The Influence of Violence, Policing, and Substance Use Stigma on Sexual and Substance Use Risk Engagement in Substance Using Men Along the U.S.-Mexico Border
Background: Cities along the U.S.-Mexico border are unique environments where structural level variables place residents at risk for increased substance use subsequently impacting HIV rates and acquisition. Growing evidence emphasizes the importance of understanding how structural drivers of infectious diseases impact community and social networks to develop interventions to reduce HIV transmission among hard-to-reach populations. Aims and Objectives: The goal of this study was to investigate the influence of structural factors such as neighborhood disruption, harsh policing, and substance use stigma on engagement of HIV risk behaviors among social networks of people who use drugs and who reside in El Paso, Texas and Ciudad Juarez, Chihuahua. Hypotheses: It was hypothesized that higher levels of neighborhood disruption, harsh policing, and substance use self-stigma would be positively associated with engagement in HIV risk behaviors among social networks. Methods: This study analyzed data from a sample of men using heroin and/or crack cocaine and who were residing in various communities on both the border cities (Cd. Juarez and El Paso). Participants were recruited to take part in a cross-sectional survey as part of a larger study testing an HIV risk reduction behavioral intervention. As part of the larger study, several cycles of cross-sectional surveys including two baseline assessments were administered to assess intervention effectiveness. The baseline assessment survey data used for this study were collected before any intervention component was implemented. Bivariate correlations between variables were computed. Furthermore, two general linear mixed model (GLMM) equations specifying a Poisson distribution were computed to assess associations between the city of recruitment, indices of neighborhood disruption, harsh policing, and stigma towards substance use and engagement in risk behaviors. Results: Using bivariate correlations we found that increased exposure to harsh policing was positively associated with neighborhood disruption, condomless sex, and syringe sharing. Also, living in Cd. Juarez was associated with greater instances of harsh policing, neighborhood disruption, substance use stigma, syringe sharing, and condomless sex compared to living in El Paso, Texas. Results of the GLMM analysis indicated that neighborhood disruption (β = 34.94, p = .003) and the interaction between city and disruption emerged (β = .18, p = .018) as significantly associated with condomless sex with members of the social network. Conclusions: This study builds on previous research and indicates that environmental factors, such as neighborhood disruption and harsh policing are associated with behavior patterns that place individuals at risk of contracting infectious diseases such as HIV. There is a dearth of research describing the impact of social and physical structural drivers on HIV risk behaviors that make it challenging to implement risk-reduction interventions for people living in binational communities. There is a need to continue research that examines associations between social networks, environmental factors, and other variables that capture social and political contexts along the Texas-Mexico border. Our findings emphasize the importance of creating interventions that are tailored to specific cities in Mexico and the U.S. along the border.
Terrazas, William Campillo, "The Influence of Violence, Policing, and Substance Use Stigma on Sexual and Substance Use Risk Engagement in Substance Using Men Along the U.S.-Mexico Border" (2022). ETD Collection for University of Texas, El Paso. AAI29210925.