Mexico's northern border conflict: collateral damage to health and human rights of vulnerable groups

Abstract

Objectives: Given links between policing environment and infectious disease risk among vulnerable groups, we surveyed female sex workers who inject drugs in Tijuana and Ciudad (Cd.) Juarez. Data were used to 1. compare distributions of human rights violations and disease risk, 2. juxtapose these patterns against demographic and structural environment variables, and 3. formulate implications for structural interventions. Methods: Structured interviews and testing for sexually-transmitted infections (STIs) were conducted (October 2008-October 2009). Frequency of individual and environmental factors, including police abuse, HIV risk and protective behaviors were compared between sites using univariate logistic regression. Results: Of 624 women, almost half reported police syringe confiscation despite syringes being legal and 55.6% reported extortion (last 6 months), with significantly-higher proportions in Cd. Juarez (p<0.001). Reports of recent solicitation of sexual favors (28.5% in Tijuana, 36.5% in Cd. Juarez, p=0.04) and sexual abuse were commonplace (15.7% v 18.3%). Significantly lower prevalence of STIs in Tijuana (64.2% v 83.4%, p<0.001) paralleled lower prevalence of sexual risk behaviors there. Cd. Juarez respondents reported significantly-higher median client loads (1.5 v 6.9, p<0.001) and lower median pay per sex act (US$20 v US$10, p<0.001) (last month). Relative to Tijuana, security deployment was perceived to increase more in Cd. Juarez (last year), especially army presence (59.2% v 72.1%, p=0.001). Conclusions: Collateral damage from police practices in the context of Mexico’s drug conflict may impact public health in the Northern Border Region. Itinerant officers may facilitate disease spread beyond the Region. The urgency for mounting structural interventions is discussed.