Patricia Case

Trends in Production, Trafficking, and Consumption of Methamphetamine and Cocaine in Mexico

Over the past decade, Mexico has experienced a significant increase in trafficking of cocaine and trafficking and production of methamphetamine. An estimated 70% of United States cocaine originating in South America passes through the Central America–Mexico corridor. Mexico-based groups are now believed to control 70%–90% of methamphetamine production and distribution in the United States. Increased availability of these drugs at reduced prices has led to a parallel rise in local drug consumption. Methamphetamine abuse is now the primary reason for seeking drug abuse treatment in a number of cities, primarily in northwestern Mexico. Although cocaine and methamphetamine use have been linked with the sex trade and high-risk behaviors, such as shooting gallery attendance and unprotected sex in other settings, comparatively little is known about the risk behaviors associated with use of these drugs in Mexico, especially for methamphetamines. We review historical aspects and current trends in cocaine and methamphetamine production, trafficking, and consumption in Mexico, with special emphasis on the border cities of Ciudad Juarez and Tijuana. Additionally, we discuss the potential public health consequences of cocaine use and the recent increase in methamphetamine use, especially in regards to the spread of bloodborne and other infections, in an effort to inform appropriate public health interventions.

Physicians Don't Ask, Sometimes Patients Tell Disclosure of Sexual Orientation among Women with Breast Carcinoma

The disclosure of sexual orientation to physicians is uncertain and the reasons are poorly understood. The current study was undertaken to describe the disclosure of sexual orientation among sexual minority women with breast carcinoma.

Vivo para consumirla y la consumo para vivir ["I live to inject and inject to live"]: high-risk injection behaviors in Tijuana, Mexico.

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 indepth 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.

HIV Prevalence, Risk Behaviors, and High-Risk Sexual and Injection Networks Among Young Women Injectors Who Have Sex With Women

Women injection drug users who have sex with women (WSW IDUs) constitute 20% to 30% of American women IDUs.1 Compared with other women IDUs, WSW IDUs have higher HIV prevalence and incidence rates and a greater likelihood of engaging in high-risk injection and sexual practices with men.1–16 n nPrevious reports suggested that WSW IDUs may be particularly likely to engage in drug injection and sex with men who have sex with men (MSM)1,2,5,6,9,17–19 and to be subordinated and isolated within drug users’ social milieus and more generally.1,20,21 Historical and generational factors may have changed some relationships as a consequence of the HIV epidemic itself, however. Ethnographic data from New York City and Boston, Mass, suggest that many older MSM IDUs and WSW IDUs who injected drugs together may have died earlier in the epidemic, which might reduce the extent to which WSW IDUs currently engage in drug injection and sex with MSM. To further examine HIV risk among WSW IDUs, we compared social situations, injection and sexual networks, and behaviors of young WSW IDUs with those of other young women IDUs.

Women Injection Drug Users Who Have Sex with Women Exhibit Increased HIV Infection and Risk Behaviors

This article is a comprehensive review of published research on HIV seroprevalence and HIV-related risk behaviors among women injection drug users (IDUs) who have sex with women (WSW). At least 14 studies since the late 1980s converge into a consistent pattern: compared to other IDUs, WSW IDUs report higher levels of HIV-related risk behaviors and in many cases exhibit higher rates of HIV seroconversion or seroprevalence. Data from these and additional studies also indicate that large numbers of women IDUs are WSWs. Since information regarding WSW IDUs are widely collected but infrequently analyzed and reported, we suggest promising research and analysis strategies for exploring the meaning behind this pattern of increased vulnerability to HIV. Finally, we assert that enough is currently known to warrant significant investment in targeted prevention and intervention programs to address the critical HIV-related needs of lesbian, bisexual, and other WSW IDUs.

Sexual minority women's interactions with breast cancer providers.

SUMMARY Good patient-physician relationships and communication lead to better patient health and more satisfied patients. So far, satisfaction of sexual minority (lesbian, bisexual or women who partner with women) cancer patient-physician interactions is unknown. This study describes sexual minorities experiences with their treating physicians and which provider attitudes were perceived as positive or negative. We conducted separate individual interviews with 39 sexual minority women diagnosed with breast cancer. All interviews were audio-recorded, transcribed and then analyzed from a Grounded Theory perspective. Participants narratives indicated that satisfaction is connected with a certain style of patient-physician interactions rather than physician gender. Specific provider traits in the two domains of (1) inter-personal behaviors and (2) medical expertise and decision-making determined patient satisfaction. These findings suggest that physicians of either gender can develop the skills needed to improve quality of breast cancer care for sexual minority women.

17 – Drug Use

This chapter discusses several approaches to disease prevention among drug-using populations before and after the HIV epidemic began. The chapter offers an insight into the future directions for prevention of the HIV epidemic as the 21st century unfolds. Noninjected drugs have played a major role in the epidemic of HIV. Using stimulant drugs such as crack cocaine and methamphetamine has also been associated with sexual behaviors that pose a higher risk of HIV infection—greater numbers of partners, decreased condom use during vaginal and anal intercourse, and involvement in the sex trade. The paucity of options for the care of drug users changed dramatically with the AIDS epidemic because a remarkable diversity of risk-reduction efforts were rapidly developed, primarily focused on (1) risk reduction efforts such as increasing access to sterile syringes through multiple venues, community outreach and education, and syringe disinfection protocols, (2) legal and policy interventions designed to encourage legal and policy changes, and (3) new drug treatment options using formulations of drugs such as buprenorphine.