Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego

https://doi.org/10.1016/j.drugpo.2016.12.010Get rights and content

Abstract

Background

Research among people who inject drugs (PWIDs) in the USA and Mexico has identified a range of adverse health impacts associated with policing of PWIDs. We employed a mixed methods design to investigate how PWIDs from San Diego and Mexico experienced policing in Tijuana, and how these interactions affect PWIDs behavior, stratifying by country of origin.

Methods

In 2012–2014, 575 PWIDs in San Diego, 102 of whom had used drugs in Mexico in the past six months, were enrolled in the STAHR-II study, with qualitative interviews conducted with a subsample of 20 who had recently injected drugs in Mexico. During this period, 735 PWIDs in Tijuana were also enrolled in the El Cuete-IV study, with qualitative interviews conducted with a subsample of 20 recently stopped by police. We calculated descriptive statistics for quantitative variables and conducted thematic analysis of qualitative transcripts. Integration of these data involved comparing frequencies across cohorts and using qualitative themes to explain and explore findings.

Results

Sixty-one percent of San Diego-based participants had been recently stopped by law enforcement officers (LEOs) in Mexico; 53% reported it was somewhat or very likely that they would be arrested while in Mexico because they look like a drug user. Ninety percent of Tijuana-based participants had been recently stopped by LEOs; 84% reported it was somewhat or very likely they could get arrested because they look like a drug user. Participants in both cohorts described bribery and targeting by LEOs in Mexico. However, most San Diego-based participants described compliance with bribery as a safeguard against arrest and detention, with mistreatment being rare. Tijuana-based participants described being routinely targeted by LEOs, were frequently detained, and reported instances of sexual and physical violence. Tijuana-based participants described modifying how, where, and with whom they injected drugs in response; and experienced feelings of stress, anxiety, and powerlessness. This was less common among San Diego-based participants, who mostly attempted to avoid contact with LEOs in Mexico while engaging in risky injection behavior.

Conclusion

Experiences of discrimination and stigma were reported by a larger proportion of PWIDs living in Mexico, suggesting that they may be subject to greater health harms related to policing practices compared with those residing in the USA. Our findings reinforce the importance of efforts to curb abuse and align policing practices with public health goals in both the US and Mexico.

Introduction

Tijuana is a city in the Mexican state of Baja California across the border from San Diego, California. Both cities are located on a major international drug trafficking route that runs from the Andean region in South America to the United States, making drugs such as heroin, methamphetamine, and cocaine abundant in both cities (Bucardo et al., 2005). Approximately 10,000 people who inject drugs (PWIDs) reside in Tijuana, with many more crossing the border from San Diego, reportedly to use and buy illicit drugs because of lower prices, easier access, and to avoid facing legal penalties in the United States (Morales, Lozada, Magis, & Saaverda, 2004; Volkmann et al., 2011, Wagner et al., 2012).

In 2010 Mexico decriminalized possession of small amounts of illegal drugs (e.g., heroin, cocaine, methamphetamines) for personal use (Moreno, Licea, & Rodriguez-Ajenjo, 2010). Carrying syringes is also permitted in Mexico; however, past research has shown that in Mexico “laws on the books” are not always applied by law enforcement officers on the streets, resulting in arbitrary policing (Beletsky, Lozada et al., 2013, Beletsky, Thomas et al., 2012, Miller et al., 2009). Additionally, evidence of widespread police corruption in some cities in Mexico, including instances of PWIDs being targeted and experiencing physical and sexual abuse from the police, has been recorded (Beletsky, Lozada et al., 2013; Beletsky, Wagner et al., 2015, Miller et al., 2009, Werb et al., 2015).

The risk environment framework posits that health outcomes are not only a result of individual-level behaviors and characteristics but also are influenced by the larger structure and environment within which individuals reside (Rhodes, 2002). Law enforcement practices, both official laws and enforcement of those laws, are one of the structural aspects that shape PWIDs’ risk environment (Burris et al., 2004, Rhodes, 2002), including individuals’ ability to access sterile needle/syringes and their capacity to avoid risky injection behaviors (Bluthenthal, Kral, Erringer, & Edlin, 1999; Bluthenthal, Lorvick, Kral, Erringer, & Kahn, 1999; Miller et al., 2009; Strathdee, Beletsky, & Kerr, 2015). Research among PWIDs in the Tijuana–San Diego border region has shown that individuals frequently travel between these two cities and have social relationships that transcend the international border (Volkmann et al., 2011, Wagner et al., 2010, Wagner et al., 2012, Zúñiga et al., 2006). Given the connectedness of these two communities and the recent legal change in Mexico that has the potential to impact drug use risk environments in San Diego and Tijuana, we sought to investigate how policing practices in Tijuana may affect Mexican and American PWIDs differentially, in order to inform public health intervention and policies to reduce health and social risks associated with injection drug use.

Section snippets

Setting

This mixed methods analysis used data from two cohorts of PWIDs from Tijuana and San Diego. Between 2012 and 2014, data were collected from two independent mixed methods cohort studies among PWIDs, which were both designed to study the impact of the 2010 law through which Mexico decriminalized possession of small amounts of certain drugs (e.g., heroin) for personal use (Moreno et al., 2010). The El Cuete-IV study recruited 735 PWIDs in Tijuana, while the STAHR-II study recruited 575 PWIDs in

Results

From 2012 to 2014, 575 San Diego-based participants provided data on the quantitative survey, 102 of whom (79.4% male) had used drugs in Mexico in the past six months. The majority of participants were White (58.8%) with a mean age of 40.1 years (range = 18–64 years). Most participants (64.7%) had completed high school, and 64.7% considered themselves to be homeless in the past six months. The majority of participants spoke only English; 27.5% reported being able to converse in Spanish.

Seven

Discussion

The findings presented herein indicate that San Diego and Tijuana-based PWIDs experienced differential treatment by law enforcement in Tijuana. According to PWIDs, this disparity in treatment stems, in large part, from the perceived higher economic status of PWIDs who reside in the United States. While it should be acknowledged that not all encounters with law enforcement officers described by our participants were negative, our findings suggest that Tijuana-based PWIDs experienced more

Conclusion

Although Mexico has made great strides in enacting public health-minded laws that decriminalize possession of paraphernalia and small amounts of drugs, some law enforcement practices in Tijuana have continued to perpetuate the stigma associated with injection drug use and aggravate the structural risk environment for PWIDs. Our research suggests that, for some PWIDs, negative interactions with law enforcement in Tijuana during the study period may have caused increased drug use and risky

Conflict of interest

None of the authors has any conflicts of interest to disclose.

Acknowledgements

This research was supported by the US National Institutes of Health grant numbers: DP2-DA040256 (PI: Werb), K01DA031031 (PI: Wagner), R01DA031074 (PI: Garfein), R37DA019829 (PI: Strathdee). The above mentioned funding source had no involvement in the study design, collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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