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Author Manuscript
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Published in final edited form as:
AIDS Behav. 2008 July ; 12(4): 552–560. doi:10.1007/s10461-008-9372-6.
Shooting Gallery Attendance among IDUs in Tijuana and Ciudad
Juarez, Mexico: Correlates, Prevention Opportunities, and the
Role of the Environment
Morgan Philbin,
Department of Family and Preventive Medicine, School of Medicine, University of California, San
Diego, 9500 Gilman Drive, La Jolla, CA 92093−0622, USA
Robin A. Pollini,
Department of Family and Preventive Medicine, School of Medicine, University of California, San
Diego, 9500 Gilman Drive, La Jolla, CA 92093−0622, USA
NIH-PA Author Manuscript
Rebecca Ramos,
United States–Mexico Border Health Association, El Paso, TX, USA
Remedios Lozada,
Pro-COMUSIDA, Tijuana, Baja California, Mexico
Kimberly C. Brouwer,
Department of Family and Preventive Medicine, School of Medicine, University of California, San
Diego, 9500 Gilman Drive, La Jolla, CA 92093−0622, USA
Maria Elena Ramos,
Programa Compañeros, Ciudad Juarez, Chihuahua, Mexico
Michelle Firestone-Cruz,
Department of Family and Preventive Medicine, School of Medicine, University of California, San
Diego, 9500 Gilman Drive, La Jolla, CA 92093−0622, USA
Patricia Case, and
The Fenway Institute, Fenway Community Health, Boston, MA, USA
NIH-PA Author Manuscript
Steffanie A. Strathdee
Department of Family and Preventive Medicine, School of Medicine, University of California, San
Diego, 9500 Gilman Drive, La Jolla, CA 92093−0622, USA
Abstract
We identified factors associated with shooting gallery attendance among injection drug users (IDUs)
in two Mexico–US border cities. IDUs in Tijuana (n = 222) and Ciudad Juarez (n = 205), Mexico,
who were ≥18 years and injected illicit drugs in the last month were recruited using respondentdriven sampling (RDS). An interviewer-administered survey collected sociodemographic and
behavioral data. Logistic regression was used to examine correlates of shooting gallery attendance
in each of the two cities. Homelessness and being arrested for syringe possession—both structural
level factors—were associated with shooting gallery use in both cities. In Ciudad Juarez, younger
age and having overdosed were also associated with shooting gallery use. Our study highlights the
need for structural interventions that mitigate homelessness among IDUs and facilitate changes in
© Springer Science+Business Media, LLC 2008
e-mail: rpollini@ucsd.edu.
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law enforcement practices associated with shooting gallery use. Harm reduction interventions based
within shooting galleries should also be considered to prevent transmission of blood-borne pathogens
among IDUs.
Keywords
HIV/AIDS; IDU; Mexico; Shooting gallery
Introduction
Tijuana and Ciudad Juarez are located near the United States–Mexican border adjacent to San
Diego, California and El Paso, Texas, respectively, and both are situated along major
northbound drug trafficking routes (Brouwer et al. 2006a). In Tijuana, the percentage of the
general population reporting having ever used an illegal drug is the highest in Mexico (14.7%)
and almost three times the national average (5.3%); Ciudad Juarez has the second highest
prevalence in the country (9.2%) (Consejo Nacional Contra las Adicciones 1998; Dantés
1999).
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The prevalence of HIV in Mexico is 0.3%, but is substantially higher among some high risk
subpopulations on Mexico's northern border. HIV prevalence among injection drug users
(IDUs) has remained below 5% in Tijuana and Ciudad Juarez (Frost et al. 2006; MagisRodriguez et al. 2005) but prevalence is 12% in both cities among female sex workers who
inject drugs (Strathdee et al. 2008). In 2005, up to one in 125 adults (0.8%) aged 15−49 was
estimated to be HIV positive in Tijuana (Brouwer et al. 2006b).
Concern has been raised about the potential for HIV to spread rapidly through IDU populations
in Tijuana and Ciudad Juarez because many IDUs in these cities report high risk injection
behaviors, including injecting in shooting galleries. The term “shooting gallery” is used to
describe a location where IDUs exchange drugs or money for a place to inject. Syringes are
often borrowed, rented, or purchased at these venues and other injection paraphernalia (e.g.,
cookers, cotton) are commonly shared among friends and strangers alike (Celentano et al.
1991; Fuller et al. 2003; Reyes et al. 1996; Strathdee et al. 2005). In cities where shooting
galleries are part of the drug culture, they tend to be located in high drug use neighborhoods
near points of drug purchase (Kimber and Dolan 2007; Reyes et al. 1996) but hidden from view
of law enforcement and the general public.
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In northern Mexico, shooting galleries are referred to as picaderos (derived from the Spanish
verb picar—to prick or puncture) and are described as dilapidated buildings, vacant lots, or
alleyways where IDUs are required to pay the shooting gallery operator a sica [fee]—
commonly a few pesos or drops of drug from a syringe—to gain access (Firestone-Cruz et al.
2007; Strathdee et al. 2005). In 2004, there were approximately 200 picaderos in Tijuana and
185 in Ciudad Juarez (Cravioto 2003; Strathdee et al. 2005).
Because sharing injection equipment is common in these settings, shooting gallery use has
been identified as a risk factor for HIV infection in several cities in the US, Puerto Rico and
Canada (Chitwood et al. 1990; Corneil et al. 2006; Craib et al. 2003; Deren et al. 2004; Freeman
et al. 1999; Robles et al. 1992; Strathdee et al. 1997). Despite its potentially important role in
furthering HIV epidemics, few studies have examined correlates of shooting gallery use and
no published papers have done so in the Mexican context. A study of IDUs in Baltimore,
Maryland, (Celentano et al. 1991) found that shooting gallery use was significantly associated
with heavier drug use and being male, homosexual/bisexual, of low socioeconomic status, or
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black race. Homelessness was also associated with recent shooting gallery use in Philadelphia,
Pennsylvania (Metraux et al. 2004) and Puerto Rico (Reyes et al. 1996).
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Findings that factors like homelessness and socioeconomic status are associated with shooting
gallery use are consistent with research showing that factors above the level of the individual
—referred to as “structural level factors”—can influence IDU risk behaviors by shaping the
environment in which injection occurs (Rhodes et al. 2003). For example, although sterile
syringes can be legally purchased and possessed in Mexico, qualitative interviews of IDUs
conducted by our group in Tijuana and Ciudad Juarez showed that fear of detection by police
discourages the carrying of syringes for personal use and is an important factor in an IDU's
decision to use shooting galleries, where syringes can be readily obtained (Miller et al. in
press; Strathdee et al. 2005). A more recent study by our group showed a quantitative
association between arrests for syringe possession and receptive syringe sharing (Pollini et al.
2008). Similar associations between fear of police detection and syringe sharing have been
demonstrated in other countries as well (Cooper et al. 2005; Rhodes et al. 2003), and at least
two studies have linked the need to avoid police detection with shooting gallery use (Celentano
et al. 1991; Kimber and Dolan 2007). The current study sought to identify individual and
structural level factors associated with shooting gallery use in Tijuana and Ciudad Juarez in
order to guide interventions to reduce transmission of blood-borne infections in these cities.
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Methods
Participants
We conducted a cross sectional study of behavioral and contextual factors associated with HIV,
HCV, and syphilis infection among IDUs in Tijuana and Ciudad Juarez, Mexico. Recruitment
of IDUs occurred between February and April 2005, and eligibility criteria included having
injected illicit drugs within the past thirty days, confirmed by inspection of injection stigmata
(“track marks”); age ≥18 years; ability to speak Spanish or English; and being willing and able
to provide written informed consent.
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Participants were recruited using respondent-driven sampling (RDS) methods. A diverse group
of “seeds” (selected for heterogeneity by age, gender, drug of choice, and recruitment venue)
were given three uniquely coded coupons to refer their peers to the study (Heckathorn 1997).
This study population was comprised of 15 seeds and 207 recruits in Tijuana and 9 seeds and
197 recruits in Ciudad Juarez, as previously described (Frost et al. 2006). Waves of recruitment
continued as subjects referred to the study were each given three coupons to further recruit
members of their own social networks. Participants received $5 in compensation for each
individual recruited. In Ciudad Juarez, recruitment was based at a clinic run by a trusted nongovernmental organization (NGO), Programa Compañeros, which has provided outreach,
prevention, and treatment services to injection drug users and conducted studies with this
population since 1986. In Tijuana, an NGO called Centro de Integración y Recuperación para
Enfermos de Alcoholismo y Drogadicción “Mario Camacho Espíritu”, A.C. (CIRAD), which
began working with drug users over 15 years ago, based recruitment from a mobile van that
made weekly trips to three geographically diverse colonias (neighborhoods): Zona Norte,
Grupo Mexico, and Sepanal.
Measures
Participants received up to $20 USD compensation for completing the survey, which was
administered by trained staff. Questions were informed by prior qualitative interviews
conducted by our study team in both Tijuana and Ciudad Juarez (Strathdee et al. 2005) as well
as research experience from several of our co-investigators regarding policing practices and
other structural level factors in different countries (e.g., the United States, Canada, Russia).
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Questions on individual risk behaviors were based on the last author's 15 years of experience
with the ALIVE and VIDUS IDU cohort studies in Baltimore and Vancouver, respectively.
The survey instruments from these two studies have been used as models for IDU studies in
several countries. In this study, the survey elicited information on background characteristics,
drug use history, risk behaviors, and knowledge and utilization of health services. This included
socio-economic and demographic profiles, drug use practices, information on syringe sharing
and acquisition, arrest history, medical history, and HIV/STI knowledge. Participants were
asked specifically about their lifetime drug use histories and more recent (past 6 months) drug
use, including routes of administration, types of drugs used, and location of injection (e.g., at
their home, at a friend's home, on the street, at a bar, shooting gallery, alleyway, construction
site, or other location). Shooting gallery use was coded as a dichotomous variable based on
their response to the question: “In the past 6 months, tell me if you injected drugs in a
picadero?”
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Participants were screened on-site for HIV antibody with the Determine Rapid Test (Abbott
Laboratories, Abbott Park, IL). We obtained blood samples through venipuncture and serum
was stored at the municipal health clinic before being shipped to the New Mexico State
Laboratory (for Ciudad Juarez samples) or San Diego County public health laboratory (for
Tijuana samples) for further testing. A western blot, HIV enzyme immunoassay (EIA), and/or
HIV immunofluorescence assay was used to confirm HIV-seropositive and indeterminate
results. All samples were tested for anti-HCV antibodies using an EIA test (Ortho Diagnostic
Systems EIA 3.0, Raritan, NJ) and for syphilis antibody with the rapid plasma reagin (RPR)
test (Macro-Vue, Becton Dickinson, Franklin Lakes, NJ). Reactive HCV samples were retested
with an EIA to confirm, and reactive syphilis samples were confirmed using a Treponema
pallidum particle agglutination assay (TPPA) (Serodia, Fujirebio Diagnostics, Malvern, PA).
In the absence of clinical information, those with syphilis titers ≥1:8 were considered
suggestive, but not conclusive, of incident syphilis infection. All participants were provided
pre- and post-test counseling and those testing positive for HIV, Hepatitis C or syphilis were
referred to local municipal health clinics for free medical care.
Data Analysis
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We used descriptive statistics to characterize the study population, and compared participants
enrolled in Tijuana and Ciudad Juarez to identify any significant differences by site using Chisquare or Fisher's exact test for categorical variables and t-tests and the Wilcoxon rank sum
test for normally and non-normally distributed continuous variables, respectively. Univariate
analyses comparing IDUs who reported shooting gallery attendance in the last 6 months to
those who did not were conducted using the same statistical tests. Variables associated with
shooting gallery attendance at a level of P < .10 were entered into a multiple logistic regression
model in a manual stepwise fashion, starting with those with the lowest P-value and proceeding
through those with the highest value, to identify factors independently associated with shooting
gallery use in each city. The likelihood ratio test was used to compare nested models to
determine which variables should be retained in multivariable models at a P <. 05.
To determine whether these multivariable models were both generalizable and valid, we
undertook two additional analyses to explore potential effects of the RDS recruitment process
on our estimates. First, to identify bias that might arise from the RDS sampling process, we
generated overall sampling weights based on recruitment weights and degree weights
(Heckathorn 1997) using the RDS Analysis Tool (RDSAT) Version 5.6.0 developed by
Heckathorn and Volz (2006) and applied these weights to the logistic regression models.
Second, to identify effects that might arise from correlation between recruiters and recruitees,
we developed a random effects logistic regression model in which covariates of interest were
used as fixed effects and where the design matrix of the random effects indicated who recruited
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whom. This model was fit using WinBUGS and results were obtained using two Markov
chains. In one chain, initial values of the parameter estimates were taken from the ordinary
logistic regression models and in the other chain, the initial values were set to zero. Odds ratios
and 95% confidence intervals produced by the RDS analyses were compared to the estimates
from our multiple logistic regression models to identify any significant differences.
Results
We interviewed a total of 428 IDUs (222 and 206 in Tijuana and Ciudad Juarez, respectively).
One individual in Ciudad Juarez did not respond to the shooting gallery attendance question
and was excluded from analyses, leaving 427 respondents. Table 1 presents the
sociodemographic and drug use characteristics of the study population. Overall, the median
age was 34 years (inter-quartile range [IQR]: 28−40), 92% were male, median age of first
injection was 19.5 years (IQR: 16−25) and median time since first injection was 12.5 years
(IQR: 8−19).
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Among the 427 IDUs, 60% reported attending a shooting gallery in the last 6 months and 38%
reported that a shooting gallery was their primary place of injection. Additional risky behaviors
included reporting often or always engaging in distributive sharing of syringes and injection
equipment (70% and 75%, respectively), and often or always receptive sharing of syringes and
injection equipment (71% and 76%, respectively), in the prior 6 months.
Table 1 also compares the demographic characteristics of IDUs in Tijuana and Ciudad Juarez.
Those in Tijuana were more likely than those in Ciudad Juarez to have never married, be
homeless, to have lived or worked in the United States in the past 10 years, and to report an
illegal main source of income. IDUs in Tijuana were also more likely to report using a shooting
gallery in the past 6 months (69 vs. 51%) but were less likely than those in Ciudad Juarez to
report their home, someone else's home or a construction site as a place of injection.
In terms of drug use and risk characteristics, IDUs in Tijuana were more likely than those in
Ciudad Juarez to have injected methamphetamine alone or in combination with heroin, to report
receptive sharing of syringes and injection equipment in the last 6 months, to have noticed
blood from another person on their equipment while injecting, and to report still using these
tools even in these situations. IDUs in Tijuana were also significantly more likely to have ever
been arrested for carrying syringes, whether sterile or unused.
Correlates of Shooting Gallery Attendance
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Table 2 presents factors significantly associated with shooting gallery attendance, stratified by
city. In both cities, IDUs who reported shooting gallery attendance in the last 6 months were
more likely than those who did not to be younger, homeless in the last 6 months, and ever been
arrested for carrying a used syringe. In Ciudad Juarez, IDUs who attended shooting galleries
were more likely to have ever noticed blood on equipment while injecting heroin, and to still
use that equipment despite the visible blood. Those who attended shooting galleries were also
more likely to report injecting for a longer period of time, being arrested for carrying sterile
syringes, acquiring a used syringe, and overdosing. Additional correlates associated with
injecting in a shooting gallery included receptive and distributive syringe sharing, and sharing
injection equipment.
Table 3 presents the final model of factors independently associated with attending a shooting
gallery among IDUs in both Tijuana and Ciudad Juarez. In both cities, IDUs who reported
attending a shooting gallery in the last 6 months were more likely to be homeless in the last 6
months. IDUs who attended shooting galleries in Tijuana were more likely than those who did
not to report being arrested for carrying used syringes. Those reporting shooting gallery
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attendance in Ciudad Juarez were more likely to be younger, have been arrested for carrying
a sterile syringe, and have ever overdosed. Results of Pearson's chi-square tests for goodnessof-fit were P = 0.85 and P = 0.22 for Tijuana and Ciudad Juarez, respectively. Odds ratios and
point estimates generated by analyses to account for the potential effects of the RDS recruiting
process (data not shown) did not appreciably differ.
Discussion
This study found that more than two-thirds of IDUs in Tijuana and half of IDUs in Ciudad
Juarez reported using a shooting gallery in the past 6 months. Of interest, IDUs who reported
shooting gallery attendance had different sociodemographic and risk characteristics than IDUs
who injected elsewhere. Shooting gallery attendees in both cities were more likely to be
homeless and to have been arrested for syringe possession. IDUs in Ciudad Juarez who used
shooting galleries were also younger and more likely to have ever overdosed.
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Notably, two of the correlates of shooting gallery attendance that we identified in this study—
homelessness and arrest for syringe possession—were structural level factors, which are
increasingly viewed as having a substantial impact on HIV risk behaviors among IDUs
(Kalichman et al. 2000; Rhodes et al. 2005). These findings provide additional insight into the
role of the risk environment in shaping behaviors at the individual level and emphasize the
need for structural level interventions to facilitate safer injection practices among IDUs.
The finding that recent homelessness was the factor most strongly associated with shooting
gallery use suggests that shooting galleries play the role of stable injection locations for IDUs
who lack stable living arrangements. A substantial percentage of the IDUs in our study were
homeless; while homelessness is common in IDU populations, the situation in northern Mexico
border cities is exacerbated by the fact that many IDUs reside in these cities as the result of
deportation from the United States and thus lack local familial and financial support. Studies
in the US and Puerto Rico have also found homelessness to be significantly associated with
attending shooting galleries (Coady et al. 2007; Metraux et al. 2004; Reyes et al. 1996), with
one New York study among homeless IDUs showing two-thirds reporting syringe sharing and
shooting gallery use (Susser et al. 1996). Other studies have demonstrated an increased
likelihood of both HIV risk behaviors and HIV prevalence among unstably housed individuals
(Aidala et al. 2005; Corneil et al. 2006; Klinkenberg et al. 2003; Kilbourne et al. 2002; Strathdee
et al. 1997; Zolopa et al. 1994). The increasing evidence regarding associations between
homelessness and HIV suggest that reducing housing instability among IDUs should be a goal
of HIV prevention programs.
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We also found that arrests for syringe possession were commonplace in these two cities, despite
the fact that purchase and possession of sterile syringes without a prescription is legal in
Mexico. This is cause for significant concern and corroborates findings from prior qualitative
interviews by our study team that indicated syringe possession arrests are common among
IDUs in Tijuana and Ciudad Juarez and drive them to seek out shooting galleries to avoid
detection by police (Miller et al. in press; Strathdee et al. 2005). Beyond providing a less visible
location for injection, shooting galleries also provide a place where syringes can be easily
obtained, thus eliminating the need for users to carry their own syringe but increasing the
likelihood of syringe sharing. Other studies (Cooper et al. 2005; Kerr et al. 2005; Rhodes et
al. 2003; Wood et al. 2003) have similarly demonstrated that policing activities can have an
adverse effect on IDUs’ abilities to adhere to safe injection practices by discouraging sterile
syringe seeking, promoting syringe sharing, and rushing injection to avoid detection. In this
context, shooting gallery use may be viewed as a practical response to structural level barriers
to possession and safe usage of sterile syringes (Celentano et al. 1991; Vlahov et al. 1990).
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Notably, the proportion of IDUs reporting lifetime history of arrest for syringe possession was
significantly lower in Ciudad Juarez than in Tijuana and the associations between syringe
possession arrests and shooting gallery use differed in the two cities; arrests for sterile syringe
possession were associated with shooting gallery use in Ciudad Juarez, while arrests for used
syringes were associated in Tijuana. Programa Compañeros has undertaken efforts to educate
police officers in Ciudad Juarez about harm reduction and the potential for policing practices
to influence risky injection behaviors, leading some officers to avoid confiscating syringes
from IDUs (Miller et al. in press). This may help explain the site-specific differences in
proportions of syringe possession arrests and the relationship between shooting gallery use and
the less justified practice of arresting IDUs for sterile syringe possession, which drives IDUs
out of sight to inject. Arrest for possession of used syringes can be justified under Mexican
law if there is residual drug in the syringe chamber; however, it's not clear why these arrests
emerged as independently associated with shooting gallery use in Tijuana instead of arrests for
sterile syringes. More research is needed to elucidate policing practices regarding syringe
possession and their impact, and interventions to change policing practices should be tailored
to the specific needs of each of these two Mexican border cities to most effectively reduce the
need for shooting gallery attendance and the risk of syringe sharing and HIV transmission.
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While facilitating more stable housing arrangements and addressing policing practices would
likely contribute to reductions in shooting gallery use and syringe sharing among IDUs, these
structural interventions require funding and the participation and endorsement of key
government decision makers, and thus may take substantial time to implement. In the interim,
interventions conducted within shooting galleries to reduce the harm associated with their use
may be advisable. Provision of HIV prevention information, bleach and water for syringe
cleaning, syringe distribution and exchange, and other interventions could mitigate the risky
injection behaviors associated with use of these venues (Page and Llanusa-Cester 2007; Reyes
et al. 1996). Programa Compañeros in Ciudad Juarez has been providing syringe exchange and
bleach and water to IDUs and shooting galleries on an informal basis as part of their outreach
activities, which are limited due to scarcity of funds.
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We also found that ever having overdosed was significantly associated with recent shooting
gallery attendance, suggesting that IDUs with risk factors beyond syringe sharing are likely to
utilize these injection sites. Although drug overdoses are largely preventable, overdose
prevention education programs remain in their infancy and inappropriate witness responses to
overdose are common (Pollini et al. 2006; Sergeev et al. 2003; Tobin et al. 2005; Tracy et al.
2005). Programs in the US cities of New York, San Francisco, Chicago, Baltimore, and
elsewhere have provided overdose prevention education and provision of naloxone—an
injectable opiate antagonist that can immediately reverse an opiate overdose and prevent
overdose death—to IDUs in an effort to prevent overdose morbidity and mortality (Maxwell
et al. 2006; Piper et al. 2007; Seal et al. 2005). Targeting shooting galleries as locations for
overdose prevention programs may be an efficient way to prevent overdoses among those at
high risk.
Shooting gallery attendance was also independently associated with younger age in our study.
Fuller et al. (2003) found that young IDUs in Baltimore who attended shooting galleries tended
to be initiated by older, high-risk IDUs who then share their knowledge and practice, promoting
a culture of syringe sharing. The relationship of youth and shooting gallery use is especially
important when placed in the context of other studies showing that both young and recentonset IDUs have higher levels of risky behavior associated with HIV infection (Booth et al.
1991; Fennema et al. 1997). This provides yet more justification for targeting shooting galleries
in Mexico for harm reduction interventions.
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Due to the cross sectional design of this study, we were unable to determine what factors predict
shooting gallery use, though these results suggest strong associations and are consistent with
prior qualitative studies by our team in the same two cities that indicated a causative association
between syringe possession arrests and shooting gallery attendance. As with all studies of drug
behavior, ours is subject to the limitations inherent in self-report. We did not have corroborating
information from police regarding arrests reported by study participants. Another potential
weakness is the relatively small number of IDUs enrolled in each city, but this would tend to
dampen any true associations. The use of RDS to recruit study participants, however, helps
ensure that each person had an equally likely chance of being selected. Statistical adjustment
to correct for any bias or clustering introduced by RDS did not change our point estimates
markedly, suggesting that our findings are generalizable to the overall IDU population in both
Tijuana and Ciudad Juarez.
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This study found that shooting gallery attendance is common in the Mexican-US border cities
of Tijuana and Ciudad Juarez. Homelessness and policing practices—both structural level
factors—may be contributing to high utilization of these venues, where syringe sharing is
common and young IDUs and those with a history of drug overdose are more likely to be found.
Structural interventions to modify policing practices regarding syringe possession are clearly
warranted in these two cities, as are efforts to address high levels of homelessness among IDUs.
In the shorter term, targeting shooting galleries as venues for harm reduction activities
including dissemination of HIV prevention information, syringe distribution and exchange,
and overdose prevention may provide a successful and cost-effective approach for reducing
morbidity and mortality among IDUs.
Acknowledgements
Proyecto El Cuete was funded by the National Institute on Drug Abuse (NIDA) (DA09225-S11 and DA019829). Dr.
Pollini is funded under a T32 grant from the National Institute of Allergies and Infectious Diseases (AI007382) and
Dr. Brouwer is supported by a K01 grant from NIDA (DA020354). The authors gratefully acknowledge the
contributions of study participants and staff; Programa Compañeros and CIRAD for assistance with data collection;
Centro Nacional para la Prevención y el Control del VIH/SIDA (CENSIDA); Instituto de Servicios de Salud de Estado
de Baja California (ISESALUD); and the UCSD Center for AIDS Research (P30 AI36214-06).
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Table 1
Sociodemographic and drug use characteristics of IDUs in Tijuana and Ciudad
Juarez, Mexico
NIH-PA Author Manuscript
Total (n = 427) %
Tijuana (n = 222)
%
Ciudad Juarez
(n = 205) %
Chi-square
Median age (IQR)
34 (28, 40)
34 (29, 40)
33 (28, 42)
Male
91.8
91.4
92.2
.09
Completed high school
29.7
32.1
27.2
1.25
Married/common law
59.0
65.8
51.7
8.71**
Homelessb
42.8
50.5
34.5
11.15**
Crossed US borderb
13.7
10.3
17.4
4.45*
Lived/worked outside Mexico (past
10 years)
35.1
39.8
30.1
4.42*
Illegal source of main income
18.7
22.5
14.6
4.45*
Home
51.3
34.7
69.3
51.02**
Shooting gallery
60.4
69.4
50.7
15.48**
Sociodemographics
2.94a
Injection locationsb
NIH-PA Author Manuscript
In a bar
9.6
10.4
8.8
.31
On the street
37.0
39.6
34.2
1.38
Heroin alone
97.4
97.3
97.6
.01
Cocaine and heroin
49.4
31.1
58.5
45.03**
Crystal meth alone
23.2
44.1
0.49
114.54**
Crystal meth and heroin
34.5
64.9
0.49
265.66**
Cocaine alone
30.7
13.5
49.0
57.64**
Injected daily (any drugs)
85.2
73.5
97.6
48.33**
Often/always reported receptive
syringe sharingb
27.2
31.7
22.5
4.58*
Often/always reporting receptive
sharing paraphernaliab
40.1
46.5
33.8
6.76**
Often/always distributive
paraphernalia sharingb
41.8
48.5
35.1
6.76**
Ever been arrested
93.4
96.0
90.3
5.41*
Ever arrested for carrying a sterile
syringe
47.8
56.6
38.4
14.17**
Ever arrested for carrying a used
syringe
57.0
71.2
41.2
37.77**
Drug use historyb
Risk behavior
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*
Significant at P < .05
**
Significant at P < .01
a
t-test
b
Last 6 months
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Table 2
Associations with shooting gallery attendance in Tijuana and Ciudad Juarez (n = 427)
Attended shooting
galleriesan (%)
Ciudad Juarez (n = 205)
OR
95% CI
Attended shooting
galleriesan (%)
OR
95% CI
Philbin et al.
Tijuana (n = 222)
Sociodemographics
AIDS Behav. Author manuscript; available in PMC 2009 August 27.
Median age (IQR)
34 (29, 40)
0.96*
.93−1.00
33 (28, 41)
0.94**
.91−.97
Male
203 (91.4)
2.20
.85−5.68
190 (92.7)
1.19
.42−3.42
.83−1.00
7 (6,9)
1.08
.98−1.18
3.09−11.52
1.32−7.38
7 (6,9)
0.91*
Homelessa
112 (50.5)
3.93**
2.11−7.31
71 (34.6)
5.96**
Illegal main source of income
50 (22.5)
2.04
.95−4.36
30 (14.6)
3.12**
Age at first injection (IQR)
19 (15, 24)
0.97
.94−1.01
20 (16, 25)
0.96*
.92−.99
Inject dailya
158 (73.5)
1.74
.92−3.29
199 (97.5)
4.29
.47−39.08
2 (1, 4)
1.12
1.03−1.22
2 (1, 4)
1.09**
1.02−1.17
Ever noticed blood on tools while injecting
heroin
76 (34.2)
1.37
74−2.54
77 (38.1)
2.75**
1.52−4.97
Ever still used tool with visible blood while
injecting heroin
72 (32.4)
1.50
.80−2.82
71 (35.1)
2.39**
1.31−4.34
Ever had sex with a male (males only)
91 (46.9)
1.52
.82−2.84
24 (13.1)
2.52*
.99−6.41
Ever gotten or acquired a used syringe
160 (73.1)
2.21
1.19−4.13
113 (55.7)
11.34**
5.85−22.00
Ever overdosed
96 (43.2)
1.23
.69−2.20
99 (48.8)
2.57**
1.46−4.54
24 (11.8)
5.78**
1.90−17.60
12 (7, 17)
0.96*
0.93− 1.00
1.53−4.92
Highest year of school completed (IQR)
Drug use history
Average number of people injected witha
(IQR)
Risk behaviors
Overdosed in last 6 months
Median number of years injecting (IQR)
18 (8.1)
13 (9, 20)
1.17
0.99
.40−3.42
.95−1.02
Ever arrested for carrying sterile syringes
93 (60.8)
1.74
.98−3.10
52 (50.0)
2.74**
Ever arrested for carrying used syringes
120 (77.9)
2.79*
1.51−5.14
56 (53.8)
2.82**
1.58−5.03
Number of times arrested for carrying a
syringe (IQR)
6 (0, 20)
1.00
1.00−1.01
0 (0, 6)
1.04*
1.01−1.07
*
**
Significant at P < .01
Page 13
Significant at P < .05
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Page 14
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a
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Last 6 months
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Page 15
Table 3
Factors independently associated with shooting gallery use among IDUs
Tijuana
Ciudad Juarez
NIH-PA Author Manuscript
AOR
95% CI
AOR
Ever arrested for carrying used
syringes
2.62**
1.38−4.97
–
Ever arrested for carrying sterile
syringes
–
Homelessa
3.77**
Age
Ever overdoseda
95% CI
1.96*
1.01−3.79
4.43**
2.2−8.93
–
.95**
.91−.98
–
4.45*
1.36−14.61
2.01−7.11
*
Significant at P < .05
**
Significant at P < .01
a
Last 6 months
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AIDS Behav. Author manuscript; available in PMC 2009 August 27.