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@article{Borquez:2018:10.1016/S2468-2667(18)30097-5,
author = {Borquez, A and Beletsky, L and Nosyk, B and Strathdee, SA and Madrazo, A and Abramovitz, D and Rafful, C and Morales, M and Cepeda, J and Panagiotoglou, D and Krebs, E and Vickerman, P and Boily, MC and Thomson, N and Martin, NK},
doi = {10.1016/S2468-2667(18)30097-5},
journal = {Lancet Public Health},
pages = {e429--e437},
title = {The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study},
url = {http://dx.doi.org/10.1016/S2468-2667(18)30097-5},
volume = {3},
year = {2018}
}

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TY  - JOUR
AB  - BackgroundAs countries embark on public health-oriented drug law reform, health impact evaluations are needed. In 2012, Mexico mandated the narcomenudeo reform, which depenalised the possession of small amounts of drugs and instituted drug treatment instead of incarceration. We investigated the past and future effect of this drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico.MethodsIn this epidemic modelling study, we used data from the El Cuete IV cohort study to develop a deterministic model of injecting and sexual HIV transmission in people who inject drugs in Tijuana between 2012 and 2030. The population was stratified by sex, incarceration status, syringe confiscation by the police, HIV stage, and exposure to drug treatment or rehabilitation (either opioid agonist treatment or compulsory drug abstinence programmes). We modelled the effect of these exposures on HIV risk in people who inject drugs, estimating the effect of observed and potential future reform enforcement levels.FindingsIn 2011, prior to the narcomenudeo reform, 547 (75%) of 733 people who inject drugs in the El Cuete cohort reported having ever been incarcerated, on average five times since starting injecting. Modelling estimated the limited reform implementation averted 2% (95% CI 0·2–3·0) of new HIV infections in people who inject drugs between 2012 and 2017. If implementation reduced incarceration in people who inject drugs by 80% from 2018 onward, 9% (95% CI 4–16) of new HIV infections between 2018 and 2030 could be averted, with 21% (10–33) averted if people who inject drugs were referred to opioid agonist treatment instead of being incarcerated. Referral to compulsory drug abstinence programmes instead of prison could have a lower or potentially negative impact with −2% (95% CI −23 to 9) infections averted.InterpretationMexican drug law reform has had a negligible effect on the HIV epidemic among people who inject drugs
AU  - Borquez,A
AU  - Beletsky,L
AU  - Nosyk,B
AU  - Strathdee,SA
AU  - Madrazo,A
AU  - Abramovitz,D
AU  - Rafful,C
AU  - Morales,M
AU  - Cepeda,J
AU  - Panagiotoglou,D
AU  - Krebs,E
AU  - Vickerman,P
AU  - Boily,MC
AU  - Thomson,N
AU  - Martin,NK
DO  - 10.1016/S2468-2667(18)30097-5
EP  - 437
PY  - 2018///
SN  - 2468-2667
SP  - 429
TI  - The effect of public health-oriented drug law reform on HIV incidence in people who inject drugs in Tijuana, Mexico: an epidemic modelling study
T2  - Lancet Public Health
UR  - http://dx.doi.org/10.1016/S2468-2667(18)30097-5
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000444479400010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/63360
VL  - 3
ER  -

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