b) had been living/working in the United States for more than 5 years but returned
to Mexico at least every 24 months on average. Additionally, basic fluency in Span-
ish or English was required to participate. More than 150 sites identified through
key informants and field staff were assessed for potential participation in the survey
throughout the 2-year study period. The assessment consisted of an initial screening
visit and, if promising, enumeration. The screening criteria considered if the site was
suitable for the study protocol and confirmed the presence of the target population.
Enumeration consisted of systematically screening the population (e.g., every third
person at a day laborer pick-up location, or every other person walking by the main
entrance of a bar/club) using a 2-minute questionnaire to assess the volume and
proportion of our target population at a given site during time frames of one to four
hours. Three types of sampling venues were identified:
1. Male work (male migrant camps and day laborer pick-up locations)
2. Community (family migrant camps, laundromats, parks, adult schools and
churches)
3. High-risk behavior (bars and clubs including sites with MSM, and parks and
streets with drug use or MSM activity)
Only enumerated sites with relatively high volumes and proportions of the target
population were selected for the survey (except for high-risk behavior venues that
had their own sampling frame with a lower volume threshold). A given site was
added or dropped throughout the study depending on its enumeration data at that
time and the proportion of persons who had already participated in the study. Sub-
sequently, we systematically sampled individuals from each site in proportion to
the volume of eligible migrants enumerated there. During the survey, a systemati-
cally selected person at a site was first enumerated and, if found to be eligible, was
offered participation in the study. The survey was composed of informed consent
procedures, a 35-minute interviewer-administered questionnaire, and collection of
blood and urine specimens for testing for HIV, STIs, and hepatitis C virus. The ques-
tionnaire included sections on demographics, migration patterns, sexual behavior,

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DRUG USE AMONG MEXICAN MIGRANTS 37
substance use, and HIV knowledge. The questionnaire, consent forms and proce-
dures, and study design were approved by the Committee on Human Research at the
University of California, San Francisco, and by the Committee for the Protection of
Human Subjects, California Health and Human Services Agency.
MEASURES
Reported Methamphetamine/Cocaine Use. The questionnaire asked participants to
self-report use of methamphetamine, cocaine, heroin, and other drugs in the past 12
months. As data collection began, field staff reported that participants often referred
to methamphetamine as “coca” or cocaine or thought they were the same drug. Key
informants and field staff both indicated that “cranka” (methamphetamine) was
prevalent in many of our sampling sites and participants were likely to refer to it as
“coca.” In the sampling during the second year we added questions in the survey
on cocaine cost and amount purchased to determine whether methamphetamine use
was being reported as cocaine use. However, most of the participants could only
provide approximate amounts and stated that they had purchased “un poquito”
(a little bit) for “un veinte” (twenty dollars’ worth). More specific information was
reported by a subset of 13 respondents, who reported the purchase of .25 to 1 gram
of the drug for U.S.$20, which suggests the cost range for methamphetamine, crack
cocaine or lowest purity level powder cocaine (Executive Office of the President,
Office of National Drug Control Policy, 2004). Both Fresno and San Diego counties
are in methamphetamine transportation corridors and distribution areas (National
Drug Intelligence Center, United States Department of Justice, 2006). Although the
CMESP ethnographic information supported the prevalence of methamphetamine
use, it is likely that some cocaine, crack cocaine, a combination of these, or some
other drug was consumed by participants at any given site. Based on the difficulty
in differentiating between cocaine and methamphetamine, we combined these two
drugs to create the methamphetamine/cocaine variable.
Acculturation was assessed using a seven-item Likert language preference scale.
A “low” category, derived when a participant reported listening to and speaking
exclusively in Spanish at home, at work, and at leisure, has been found among
Mexican migrants to be associated with a lower prevalence of psychiatric disorders
and depressive symptomatology and a lower prevalence of illicit drug use (Alderete,
Vega, Kolody, & Aguilar-Gaxiola, 1999; Alderete, Vega, Kolody, & Aguilar-Gaxi-
ola, 2000; Vega, Alderete, Kolody, & Aguilar-Gaxiola, 1998). Alcohol use in past
30 days reflects the number of days in which participants consumed at least five
alcoholic drinks. Depressive symptoms in the past 7 days were defined by a score
≥ 16 using the Center for Epidemiologic Studies-Depression (CES-D) scale, previ-
ously used in Mexican immigrant populations (Alderete et al., 1999). Any sexually
transmitted infection includes Chlamydia trachomatis, HIV, syphilis, and hepatitis
C virus. A Gen-Probe Aptima Combo 2 assay was used to detect Chlamydia tracho-
matis and Neisseria gonorrhoeae in urine samples. Syphilis was detected in serum
samples using Rapid Plasma Reagin and confirmed by Treponema Pallidum-Particle
Agglutination. HIV and hepatitis C were detected on serum samples by enzyme
immunoassays and confirmed, respectively, by Western blot and recombinant im-
munoblot assays. Statistical analysis was performed using SAS, Version 9.1 (SAS
Institute, Cary, NC). The unweighted results are stratified by venue to best represent
the different profiles of the three venue types. While controlling for venue, stepwise

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38 HERNÁNDEZ ET AL.
logistic regression was used with variables that were significantly associated with
methamphetamine/cocaine in the univariate analysis.
RESULTS
There were 1,283 participants recruited across 68 sampling sites (31 male work ven-
ues, 24 community venues, 13 high-risk behavior venues), with a 21% refusal rate
during enumeration and a 24% refusal rate among eligible persons. Among the 985
men enrolled in the survey, 21% reported methamphetamine/cocaine use (20% in
male work venues, 19% in community venues, and 25% in high-risk behavior ven-
ues) (Table 1). Among men who reported methamphetamine/cocaine use, 59% re-
ported some methamphetamine use and 41% reported cocaine use. Only seven men
reported injecting methamphetamine/cocaine, and they were recruited in all three
types of venues. Use of cocaine, specifically, was not reported significantly higher in
any type or subtype of venue. Methamphetamine/cocaine use was reported by 2% of
the women in the study sample (0% in male work venues, <1% in community ven-
ues, and 17% of the women in high-risk behavior venues). Among the 43 men that
reported geographic location of drug use (in questions added in the second year of
sampling), 77% indicated methamphetamine/cocaine use exclusively in California
in the past year. The percent of heroin use was 2% among men and 1% for women,
61% (11/18) of whom reported use through injection.
Table 2 shows the univariate analysis of variables by methamphetamine/cocaine
use among men by type of venue. Younger men, as compared with those over 35
years of age, were significantly more likely to have used methamphetamine/cocaine
in male work venues and community venues. The percentage reporting methamphet-
amine/cocaine use increased significantly with the number of sexual partners in all
three types of venues. Specifically, men with multiple partners, compared with men
with zero or one partner, were significantly more likely to also report methamphet-
amine/cocaine use in all three types of venues. Methamphetamine/cocaine use was
significantly associated with sex with sex workers, higher acculturation, higher level
of alcohol use and depressive symptoms in the past week in only the male work and
high-risk behavior venues although the trend was generally similar in the community
venues. Among men disclosing the characteristics of their sex work partners (n =
TABLE 1. Methamphetamine/Cocaine and Heroin Use by Type of Venue;
Mexican Migrants in California, 2004-2005
Total Study
Sample
Male Work
Venues
Community
Venues
High-Risk
Behavior Venues
Methamphetamine/cocaine
Mena
(209/985) 21% (105/525) 20%(40/209) 19%(64/251) 25%
Women (5/286) 2%( 0/6) 0%(1/257) 0.4%( 4/23) 17%b
Heroin
Menc
(16/985) 2%(8/525) 2% (3/209) 1%(5/251) 2%
Womend
(2/286) 1% (0/6) 0%(0/257) 0%(2/23) 9%
aChi-square tests for differences between proportions were not significant comparing venue categories for men; 7 out
of 985 men reported injecting methamphetamine/cocaine and they were recruited across all three types of venues. bChi-
square p < .001 as compared to community venues. cAmong 16 men, 10 injected heroin, distributed across the venues;
14 also used methamphetamine/cocaine. dAmong two women, one injected heroin; both also used methamphetamine/
cocaine. Among transgenders, two out of 12 reported methamphetamine/cocaine use.

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DRUG USE AMONG MEXICAN MIGRANTS 39
TABLE 2. Mexican Migrant Male Participants Reporting Methamphetamine/Cocaine Use by Type of Venue and Selected Variables (n = 985)

Male Work Venues n = 525
Community Venues n = 209
High-Risk Behavior Venues n = 251

Men Reporting
Methamphetamine/Cocaine


Men Reporting
Methamphetamine/Cocaine


Men Reporting
Methamphetamine/Cocaine
n
% OR (95% CI)
p
n
% OR (95% CI)
p
n
% OR (95% CI)
p
Age in years












18 to 24
40
26
2.0 (1.2-3.4)
0.009
22
34 7.6 (2.9-20.1)
<.001
27
29
1.2 (0.6-2.4)
0.631
25 to 34
33
21
1.5 (0.9-2.6)
0.129
12
23 4.4 (1.5-12.4)
0.004
18
21
0.8 (0.4-1.7)
0.531
35+
32
15
ref

6
6
ref

19
26
ref

Number of sex partners











0 to 1
38
12
ref

25
16
ref

13
13
ref

2 to 4
52
34
4.0 (2.5-6.5)
<.001
13
32
2.5 (1.2-5.5)
0.018
28
24
2.1 (1.0-4.2)
0.048
5+
15
33
3.8 (1.9-7.8)
<.001
2
29 2.2 (0.4-11.8)
0.359
23
61 9.9 (4.1-23.7)
<.001
Sex with sex worker












Yes
32
31
2.2 (1.3-3.6)
0.001
4
31
2.0 (0.6-6.8)
0.272
17
37
2.0 (1.0-3.9)
0.049
No
73
17
ref

36
18
ref

47
23
ref

Acculturationa












Low
45
16
ref

25
19
ref

14
18
ref

Medium to high
60
24
1.7 (1.0-2.6)
0.016
15
20 1.1(0.5 – 2.2)
0.868
50
29
1.9 (1.0-3.6)
0.066
Alcohol use in past 30 daysb











0 or 1 day
76
17
ref
<.001
37
20
ref

14
21
ref

2 or more days
29
38
3.0 (1.8-5.0)

3
11
0.5 (0.1-1.6)
0.225
50
60 5.7 (2.6-12.7)
<.001
Depressive symptomsc











Yes
24
34
2.4 (1.4-4.1)
0.001
5
28
1.7 (0.6-5.0)
0.349
20
41
2.5 (1.3-4.9)
0.006
No
81
18
ref

35
19
ref

43
22
ref

Any STId












Yes
10
24
1.3 (0.6-2.8)
0.465
0
0e
ref
--
15
68 7.9 (3.0-20.4)
<.001
No
95
20
ref

40
20
undefined

49
21
ref

OR = Odds Ratio, CI = Confidence Interval, ref = referent category. STI = sexually transmitted infection. aTwo participants with missing acculturation scale. The Cronbach α in our analysis was .89.
bFive or more alcoholic drinks in one day. cEight participants with missing depression scale. The Cronbach α in our analysis was .90. dSome missing STI results: five CT, three syphilis, seven hepatitis
C virus, one HIV. eZero out of five participants.

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40 HERNÁNDEZ ET AL.
144), 71% reported their sex workers as Latina women, 18% as women of varied
race/ethnicities, 8% as transgender (mostly Latina/o), and 1% as men.
About half (51%) of the overall sample of migrant men reported farmwork in
the past year (57% in male work venues, 67% in community venues, and 26% in
high-risk venues), and it was not significantly associated with methamphetamine/
cocaine use. Analysis of methamphetamine/cocaine use across the sexual behavior
categories (i.e. MSM, men who have sex with women, and men who did not have
sexual partners) did not result in statistically significant findings. Additionally, men
reporting unprotected anal or vaginal sexual encounters were not more likely to re-
port methamphetamine/cocaine use as compared with men reporting only protected
sex.
Men who tested positive for any STI (including HIV) were significantly more
likely to report methamphetamine/cocaine use in high-risk behavior venues (odds
ratio [OR] = 7.9, 95% confidence interval [CI] = 3.0-20.4; see Table 2). We found six
HIV-infected men in our study, five of whom were among MSM at MSM high-risk
behavior sampling sites. Three of the six HIV-infected men in the sample reported
both multiple partners and methamphetamine/cocaine use. The three men also re-
ported use of a condom at last sexual encounter with all sexual partners. Among
men, there were 30 Chlamydia trachomatis infections, 16 syphilis infections (14
early latent, 2 primary), and 18 hepatitis C virus infections, not mutually exclusive.
There were no Neisseria gonorrhoeae infections detected.
In multivariate analysis, while controlling for type of venue, methamphetamine/
cocaine use was associated with younger age cohorts compared with age over 35
years (OR = 2.2, 95% CI = 1.5-3.3 for 18 to 24 years; OR = 1.5, 95% CI = 1.0-2.3
for 25 to 34 years), multiple sex partners as compared with zero or one partner (OR
= 2.5, 95% CI = 1.7-3.6 for two to four partners; OR = 3.7, 95% CI = 2.2-6.3 for
five or more partners), alcohol use (OR = 2.5, 95% CI = 1.6-3.8 for two or more
days in past month vs. 0 or 1 day), depressive symptoms (OR = 2.2, 95% CI =
1.4-3.3), any STI (OR = 2.0, 95% CI = 1.1-3.5) and higher acculturation (OR = 1.4,
95% CI = 1.0-2.0) (Table 3).
LIMITATIONS
Although our study includes a variety of Mexican migrant sites in the counties
of Fresno and San Diego, the results represent the sampled population at the selected
sites, not the Mexican migrant population in California as a whole. In addition,
because this was a cross-sectional design, the directionality of the associations may
vary in that some of the factors may precede, be concurrent with, or pursue meth-
amphetamine/cocaine use. Notwithstanding, the literature indicates alcohol binging
is common at the time of using methamphetamine and cocaine, and jointly, promote
unprotected sex, a greater number of sexual partners, and ultimately, an increased
likelihood of becoming infected with HIV and other STIs (Colfax et al., 2004; Sem-
ple, Zians, Grant, & Patterson, 2005; Zule et al., 2007). Another limitation is that
the drug use questions did not address intensity of use in the past 12 months. In ad-
dition, unprotected anal or vaginal sex was defined by whether a condom had been
used during the last anal or vaginal sexual encounter for each reported partner (up
to six) in the past 12 months, excluding event-level analysis on condom use under
the influence of methamphetamine/cocaine.

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DRUG USE AMONG MEXICAN MIGRANTS 41
DISCUSSION
The high percentage of methamphetamine/cocaine use in this study suggests that
Mexican migrant men are at substantial risk for this particular HIV-related high-
risk behavior. Although the percentage of methamphetamine/cocaine use in the total
study sample (21%) includes high-risk behavior venues, the percentage in these ven-
ues (25%) was not statistically greater than the percentages in male work (20%) and
community venues (19%). The Young Men’s Survey (YMS), a population-based sur-
vey of men aged 18-35 years living in low-income areas in five counties in Northern
California, reported 14% methamphetamine or cocaine or crack use in the past six
months (CDC, 2006). Given the difference in the reported time periods (12 months
in the CMESP vs. 6 months in the YMS), comparison of the studies is problematic,
but the presence of methamphetamine/cocaine use among low-income male popu-
lations in California regardless of race/ethnicity and migrant status is clear. In our
survey, the percentage of women reporting methamphetamine/cocaine use was low
in community venues (<1%). However, in the high-risk behavior venues, men and
women appear to have similar rates of methamphetamine/cocaine use.
The Borges, Medina-Mora, Breslau, and Aguilar-Gaxiola (2007) analysis of the
2001-2002 Mexican National Comorbidity Survey indicates a lower prevalence of
methamphetamine/cocaine use among migrants than in our study. Persons with a his-
tory of labor migration to the United States had a prevalence of lifetime use (ever) of
10.0% for cocaine and 6.4% for other drugs. Moreover, in this analysis, migrants
TABLE 3. CMESP Methamphetamine/Cocaine Use Multivariate Analysis,
Mexican Migrant Male Study Population in California, 2004-2005
OR (95% CI)
p
Venue
High-risk behavior
Male work
Community
Age in years
18 to 24
25 to 34
35+
Number of sex partners
0 to 1
2 to 4
5+
Alcohol use in past 30 days
0 or 1 day
2 or more days
Depressive symptoms
Yes
No
Any STI
Yes
No
Acculturation
Low
Medium to high

0.7 (0.4-1.2)
0.8 (0.5-1.2)
0.162
0.204
ref

2.2 (1.5-3.3)
1.5 (1.0-2.3)
<.001
0.048
ref



ref
2.5 (1.7-3.6)
3.7 (2.2-6.3)
<.001
<.001

ref
2.5 (1.6-3.8)<.001

2.2 (1.4-3.3)<.001
ref

2.0 (1.1-3.5)0.023
ref



ref
1.4 (1.0-2.0)0.04
Note. CMESP = California-Mexico Epidemiological Surveillance Pilot. OR = odds ratio. CI = confidence interval. ref =
referent category. Logistic regression analysis with n = 977; eight observations excluded due to incomplete data.

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42 HERNÁNDEZ ET AL.
had a higher prevalence of lifetime use of cocaine and other drugs as compared with
family members of migrants, and other Mexicans. As compared with this population-
based survey, the selection of sampling sites based on high concentrations of the target
population in our study could have selected for Mexican migrants at a higher risk for
methamphetamine/cocaine use than other Mexican migrants. The 1999 California Ag-
ricultural Worker Health Survey, where 90% of the sample was born in Mexico, found
that 14% (60/416) of farmworkers had ever used methamphetamine, speed, crack, or
cocaine (Villarejo, 2008). The lower prevalence in this study may be explained by data
from the national treatment admissions in the United States and in Mexico suggesting
that in 1999 the trend of smoking methamphetamine and crack cocaine was just start-
ing to rise in the border states and had doubled by 2003 (Maxwell et al., 2006).
Younger age and having multiple sexual partners were associated with meth-
amphetamine/cocaine use in all three venue types in this sample of Mexican migrant
men. This finding is similar to other studies of methamphetamine use among hetero-
sexuals (CDC, 2006; Molitor et al., 1998; Zule et al., 2007). Higher acculturation
has previously been shown to be associated with illicit drug use among Mexican
immigrants (Vega et al., 1998), similar to the association with methamphetamine/
cocaine use found in our study. Previous studies of Mexican migrants have also
reported the common practice of having sex with sex workers, where a network of
men may be linked by one or more female sex workers, which consequently gener-
ates the potential for multiple infections at one site (Organista & Organista, 1997;
Painter, 2008). In our study, methamphetamine/cocaine use was significantly associ-
ated with sex with sex workers in our univariate analysis but not in our multivariate
analysis, while controlling for number of partners. This may be due to migrant men
reporting sex workers as simply sexual partners, given the ambiguity in classifying
a friend who performs sex work, as reported by field staff. Additionally, depressive
symptoms and alcohol use were associated with methamphetamine/cocaine use in
our sample. Depression has been shown to be a common comorbidity among per-
sons with drug and alcohol dependence (Regier et al., 1990). Among cocaine and
methamphetamine users, depression has also been associated with higher levels of
impulsivity in sexual behavior (Semple et al., 2005).
In the high-risk behavior venues, our results are consistent with previous stud-
ies finding an association between STIs, including HIV, and methamphetamine/co-
caine use among MSM and heterosexual men (CDC, 2006; Mansergh et al., 2006).
Cocaine use and, in particular, crack cocaine, has been strongly associated with
HIV high-risk behaviors, sex work, and STIs in various populations in the United
States (Compton et al., 1995) and also among Latino immigrants (Paz-Bailey, Teran,
Levine, & Markowitz, 2004). In our study, the combination of these factors adds
up to a risk profile for Mexican migrant men that is similar to other young men liv-
ing in California that struggle with poverty. However, as compared with U.S.-born
populations in California, Mexican migrants and immigrants are less likely to have
regular sources of health care and insurance that contribute to delayed testing and
late HIV presentation.
Our findings underscore the importance of targeting the three types of venues
for prevention interventions, not only traditional high-risk venues. Moreover, the
profiles of the three different venues in our study provide distinct contexts for pre-
vention opportunities. In the male work venues, sex workers, alcohol, and drugs
were frequently available to men that primarily attended or lived at these sites for
employment purposes, not leisure. Most of these men were separated, even if tem-
porarily, from female partners and families. Therefore, interventions should include

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DRUG USE AMONG MEXICAN MIGRANTS 43
focus on resiliency factors in the face of separation from partners and families and
the pervasive offers to engage in high-risk behaviors. In the community venues, espe-
cially through adult schools, churches, and community groups, prevention programs
can address experimenting with and addiction to methamphetamine/cocaine, alco-
hol bingeing, and harm reduction services. Most of the HIV and STIs were found
in the high-risk behavior venues, where mixing of migrant and nonmigrant sexual
networks was visually evident. The majority of the bars and clubs were completely
devoid of any prevention messages or interventions. Therefore, we recommend peer-
driven interventions promoting the use of condoms, drug and alcohol prevention and
harm reduction, and also having condoms available at the high-risk behavior sites.
For all three venue types, given the transient nature of the population, peer-driven
prevention interventions that can continue wherever the migrants relocate may yield
significant impact on knowledge, awareness, and behavior change or avoidance.
Lastly, our study highlights the need to target the populations at Mexican migrant
sites with alcohol and drug-related education and prevention interventions, harm
reduction services, testing and treatment for STIs and HIV, mental health services,
and other comprehensive care and prevention services.
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