Article

Conflicting Laws and Priorities as Drug Policy Implementation Barriers: A Qualitative Analysis of Police Perspectives in Tijuana, Mexico

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Background and Aims Drug policy reforms typically seek to improve health among people who use drugs (PWUD), but flawed implementation impedes potential benefits. Mexico’s 2009 drug policy reform emphasized public health-oriented measures to address addiction. Implementation has been deficient, however. We explored the role of municipal police officers’ (MPOs) enforcement decision-making and local systems as barriers to reform operationalization. Methods Between February-June 2016, 20 semi-structured interviews were conducted with MPOs in Tijuana. Interviews were transcribed, translated and coded using a consensus-based approach. Emergent themes, trends and frameworks were analyzed through a hermeneutic grounded theory protocol. Results In conceptualizing their orientation towards municipal (not state) law, MPOs reported prioritizing enforcement of nebulous anti-vice ordinances to control PWUD activity. Local laws were seen as conflicting with drug policy reforms. Incentives within the police organization were aligned with ordinance enforcement, generating pressure through quotas and reinforced by judges. Driven by discretion, fuzzy understanding of procedures, and incentives to sanitize space, detention of PWUD for minor infractions was systematic. Conclusions Failure to harmonize policies and priorities at different levels of government undermine effective operationalization of health-oriented drug policy. Implementation must address local priorities and administrative pressures shaping MPO decision-making and enforcement practice.

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... In 2009, Mexico passed national Narcomenudeo drug law reforms to integrate a health-based approach on drugs (DOF, 2014). However, they have not been effectively implemented in the city because the municipal police had prioritized the enforcement of local quality-oflife ordinances, which criminalize behaviors associated with homeless PWUD, such as loitering (Morales et al., 2020). This misalignment of policing practices and public health priorities has had deleterious consequences for PWUD in Tijuana. ...
... Another participant stated that those people who did not want to be referred to drug centers were apprehended for violations to quality-of-life ordinances. In contrast, previous research has suggested the lack of coordination between the three levels of government to enforce the Narcomenudeo reforms in Tijuana Morales et al., 2020). For instance, MPOs reported that Narcomenudeo reforms were created to be enforced by federal and state police officers, not by local ones (Morales et al., 2020). ...
... In contrast, previous research has suggested the lack of coordination between the three levels of government to enforce the Narcomenudeo reforms in Tijuana Morales et al., 2020). For instance, MPOs reported that Narcomenudeo reforms were created to be enforced by federal and state police officers, not by local ones (Morales et al., 2020). Consequently, further research needs to be done to characterize the mechanisms of coordination between the three levels of government and to clarify why the coordination was successful in enforcing the local ordinances but not the federal/state law on drugs, as the latter have more legal weight than the former. ...
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Background: Homeless people who use drugs (PWUD) are often displaced, detained, and/or forced into drug treatment during police crackdowns. Such operations follow a zero-tolerance approach to law enforcement and have a deleterious impact on the health of PWUD. In Mexico, municipal police officers (MPOs) conducted the largest crackdown documented at the Tijuana River Canal (Tijuana Mejora) to dismantle an open drug market. We analyzed active-duty MPOs' attitudes on the rationale, implementation, and outcomes of the crackdown. We also included the involvement of non-governmental allies in the disguised imprisonment as drug treatment referral and potential legal consequences of having illegally detained PWUD. Methods: Between February-June 2016, 20 semi-structured interviews were conducted with MPOs in Tijuana. Interviews were transcribed, translated and coded using a consensus-based approach. Emergent themes, trends and frameworks were analyzed through a hermeneutic grounded theory protocol. Results: Participants recognized the limitations of Tijuana Mejora in effectively controlling crime and addressing drug treatment solutions. MPOs perceived that the intent of the operation was to displace and detain homeless PWUD, not to assist or rehabilitate them. The police operation was largely justified as a public safety measure to reduce the risk of injury due to flooding, decrease drug consumption among PWUD and protect local tourism from PWUD. Some participants perceived the crackdown as a successful public health and safety measure while others highlighted occupational risks to MPOs and potential human rights violations of PWUD. Conclusions: Tijuana Mejora illustrated why public and private actors align in enforcing zero-tolerance drug policy. Perceptions of care are often based on captivity of the diseased, not in health and well-being of PWUD. Officer perceptions shed light on the many limitations of this punitive policing tool in this context. A shift towards evidence-based municipal strategies to address drug use, wherein police are perceived as partners in harm reduction rather than antagonists, is warranted.
... Policing is another common SCS access and utilization barrier. Numerous international and Canadian studies have documented law enforcement presence, activities, and treatment of PWUD near/within SCS negatively impacts SCS utilization (Arredondo et al., 2017(Arredondo et al., , 2019Bardwell et al., 2019 ;Bennett & Larkin, 2018 ;Collins et al., 2019a;Herring, 2021 ;Jozaghi & Andresen, 2013 ;Kerr et al., 2004Kerr et al., , 2014Petrar et al., 2007 ;Small et al., 2012 ;Van Beek and Gilmour, 2000 ;Watson et al., 2020 ;Morales et al., 2019 ). These studies find that law enforcement presence and activities on-site or near harm reduction services tend to discourage PWUD from accessing health services due to concerns of police mistreatment, including arrest, harassment, (brutal) violence and surveillance ( see also Aitken et al., 2002 ;Dertadian & Tomsen, 2021 :7-9;Sarang et al., 2011). ...
... Police presence near SCS that deters PWUD from accessing services has been shown to contribute to additional negative collateral consequences that can encourage public (and sometimes riskier) drug consumption, increase risk of violent victimization in the community, hinder the likelihood of carrying injection and other harm reduction equipment, and limit other healthcare services access, which can negatively influence relationships between clients and health service staff (Abadie et al., 2018;Baker et al., 2019 ;Beletsky et al., 2011Beletsky et al., , 2013Beletsky et al., , 2014Burris et al., 2004 ;Cooper et al., 2004Cooper et al., , 2005Fairbairn et al., 2008 ;Greer et al., 2018 ;Kennedy et al., 2020 ;Kerr et al., 2005Kerr et al., , 2014Miller et al., 2008 ;Morales et al., 2019 ;Pan et al., 2013 ;Pinedo et al., 2015 ;Shannon et al., 2008;Strathdee, Beletsky, & Kerr, 2015 ;Werb et al., 2015 ). In addition, the collateral consequences of police presence can increase disease transmission and fatal overdose rates. ...
Article
Background Police presence near Supervised Consumption Services (SCS) and other harm reduction services has been shown to hamper access to these critical facilities for People Who Use Drugs (PWUD). However, few studies document the empirical nuances of these contextually dependant police-PWUD relationships, and how PWUD’ experiences and perceptions of policing near harm reduction services shape SCS access. If the goal is to increase SCS uptake, understanding the complexities of PWUD-police relations near SCS is imperative for guiding both formal policy and informal best-practices. Methods We report findings from a larger qualitative study on PWUD’ experiences with SCS in two Canadian cities. Data were collected through 75 face-to-face interviews and observations with street-involved PWUD near local SCS in Edmonton and Calgary, Alberta. Results Participants’ perceptions of and experiences with policing varied across jurisdictions. Participants in Calgary reported concentrated police presence in and near SCS, in addition to harassment, negative encounters, fears about getting arrested, and experiences of being displaced from the area. Participants in Edmonton, despite also reporting heavy police presence near SCS, reported feeling relatively safe from police intervention and harassment, within SCS and the surrounding area. Conclusion Rather than the presence/absence and quantity of policing near SCS, our findings show that the quality of policing experienced in the community shapes PWUD’ perceptions, experiences, and willingness to access SCS.
... There are several implications of the convergence of autonomous social control actors on PWUD's health service access. This is particularly true of intensive police presence near SCS, as regardless of motivation, police presence can harm PWUD by pushing them into riskier spaces (Morales et al., 2020;Robinson, 2019;Urbanik & Greene, 2021). Furthermore, the police directly targeting PWUD and conducting formal investigations within/outside SCS via undercover officers is highly problematic from a harm reduction perspective; some PWUD have been and are deterred from SCS access given the Calgary Police Service's aggressive local policing strategies. ...
Article
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Barriers to accessing supervised consumption services are well documented in the literature. Police and security presence in the areas surrounding these sites are two such barriers. Yet, despite what we know about these autonomous social control actors, less is known about whether/how the convergence of actors within neighborhoods housing supervised consumption sites shapes service access. This paper examines how people who use drugs navigate police, security, and residents to access harm reduction services in Calgary, Canada. Based on qualitative interviews with persons who use drugs, our findings suggest that these public health services are undermined when police, security and area residents converge in their efforts to address social ‘disorder’. Participants reported displacement from the area surrounding these health services, resulting in greater public drug use and reduced service access. This research extends knowledge on supervised consumption site access barriers and social control of people who use drugs.
... It may be that attitudes related to their role influence referral behaviors among police, but do not influence which services officers perceive should be included in a referral. Also, it may be difficult to distinguish between voluntary referrals (as specified in the referral survey completed for this analysis) and coerced referrals in this context as forced admissions to drug treatment, typically abstinence-based programs, is common [40,47,65]. ...
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Background Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals. Methods Between January and June 2018, police officers ( n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers’ support for including addiction treatment and SSP in referrals. Results Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33–43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71). Conclusions Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. Trial Registration : NCT02444403.
... The spatial risk environment of jails/prisons and the intersection of disproportionately male economic and social risk environments were also identified as contributing to gender concordant IDU initiation events in Tijuana. This could be driven, in part, by conflicting local laws and drug policy reform within Tijuana, that ultimately result in the systematic, extrajudicial arrest of people who use drugs ( Morales et al., 2018( Morales et al., , 2020. This is in contrast with the drug policing and policy environments in California, USA and Vancouver, Canada, in which there have been efforts to decriminalize or reduce felony convictions for drug possession and to employ health-and social service-related interventions within the justice system ( Elderbroom & Durnan, 2019 ;Garcia, Kenyon, Brolan, Coughlin & Guedes, 2019 ;Werb, 2018 ). ...
Article
Background: Gender influences the health and social risks faced by individuals initiating drug injecting. Using mixed methods across three settings in North America, we investigated the gender composition of injection initiation events and the gendered risk environments in which they occurred. Methods: The PReventing Injecting by Modifying Existing Responses (PRIMER) study pooled data from three prospective community-recruited cohorts of people who inject drugs (PWID) in San Diego, USA, Vancouver, Canada, and Tijuana, Mexico. A qualitative subsample provided narrative data on their experiences of, and the contexts for, injection initiation events. Guided by Rhodes' risk environment framework, we examined the gender composition of initiation events stratified by city, and analyzed qualitative data using abductive thematic analyses. Results: Among 2,622 PWID (Tijuana: n = 531; San Diego: n = 352; Vancouver: n = 1,739), 112 (4.3%) reported providing initiation assistance to injection-naïve individuals in the previous six months. The proportion of gender concordant (e.g., male-male) initiation pairs varied, (2 = 10.32, p < 0.001) with greater than expected concordance among pairs in Tijuana compared with those in Vancouver or San Diego. Sixty-one interviews provided context for the discrepancy across sites by highlighting the gendered injection initiation risk environments of prison/jail detention in Tijuana, intimate partnerships in San Diego, and overdose risk in Vancouver. Conclusions: These results highlight how gender influences injection initiation events within spatial, social, and economic risk environments, and how this influence varies across settings. These findings can inform interventions to reduce the risk of injection initiation and related harms.
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Las consecuencias negativas por COVID-19 en México se han documentado para las poblaciones en alta vulnerabilidad sobre todo por la disminución de la posibilidad de albergue y del acceso a los servicios de salud. Durante el primer año de pandemia se han emitido recomendaciones para prevenir y mitigar los contagios, entre ellas el distanciamiento social y el lavado de manos, mismas que no se pueden seguir si no se cuenta con un lugar de refugio o para el aseo. El objetivo de este trabajo fue ilustrar la vulnerabilidad social en salud por la que las personas usuarias de drogas de la ciudad de Tijuana atravesaron durante los primeros siete meses de la pandemia por COVID-19. Para explorar la vulnerabilidad social en salud, utilizamos un caso de estudio en el que realizamos observaciones de campo y entrevistamos a 42 personas usuarias de drogas que reciben servicios de una organización de la sociedad civil (OSC) sin fines de lucro y que ofrece servicios de salud a población vulnerable. Se aplicó verbalmente un cuestionario de 110 preguntas y se realizaron observaciones y entrevistas con los colaboradores de la OSC. Se exploró el apego a las medidas de prevención de contagios por COVID-19, el acceso a los servicios de salud e interacción con instituciones como la policía y aspectos sociodemográficos. Se realizó un análisis descriptivo que permitió conocer que, de las personas usuarias de drogas que acuden a este centro, 59.5% no cuenta con un documento de identificación; 45.2% dijo no tener garantizado un lugar en dónde dormir; 64.3% refirió atender sus problemas de salud en organizaciones civiles y 19.1% declaró que, de tener algún problema de salud, “lo resuelve solo” o no se atiende. Asimismo, se encontró disminución en sus ingresos, mayor violencia policiaca percibida y una baja posibilidad de mantener las medidas de apego a recomendaciones sanitarias para prevenir COVID-19. Estos resultados son ilustrativos de la situación precaria que viven las personas usuarias de drogas que en su mayoría habitan las calles así como la exclusión que experimentan del sistema de salud pública. Se proveen sugerencias para poder incluir a estas poblaciones.
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Objectives. To characterize the effects of the onset of the COVID-19 pandemic on the risk environment of people who use drugs (PWUD) in Tijuana, Mexico. Methods. We used intensive participant-observation ethnography among street-based PWUD and key informants, such as frontline physicians and harm reductionists. Results. PWUD described an unprecedented cessation of police violence and extortion during the initial pandemic-related lockdown, though this quickly reversed and police violence worsened. Government-provided housing and medical treatment with methadone were temporarily provided to PWUD in a dedicated clinic, yet only for PWUD with COVID-19 symptoms. Concurrently, non‒COVID-19‒related hospital care became virtually inaccessible, and many PWUD died of untreated, chronic illnesses, such as hepatitis C, and soft-tissue infections. Border closures, decreases in social interaction, and reduced drug and sex tourism resulted in worsening food, income, and housing insecurity for many PWUD. By contrast, potent illicit drugs remained easily accessible in open-air drug markets. Conclusions. The pandemic exacerbated health risks for PWUD but also offered profound glimpses of beneficial structural changes. Efforts are needed in Tijuana and elsewhere to institutionalize positive pandemic-related shifts and ameliorate novel harms for PWUD. (Am J Public Health. 2022;112(S2):S199–S202. https://doi.org/10.2105/AJPH.2022.306796 )
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Introduction: Injection drug use initiation is commonly facilitated by other people who inject drugs (PWID). We investigated how the gender of PWID influences their risk of providing initiation assistance to others across two distinct geo-cultural settings. Methods: Data were drawn from two prospective cohorts in Tijuana, Mexico and Vancouver, Canada which conducted semi-annual interviews within the PReventing Injecting by Modifying Existing Responses (PRIMER) study. Participants consisted of PWID who had reported never providing injection initiation assistance at baseline. We then conducted site-specific discrete-time survival analyses assessing the relationship between gender and other relevant covariates (e.g. age and past 6-month sex work) on the risk of the first reported instance of providing initiation assistance. Results: Of 1988 PWID (Tijuana: n = 596; Vancouver: n = 1392), 256 (43%) and 511 (36.7%) participants were women, and 42 (1.7%) and 78 (1.6%) reported recent injection initiation assistance across a median of three and two follow-up visits, respectively. Women had a lower risk of providing injection initiation assistance for the first time in Tijuana (adjusted hazard ratio = 0.52, 95% confidence interval 0.27-0.99), but not in Vancouver. Gendered pathways, like sex work, were associated with providing initiation assistance for the first time in Vancouver (adjusted hazard ratio = 1.97, 95% confidence interval 1.08-3.61). Discussion and conclusions: Women in Tijuana, but not Vancouver, were less likely to provide first-time initiation assistance among PWID. These results can inform gender- and site-specific prevention efforts aimed at reducing transitions into drug injecting across geographic contexts.
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We aimed to determine whether syringe exchange programs (SEPs) currently receive or anticipate pursuing federal funding and barriers to funding applications following the recent removal of the long-standing ban on using federal funds for SEPs. We conducted a telephone-administered cross-sectional survey of US SEPs. Descriptive statistics summarized responses; bivariate analyses examined differences in pursuing funding and experiencing barriers by program characteristics. Of the 187 SEPs (92.1%) that responded, 90.9% were legally authorized. Three received federal funds and 116 intended to pursue federal funding. Perceived federal funding barriers were common and included availability and accessibility of funds, legal requirements such as written police support, resource capacity to apply and comply with funding regulations, local political and structural organization, and concern around altering program culture. Programs without legal authorization, health department affiliation, large distribution, or comprehensive planning reported more federal funding barriers. Policy implementation gaps appear to render federal support primarily symbolic. In practice, funding opportunities may not be available to all SEPs. Increased technical assistance and legal reform could improve access to federal funds, especially for SEPs with smaller capacity and tenuous local support.
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To assess factors associated with drug-related harms related to policing among injection drug users (IDUs) in Tijuana, Mexico. IDUs who were over 18 years old and had injected drugs within the last six months were recruited via respondent-driven sampling and underwent questionnaires and testing for HIV (human immunodeficiency virus), syphilis and TB (tuberculosis). Random effects logistic regression was used to simultaneously model factors associated with five drug-related harms related to policing practices in the prior six months (i.e., police led them to rush injections; affected where they bought drugs; affected locations where they used drugs; feared that police will interfere with their drug use; receptive syringe sharing). Of 727 IDUs, 85% were male; median age was 38 years. Within the last 6 months, 231 (32%) of IDUs reported that police had led them to rush injections, affected where they bought or used drugs or were very afraid police would interfere with their drug use, or shared syringes. Factors independently associated with drug-related harms related to policing within the last six months included: recent arrest, homelessness, higher frequencies of drug injection, use of methamphetamine, using the local needle exchange program and perceiving a decrease in the purity of at least one drug. IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs.
Article
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Assisted injection among injection drug users (IDUs) remains understudied. We recruited 1,056 IDUs using respondent-driven sampling in Tijuana, Mexico. Participants underwent HIV and syphilis testing and structured interviews. One-quarter (25%) sought injection assistance in the past 6 months. Seeking injection assistance was independently associated with being female (adjusted odds ratio [AOR]= 2.59; 95% confidence interval [CI]= 1.73-3.90), being born outside Baja California (AOR = 1.75; CI = 1.26-2.42), having recent abscesses (AOR = 2.59; CI = 1.93-3.47), using syringes previously used by others in the past 6 months (AOR = 1.99; CI = 1.45-2.71), and ever being arrested for carrying sterile syringes (AOR = 1.55; CI = 1.15-2.09).
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HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and female injection drug users (IDUs) in Tijuana in an effort to inform HIV prevention and treatment programs. IDUs aged > or = 18 years were recruited using respondent-driven sampling and underwent testing for HIV, syphilis and structured interviews. Logistic regression identified correlates of HIV infection, stratified by gender. Among 1056 IDUs, most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (34% for females, 15% for males). HIV prevalence was higher in females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N = 158), factors independently associated with higher HIV prevalence included younger age, lifetime syphilis infection and living in Tijuana for longer durations. Among males (N = 898), factors independently associated with higher HIV prevalence were syphilis titers consistent with active infection, being arrested for having 'track-marks', having larger numbers of recent injection partners and living in Tijuana for shorter durations. An interaction between gender and number of years lived in Tijuana regressed on HIV infection was significant (p = 0.03). Upon further analysis, deportation from the U.S. explained the association between shorter duration lived in Tijuana and HIV infection among males; odds of HIV infection were four-fold higher among male injectors deported from the US, compared to other males, adjusting for all other significant correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's evolving HIV epidemic, and its impact is significantly modified by gender. Future studies are needed to elucidate the context of mobility and HIV acquisition in this region, and whether US immigration policies adversely affect HIV risk.
Article
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Injection drug use is a growing problem on the US-Mexico border, where Tijuana is situated. We studied the context of injection drug use among injection drug users (IDUs) in Tijuana to help guide future research and interventions. Guided in-depth interviews were conducted with 10 male and 10 female current IDUs in Tijuana. Topics included types of drug used, injection settings, access to sterile needles, and environmental influences. Interviews were taped, transcribed verbatim, and translated. Content analysis was conducted to identify themes. Of the 20 IDUs, median age and age at first injection were 30 and 18. Most reported injecting at least daily: heroin ("carga", "chiva", "negra"), methamphetamine ("crico", "cri-cri"), or both drugs combined. In sharp contrast to Western US cities, almost all regularly attended shooting galleries ("yongos" or "picaderos") because of the difficulties obtaining syringes and police oppression. Almost all shared needles/paraphernalia ["cuete" (syringe), "cacharros" (cookers), cotton from sweaters/socks (filters)]. Some reported obtaining syringes from the United States. Key themes included (1) pharmacies refusing to sell or charging higher prices to IDUs, (2) ample availability of used/rented syringes from "picaderos" (e.g., charging approximately 5 pesos or "10 drops" of drug), and (3) poor HIV/AIDS knowledge, such as beliefs that exposing syringes to air "kills germs." This qualitative study suggests that IDUs in Tijuana are at high risk of HIV and other blood-borne infections. Interventions are urgently needed to expand access to sterile injection equipment and offset the potential for a widespread HIV epidemic.
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Previous research has identified the impact of law enforcement practices on the behaviours and health of injection drug users (IDUs). We undertook a qualitative study of IDUs' experiences of policing practices in two Mexican cities on the U.S. border. In 2004, two teams of Mexican interviewers conducted in-depth interviews with IDUs residing in Tijuana and Ciudad Juarez (Cd. Juarez), Mexico, who had injected drugs at least once in the prior month. Topics included types of drug used, injection settings, access to sterile needles and experiences with police. Field notes and transcribed interviews were analysed to identify emergent themes. Amongst the 43 participants, most reported that it is common for IDUs to be arrested and detained for 36h for carrying sterile or used syringes. Most reported that they or someone they knew had been beaten by police. Interviews suggested five key themes relating to police influence on the risk environment: (1) impact of policing practices on accessibility of sterile syringes, (2) influence of police on choice of places to inject drugs (e.g., shooting galleries), (3) police violence, (4) police corruption and (5) perceived changes in policing practices. Findings suggest that some behaviour of police officers in Tijuana and Cd. Juarez is inconsistent with legal norms and may be negatively influencing the risk of acquiring blood-borne infections amongst IDUs. Implementing a comprehensive and successful HIV prevention programme amongst IDUs requires interventions to influence the knowledge, attitudes and practices of law enforcement officers.
Article
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To identify factors associated with receptive syringe sharing among injection drug users (IDUs) and elucidate the association between syringe possession arrests and syringe sharing. Cross-sectional study. Mexican border cities of Tijuana, Baja California and Ciudad Juarez, Chihuahua. IDUs in Tijuana (n = 222) and Ciudad Juarez (n = 206) were recruited using respondent-driven sampling (RDS). IDUs were > or = 18 years and had injected illicit drugs in the past month. An interviewer-administered survey was used to collect quantitative data on socio-demographic, behavioral and contextual characteristics, including self-reported syringe sharing and arrests for syringe possession. Associations with receptive syringe sharing were investigated using logistic regression with RDS adjustment. Overall, 48% of participants reported ever being arrested for carrying an unused/sterile syringe, even though syringe purchase and possession is legal in Mexico. Arrest for possessing unused/sterile syringes was associated independently with receptive syringe sharing [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI): 1.26, 3.35], as was injecting in a shooting gallery (AOR = 3.60; 95% CI: 2.21, 5.87), injecting in the street (AOR = 2.05; 95% CI: 1.18, 3.54) and injecting methamphetamine (AOR = 2.77; 95% CI: 1.41, 5.47) or cocaine (AOR = 1.96; 95% CI: 1.15, 3.36). More than half of participants (57%) had been arrested for possessing a used syringe; in a second model, arrest for used syringe possession was also associated independently with receptive sharing (AOR = 2.87; 95% CI: 1.76, 4.69). We documented high levels of syringe-related arrests in two Mexican-US border cities and an independent association between these arrests and risky injection practices. Public health collaborations with law enforcement to modify the risk environment in which drug use occurs are essential to facilitate safer injection practices.
Article
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We examined correlates of HIV infection among injection drug users (IDUs) in Tijuana, Mexico, a city bordering the United States, which is situated on major migration and drug trafficking routes. IDUs aged > or =18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and structured interviews. Weighted logistic regression identified correlates of HIV infection. Of 1056 IDUs, the median age was 37 years, 86% were male, and 76% were migrants. HIV prevalence was higher in female participants than in male participants (8% vs. 3%; P = 0.01). Most IDUs testing HIV-positive were previously unaware of their serostatus (93%). IDUs reported injecting with a median of 2 people in the prior 6 months and had been arrested for having injection stigmata (ie, "track-marks") a median of 3 times. Factors independently associated with HIV infection were being female, syphilis titers consistent with active infection, larger numbers of recent injection partners, living in Tijuana for a shorter duration, and being arrested for having track-marks. Individual, social, and environmental factors were independently associated with HIV infection among IDUs in Tijuana. These findings suggest the need to intervene not solely on individual risk behaviors but on social processes that drive these behaviors, including problematic policing practices.
Article
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We identified factors associated with shooting gallery attendance among injection drug users (IDUs) in two Mexico-US border cities. IDUs in Tijuana (n=222) and Ciudad Juarez (n=205), Mexico, who were >or=18 years and injected illicit drugs in the last month were recruited using respondent-driven sampling (RDS). An interviewer-administered survey collected sociodemographic and behavioral data. Logistic regression was used to examine correlates of shooting gallery attendance in each of the two cities. Homelessness and being arrested for syringe possession--both structural level factors--were associated with shooting gallery use in both cities. In Ciudad Juarez, younger age and having overdosed were also associated with shooting gallery use. Our study highlights the need for structural interventions that mitigate homelessness among IDUs and facilitate changes in law enforcement practices associated with shooting gallery use. Harm reduction interventions based within shooting galleries should also be considered to prevent transmission of blood-borne pathogens among IDUs.
Article
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Since the earliest days of the discipline, sociologists have viewed homelessness as a premier index of inequality and poverty more generally. Sociologists have increasingly turned to the regulation and policing of homelessness as a lens for analyzing how a given society understands and interacts with those who exist at the bottom of the social hierarchy. Against this intellectual backdrop, this article traces recent developments in the policing of homelessness, as well as the corresponding academic attempts to make sense of this empirical phenomenon. Doing so demonstrates that a vast majority of analyses have focused narrowly on the punitive and exclusionary functions of policing and, as a result, have tended to overlook issues surrounding differentiated functions, organizational dynamics, spatial contingencies, and questions of agency. This article complicates existing approaches and thereby lays the foundation for a more accurate and nuanced rendering of the policing of homelessness.
Article
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.
Article
This short article presents the thematic issue of the Environment & Planning A journal, which builds on the analytic framework elaborated by Wacquant in Urban Outcasts (2008) and on the activities of the Leverhulme Network on Advanced Urban Marginality to synthesize and stimulate inquiries into the triadic nexus of symbolic space, social space, and physical space at the lower end of the urban spectrum. The concept of territorial stigmatization weds Goffman’s model of the management of “spoiled identity” with Bourdieu’s theory of “symbolic power” to capture how the blemish of place impacts the residents of disparaged districts, the surrounding denizens and commercial operators, street-level public bureaucracies, specialists in cultural production (such as journalists, scholars, and politicians), and state officials and policies. Spatial taint is a novel and distinctive phenomenon that crystallized at century’s end along with the dissolution of the neighborhoods of relegation emblematic of the Fordist-Keynesian phase of industrial capitalism. It differs from the traditional topography of disrepute in the industrial city in that it has become autonomized, nationalized and democratized, equated with social disintegration, racialized through selective accentuation, and it elicits revulsion often leading to punitive corrective measures. The sociosymbolic strategies fashioned by the residents of defamed quarters to cope with spatial denigration span a panoply ranging from submission to defiance, and their adoption depends on position and trajectory in social and physical space. Territorial stigmatization is not a static condition or a neutral process, but a consequential and injurious form of action through collective representation fastened on place. By probing how it operates in different urban settings and political formations, the contributors to the Environment and Planning A’s issue advance our empirical understanding of the role of symbolic structures in the production of inequality and marginality in the city. They also suggest the need for public policies designed to reduce, not only the burden of material deprivation, but also the press of symbolic domination in the metropolis.
Article
Over the past three decades, scholars have documented the emergence of a new model of urban governance predicated on the spatial exclusion of visible poverty. In order to revitalise and recommodify the prime spaces of the urban core, municipal leaders enlist the police to coercively relocate homeless people to marginal spaces. Unfortunately, little is known about the policing of homelessness in those areas into which homeless people are exiled. To address this lacuna, this article employs an ethnographic analysis of police patrols in Los Angeles' Skid Row district. The findings demonstrate that, contrary to the dominant framework of exclusion, policing in marginal space takes on a disciplinary model of recovery management' designed to coercively shepherd homeless people into rehabilitative programmes and ameliorate the individual pathologies deemed responsible for homelessness. The article thus provides an analysis of how, why and with what consequences the policing of homelessness varies over space.
Article
Mexican migrants who are deported from the US may be at elevated risk for HIV infection. Deportations of Mexican migrants by the US have reached record numbers. We critically reviewed existing literature to assess how social and structural conditions in post-deportation settings can influence Mexican deported migrants’ HIV risk. We also identify critical research gaps and make research recommendations.
Article
Editor's Note. Three years ago, I invited Robert (Bob) Gephart to write a "From the Editors" column designed to help authors improve their chances of success when submitting qualitative research to AMJ. Judging from the increasing number of quali- tative studies that have been accepted and pub- lished in AMJ since that time, I would like to think that his article, "Qualitative Research and the Academy of Management Journal," has had a pos- itive impact. Continuing in this tradition, I asked Roy Sud- daby—an excellent reviewer (and author) of quali- tative research—to tackle another "big issue" that the editorial team has noticed with respect to qual- itative submissions to AMJ: overly generic use of the term "grounded theory" and confusion regard- ing alternative epistemological approaches to qual- itative research. Like Bob before him, Roy has, I believe, produced an analysis that will greatly ben- efit those who are relatively new to qualitative re- search or who have not yet had much success in getting their qualitative research published. Hope- fully, Roy's analysis will help even more authors to succeed, thus allowing AMJ and other journals to continue to increase the quality of insights pro- vided by rich qualitative studies of individual, or- ganizational, and institutional phenomena. Sara L. Rynes
Article
This article explicates and extends the analyses put forth by the author in his book, Prisons of Poverty, which argues that the generalised increase of carceral populations in advanced societies is due to the growing use of the penal system as an instrument for managing social insecurity and containing the social disorders created at the bottom of the class structure by neo-liberal policies of economic deregulation and social-welfare retrenchment. It retraces the steps whereby this ‘neo-liberal penality’ was elaborated in the United States and then diffused throughout the world, but contends that European countries are not blindly following the American road to mass imprisonment: Europe's path to the penal state entails the conjoint intensification of both social and penal treatments of poverty and the activation of the policing functions of welfare services leading to a form of ‘social panoptism’. Only the building of a Europe-wide social state can check the spread of the penalisation of poverty and its deleterious social consequences.
Article
Abstract Not one but several ‘peculiar institutions’ have operated to define, confine, and control African-Americans in the history of the United States: chattel slavery from,the colonial era to the,Civil War; the Jim Crow system,in the,agrarian,South from,Reconstruction,to the Civil Rights revolution; the ghetto,in the,northern,industrial metropolis; and, in the post-Keynesian age of desocialized wage labor and welfare retrenchment, the novel institutional complex formed,by the,remnants,of the,dark ghetto,and,the carceral apparatus,with which,it has,become,joined by a,relationship of structural symbiosis and functional surrogacy. In the 1970s, as the urban,‘Black Belt’ lost its economic,role of labor,extraction,and proved unable to ensure ethnoracial closure, the prison was called upon,to shore,up caste,division and,help contain,a dishonored and,supernumerary,population,viewed,as both,deviant,and dangerous. Beyond the specifics of the US case, this article suggests,that much,is to be learned,from,the comparison,between ghetto,and,prison as kindred,institutions of forced ,confinement entrusted,with enclosing,a stigmatized,category,so as,to neutralize the material and/or symbolic,threat it poses,for the surrounding society. Key Words African-Americans • caste • ghetto,• prison,• racial domination • stigma,• United States Theoretical Criminology © 2000 SAGE Publications London, Thousand Oaks and New Delhi. 1362‐4806(200008)4:3 Vol. 4(3): 377‐389; 013521
Article
Public discourses on health increasingly emphasise the environment. While harm reduction has developed in parallel with the new public health movement, and both seek to encourage risk reduction by promoting individual and community action as well as environmental change, there remains an over reliance on individualistic modes of behaviour change. This commentary offers the concept of the ‘risk environment’ as a potentially useful framework for understanding and reducing drug-related harm, especially HIV infection associated with drug injection. It is argued that a shift in focus towards the ‘risk environment’ as a unit of analysis and change helps to overcome the limits of individualism characterising most HIV prevention interventions as well as to appreciate how drug-related harm intersects with health and vulnerability more generally. This in turn raises the importance of ‘non-drug’ and ‘non-health’ interventions for harm reduction and the facilitation of alliances between harm reduction and other social movements oriented to tackling vulnerability as a means of promoting public health.
Article
The comparative sociology of the structure, dynamics, and experi- ence of urban relegation in the United States and the European Union during the past three decades reveals the emergence of a new regime of marginality. This regime generates forms of poverty that are neither residual, nor cyclical or transitional, but inscribed in the future of contemporary societies insofar as they are fed by the ongoing fragmentation of the wage labour relationship, the functional disconnection of dispossessed neighbourhoods from the national and global economies, and the reconfiguration of the welfare state in the polarizing city. Based on a methodical comparison between the black American ghetto and the French working-class banlieue at century's turn, this article spotlights three distinctive spatial properties of 'advanced marginality' - territorial fixation and stigmatization, spatial alienation and the dissolution of 'place', and the loss of a hinterland - and draws out their implications for the formation of the 'precariat' in postindustrial societies.
Article
Like many countries of the Second World caught in the throes of post-Fordism before they could reap the full benefits of Fordist-style development, Brazil is tempted to import the US-style discourse and policy of 'zero tolerance' because, enshrouded in the aura emanating from America as the world's sole symbolic superpower and global Mecca of crime control, they appear cutting edge, effective and efficient; and because they are the indispensable order-maintenance counterpart to policies of economic deregulation and fiscal austerity adopted by Latin American countries under the press of international financial agencies. But in Brazil, as in neighboring nations, this borrowing promises to produce a social catastrophe of historic proportions because the depth and scale of urban poverty are much greater, violent crime is more prevalent and more entrenched in the history and economy of the country, and because the Brazilian police is not a remedy against violence but a major source of violence in its own right. Moreover, Brazil does not possess a rationalized court system capable of ensuring minimal protection of constitutional rights and its prisons are plagued by fantastic overcrowding, gross lack of access to food, hygiene and health and inordinately high levels of brutality, akin to concentration camps for the disruptive fractions of the (sub)proletariat. Under such conditions, to respond to the disorders generated by the rise of absolute and relative poverty associated with incorporation in the emergent neoliberal global order with the penal apparatus is tantamount to instituting a chaotic dictatorship over the poor, and therefore antithetical to the project of nation building on a pacified and democratic basis.
Article
The entrenchment of neoliberalism in the United States has coincided with an unprecedented expansion of punishment practices that intensify social divisions rooted in class and race. We explore the political culture of this hyperpunitiveness through a discussion of two popularized explanations for urban crime: broken windows and situational crime prevention. These popular criminological theories help legitimate the deepening of social and spatial divisions. They also rest their precepts upon the foundation of a particular geographic imagination. We use this paper to reveal and critique the core assumptions about space upon which each of these theories critically relies. We suggest that each theory understands society–space interactions too simplistically to provide comprehensive insight into the dynamics of landscape construction and interpretation. We argue further that the logics and practices of broken windows and situational crime prevention possess significant elective affinities with social dynamics characteristic of neoliberalism. For these reasons, these popularized criminologies both reflect and reinforce the processes through which neoliberalism exacerbates social differences.
Article
There is a link between changes in the contemporary political economy and the criminalization of homelessness. Anti-homeless legislation can be understood as an attempt to annihilate the spaces in which homeless people must live, and perform everyday functions. This annihilation is a response to the economic uncertainty produced by the current political economy. The process of criminalizing homelessness 1) destroys the very right of homeless people to be; and 2) reinforces particularly brutal notions of citizenship within the public sphere. Such laws are made possible when urban government and surrounding communities and elites seek to promote the urban landscape at the expense of urban public space. This usurpation of public space will have profound impact not only on homeless people but also on how the housed interact with each other.
Article
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome surveillance data are critical for monitoring epidemic trends, but they can mask dynamic subepidemics, especially in vulnerable populations that underuse HIV testing. In this case study, we describe community-based epidemiologic data among injection drug users (IDUs) and female sex workers (FSWs) in two northern Mexico-U.S. border states that identified an emerging HIV epidemic and generated a policy response. We draw from quantitative and qualitative cross-sectional and prospective epidemiologic studies and behavioral intervention studies among IDUs and FSWs in Tijuana, Baja California, and Ciudad Juarez, Chihuahua. The recognition that the HIV epidemic on Mexico's northern border was already well established in subgroups in whom it had been presumed to be insignificant was met with calls for action and enhanced prevention efforts from researchers, nongovernmental organizations, and policy makers. Successful policies and program outcomes included expansion of needle-exchange programs, a nationwide mobile HIV prevention program targeting marginalized populations, a successful funding bid from the Global Fund for HIV, TB, and Malaria to scale up targeted HIV-prevention programs, and the establishment of bi-national training programs on prevention of HIV and substance use. We discuss how epidemiologic data informed HIV prevention policies and suggest how other countries may learn from Mexico's experience.
Article
A 'risk environment' framework promotes an understanding of harm, and harm reduction, as a matter of 'contingent causation'. Harm is contingent upon social context, comprising interactions between individuals and environments. There is a momentum of interest in understanding how the relations between individuals and environments impact on the production and reduction of drug harms, and this is reflected by broader debates in the social epidemiology, political economy, and sociology of health. This essay maps some of these developments, and a number of challenges. These include: social epidemiological approaches seeking to capture the socially constructed and dynamic nature of individual-environment interactions; political-economic approaches giving sufficient attention to how risk is situated differentially in local contexts, and to the role of agency and experience; understanding how public health as well as harm reduction discourses act as sites of 'governmentality' in risk subjectivity; and focusing on the logics of everyday habits and practices as a means to understanding how structural risk environments are incorporated into experience. Overall, the challenge is to generate empirical and theoretical work which encompasses both 'determined' and 'productive' relations of risk across social structures and everyday practices. A risk environment approach brings together multiple resources and methods in social science, and helps frame a 'social science for harm reduction'.
Article
There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links; population movement and mixing; urban or neighbourhood deprivation and disadvantage; specific injecting environments (including shooting galleries and prisons); the role of peer groups and social networks; the relevance of 'social capital' at the level of networks, communities and neighbourhoods; the role of macro-social change and political or economic transition; political, social and economic inequities in relation to ethnicity, gender and sexuality; the role of social stigma and discrimination in reproducing inequity and vulnerability; the role of policies, laws and policing; and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights.
Article
Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted, but using these models in research and practice has been challenging. Examining the role of criminal law enforcement in the "risk environment" of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This article reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels--laws; management of law enforcement agencies; knowledge, attitudes, beliefs, and practices of frontline officers; and attitudes and experiences of IDUs--and that such research can be the basis of interventions within law enforcement to enhance IDU health.
Análisis Y Resultados De Una Política Prohibicionista (The Drug Policy in Mexico 2006-2012: Analysis and Results of a Prohibitionist Policy)
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