Steffanie Strathdee
University of California, San Diego, Medicine, Faculty Member
- I am Associate Dean of Global Health Sciences at UC San Diego, where I direct the campus wide Global Health Institute and am Harold Simon Professor of Medicine.edit
Research Interests:
Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities.... more
Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to
Research Interests: Pharmacology, Psychology, Epidemiology, Addiction, Public Health, and 21 moreLogistic Regression, Multivariate Analysis, Mexico, Humans, Virus, Psychoactive Drugs, Female, Male, Sexual Behavior, Drug Addiction, Injecting Drug Use, Sterilization, Sharing, Prevalence, Middle Aged, HIV testing, Adult, Public health systems and services research, MEXICO, Risk Behavior, and Needle Sharing
Some studies have indicated that needle exchange programs (NEPs) can be effective in reducing drug-related risks for human immunodeficiency virus (HIV) seroconversion; however, others have reported higher HIV incidence rates among NEP... more
Some studies have indicated that needle exchange programs (NEPs) can be effective in reducing drug-related risks for human immunodeficiency virus (HIV) seroconversion; however, others have reported higher HIV incidence rates among NEP attendees. Since many studies rely on self-reports of NEP attendance, the authors investigated the extent to which differential misreporting of NEP attendance could bias risk estimates. Over a 3-year period from 1994 to 1997, self-reports of NEP attendance from participants in a prospective study in Baltimore, Maryland, were compared with NEP records. Of 1,315 participants, 459 (35%) had registered with the Baltimore NEP. There was 86.7% concordance between self-reported and actual NEP use; 11.0% reported NEP attendance but did not attend (overreported), and 2.2% reported not attending NEP but did attend (underreported). In multivariate analyses using generalized estimating equations, persons who overreported NEP attendance were more likely to have inj...
Research Interests: Program Evaluation, Prospective studies, Humans, Mathematical Sciences, Female, and 15 moreMale, Self Disclosure, Poisson regression, American, Maryland, Human immunodeficiency virus, Adult, Patient Participation, Bias (Epidemiology), Poisson Distribution, Logistic Models, Prospective Study, Generalized estimating equation, Confidence Interval, and Risk estimation
To enhance HIV surveillance within a non-nominal provincial testing system. Confirmatory HIV tests from a provincial laboratory were analyzed during 1995 and 1996. Enhancements included elimination of repeat positive tests for the same... more
To enhance HIV surveillance within a non-nominal provincial testing system. Confirmatory HIV tests from a provincial laboratory were analyzed during 1995 and 1996. Enhancements included elimination of repeat positive tests for the same individual using automated matching of non-nominal identifiers and nurse call-back of health care providers, completion of missing information through call-back and connection of providers with resources for patient care. Forty-seven percent of 2,683 reactive HIV tests were identified as duplicates for the same individual, meaning that 1,401 people tested positive for the first time. From laboratory test data to enhanced unduplicated data after call-back, the proportion of tests for which risk and ethnic information was unknown dropped from 37% to 11% and from 64% to 18% respectively (p < 0.0001). Enhanced non-nominal surveillance for HIV is a practical means of marrying the needs of public health for epidemiological information and the rights of p...
Research Interests:
Peace and stability in Eastern Europe is now at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine. However, largely overlooked in the context of other foreign policy and diplomatic... more
Peace and stability in Eastern Europe is now at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine. However, largely overlooked in the context of other foreign policy and diplomatic priorities are the serious public health consequences for the region following the annexation of Crimea and the subsequent decision to ban opioid substitution therapy in the disputed territory. On 1 May 2014, the Republic of Crimea officially announced it would end access to opioid substitution therapy, an essential harm reduction tool recognized by international organizations and virtually all other European countries. The policy development marks a critical reversal in the region's fight against its growing HIV epidemic and also threatens years of public health gains aimed at providing evidence-based and integrated treatment approaches to combat drug dependence and HIV. Beyond these risks, the Ukrainian conflict could also negatively impact control...
To explore experiences during childhood and adolescence that influenced reproductive and sexual health among women who had entered the sex industry in adolescence. A qualitative study was conducted using information provided by 25 female... more
To explore experiences during childhood and adolescence that influenced reproductive and sexual health among women who had entered the sex industry in adolescence. A qualitative study was conducted using information provided by 25 female sex workers (FSWs) from Tijuana, Mexico, who reported entering the sex industry when younger than 18 years. In-depth, semi-structured interviews were conducted with all participants between January 31, 2011, and July 8, 2011. Four interrelated themes that shaped health experiences-early sexual abuse, early illicit drug use, ongoing violence, and limited access to reproductive and sexual health care-were identified. Participants reporting these experiences were at risk of unintended teenaged pregnancy, spontaneous abortion or stillbirth, and untreated sexually transmitted infections. Programs and policies that address social, structural, and individual vulnerabilities during adolescence and adulthood are required to promote reproductive and sexual he...
Research Interests:
Research Interests:
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
Research Interests:
Summary Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via... more
Summary Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02-2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37-11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58-13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97-7....
Research Interests: Medical Microbiology, Risk Taking, Multivariate Analysis, Mexico, Syphilis, and 16 moreHumans, Female, Male, Sexual Behavior, Young Adult, Follow-up studies, Incidence, Risk factors, Clinical Sciences, Public health systems and services research, MEXICO, Risk Factors, Drug Users, Unsafe Sex, Logistic Models, and Needle Sharing
Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims... more
Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city. We conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation. A total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4-46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0-40.0) were estimated to have ever used methamphet...
Research Interests:
Research Interests:
Research Interests: Human Rights, Global Health, Molecular Epidemiology, Humans, Female, and 4 moreMale, Sex Workers, Lancet, and Viral Load
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Disclosure of sexually transmitted infections (STI)/HIV diagnoses to sexual partners is not mandated by public health guidelines in Mexico. To assess the feasibility of couples-based STI/HIV testing with facilitated disclosure as a... more
Disclosure of sexually transmitted infections (STI)/HIV diagnoses to sexual partners is not mandated by public health guidelines in Mexico. To assess the feasibility of couples-based STI/HIV testing with facilitated disclosure as a risk-reduction strategy within female sex workers' (FSW) primary partnerships, we examined STI/HIV test result disclosure patterns between FSWs and their primary, non-commercial male partners in two Mexico-US border cities. From 2010 to 2013, 335 participants (181 FSWs and 154 primary male partners) were followed for 24 months. At semiannual visits, participants were tested for STIs/HIV and reported on their disclosure of test results from the previous visit. Multilevel logistic regression was used to identify individual-level and partnership-level predictors of cumulative (1) non-disclosure of ≥1 STI test result and (2) non-disclosure of ≥1 HIV test result within couples during follow-up. Eighty-seven percent of participants reported disclosing all S...
Research Interests:
Research Interests:
Research Interests: Global Health, Kenya, India, Canada, Humans, and 9 moreProstitution, Female, Sex Workers, Incidence, Risk factors, Lancet, Prevalence, Risk Factors, and Condoms
Research Interests:
The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in... more
The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in this population. We explored the impact of child physical abuse (CPA) on HIV seroconversion in a cohort of gay/bisexual men aged 15 to 30 in Vancouver, Canada. Cox proportional hazard models were used, controlling for confounders. Among 287 participants, 211 (73.5%) reported experiencing CPA before the age of 17, and 42 (14.6%) reporting URAI in the past year. After a median of 6.6 years follow-up, 16 (5.8%) participants HIV-seroconverted. In multivariate analysis, CPA was significantly associated with HIV seroconversion (adjusted hazard ratio [AHR] = 4.89, 95% confidence interval (CI): 1.65-14.48), after controlling for potential confounders. Our study uncovered a link between childhood physical violence and HIV incidence. Results highlight an urgent ...
Research Interests: Criminology, Psychology, Multidisciplinary, Probability, Humans, and 23 moreChild, Child Abuse, United States, Female, Male, Self Disclosure, American, Health Professionals, Physical Abuse, Risk factors, British Columbia, PLoS one, Aged, Prevalence, Middle Aged, Adult, Interpersonal Violence, Hiv seropositivity, Risk Factors, Cross Sectional Studies, Unsafe Sex, Cohort Studies, and Gastrointestinal Diseases
Research Interests: Program Evaluation, Poverty, Risk assessment, Telemedicine, Mexico, and 13 moreMedical Students, Humans, Program Development, Female, Undergraduate medical education, Male, Young Adult, Adult, Public health systems and services research, Southwestern United States, MEXICO, Risk Assessment, and Socioeconomic Factors
To compare characteristics of first-time needle exchange participants who enrolled at a mobile van-based exchange site versus a fixed pharmacy-based exchange site, in an area where both types of needle exchange programs were available.... more
To compare characteristics of first-time needle exchange participants who enrolled at a mobile van-based exchange site versus a fixed pharmacy-based exchange site, in an area where both types of needle exchange programs were available. Demographic and drug use data were collected on needle exchange program participants on enrollment. Participants were included if they were first-time participants at the Baltimore needle exchange program between December 1997 and March 1999, and if their first visit was at either one van-based site or at one of two pharmacy-based sites. Descriptive statistics and inferences were based on the type of needle exchange into which participants enrolled. Among 286 first-time participants, 92% were African American, 28% were women, 11% were currently employed, 55% completed high school, and the median age was 40 years. In multivariate analyses, van-based enrollment was more common among frequent injectors (odds ratio [OR] = 2.0), but less common among African American participants (OR = 0.21). Our data suggest that different venues for needle exchange program settings attract different types of drug injecting participants. This suggests that offering different venue types to reach participants with differing drug use patterns will be important to optimize risk reduction strategies.
Research Interests:
Research Interests: Infectious disease epidemiology, Global Health, Tobacco, Tuberculosis and Infectious Disease, Infectious Diseases, and 22 moreMultivariate Analysis, Mexico, Tuberculosis, Humans, Substance Abuse, Mycobacterium tuberculosis, Smoking, Female, M. tuberculosis, Male, Risk factors, Prevalence, Middle Aged, Saliva, Adult, Chi Square Distribution, MEXICO, Risk Factors, Drug Users, Cross Sectional Studies, Predictive value of tests, and Cotinine
Research Interests:
The objective of this study was to examine the association between adolescent exposure to and understanding of needle exchange programs (NEPs) and their perceptions of the impact of NEP on the decision to use illicit drugs. From November... more
The objective of this study was to examine the association between adolescent exposure to and understanding of needle exchange programs (NEPs) and their perceptions of the impact of NEP on the decision to use illicit drugs. From November 1998 to February 1999, ...
Research Interests:
Research Interests:
Research Interests: Adolescent, Sex Industry and Workers, Mexico, Biological Sciences, Drug abuse and addiction, and 16 moreCalifornia, Humans, Prostitution, Female, Sexually transmitted infections, Male, Risk factors, Prevalence, Questionnaires, Adult, Vih Sida, MEXICO, Risk Factors, Female Sex Workers, Sexually Transmitted Diseases, and Unsafe Sex
Research Interests: Thailand, Risk Taking, Chlamydia trachomatis, Biological Sciences, Humans, and 16 moreBaltimore, Female, Sexually transmitted infections, Male, Sexual Behavior, Trichomonas vaginalis, Coinfection, Prevalence, Questionnaires, Adult, Bacterial Vaginosis, Condoms, Cross Sectional Studies, Sexually Transmitted Diseases, Neisseria gonorrhoeae, and Cohort Studies
Research Interests:
Despite increasing prevalence of HIV among U.S. Latinos, participation in HIV clinical trials is low. Barriers to HIV clinical trial participation in U.S. Latinos are not well understood. Using in-depth, semistructured interviews with HIV... more
Despite increasing prevalence of HIV among U.S. Latinos, participation in HIV clinical trials is low. Barriers to HIV clinical trial participation in U.S. Latinos are not well understood. Using in-depth, semistructured interviews with HIV care providers serving HIV-positive Latinos and focus groups with HIV-positive Mexican-origin Latinos, we assessed cross-cultural barriers (e.g., stigma and linguistic) to HIV clinical trials in San