Remedios Lozada - Academia.edu (original) (raw)

Papers by Remedios Lozada

Background: HIV prevalence is increasing among female sex work- ers (FSWs) in Tijuana and Ciudad ... more Background: HIV prevalence is increasing among female sex work- ers (FSWs) in Tijuana and Ciudad Juarez, 2 Mexican cities on the US border. Quasilegal prostitution in both cities attracts large numbers of sex tourists. We compared FSWs with and without US clients in both cities. Methods: FSWs aged >18 years reporting unprotected sex with >1 client within the last 2 months, who were not knowingly HIV-infected, were enrolled in a behavioral intervention study. At baseline, partic- ipants underwent interviews, antibody testing for HIV and syphilis, and vaginal swabs for detecting gonorrhea and Chlamydia. Logistic regression identified factors associated with reporting >1 US client. Results: Of 924 FSWs, 69% had US clients. Median age and duration in sex work were 32 and 4 years. Prevalence of HIV, infec- tious syphilis (titer >1:8), gonorrhea, Chlamydia, and any STI was 6%, 14%, 6%, 13%, and 27%, respectively. Compared with other FSWs, FSWs with US clients were more likely to have syphilis titers >1:8 (16% vs. 10%, P 0.01), gonorrhea (8% vs. 2%, P <0.001) or any STI, including HIV (30% vs. 20%, P 0.002). Factors indepen- dently associated with having US clients were: living in Tijuana, being younger, speaking English, being paid more for having sex without a condom, having >250 clients in the last 6 months, having syphilis titers >1:8, and injecting drugs. Conclusions: In these border cities, FSWs reporting US clients were more likely to have current STIs and to engage in higher-risk behaviors. Intensified binational prevention efforts involving both FSWs and their clients are urgently needed. OF THE 5.5 MILLION people who live on the Mexican side of the US border, approximately half live in Tijuana or Ciudad (Cd.) Juarez,1 which are adjacent to San Diego, CA, and El Paso, TX,

Background: Cigarette smoking and tuberculosis are major global health concerns, and cigarette sm... more Background: Cigarette smoking and tuberculosis are major global health concerns, and cigarette smoking increases the risk of active tuberculosis disease. However, it is unknown whether a causal relationship exists between cigarette smoking and Mycobacterium tuberculosis (Mtb) infection. We analyzed data from a longitudinal cohort study of injection drug users in Tijuana, Mexico to investigate whether cigarette smoking increases the risk of Mtb infection. Methods: Participants were recruited using respondent driven sampling (RDS). Mtb infection status was ascertained using QuantiFERON-TB Gold In-Tube (QFT) assays at baseline and 18 month visits. QFT conversion was defined as interferon-gamma concentrations <0.35 IU/ml in the antigen-stimulated tube minus the nil tube at baseline and ≥ 0.35 IU/ml plus 0.7 IU/ml greater than baseline at 18 months. The number of cigarettes smoked daily was categorized into quartiles. We used multivariable Poisson regression weighted for RDS sampling ...

AIDS and Behavior, 2014

Respondent-driven sampling's (RDS) widespread use and reliance on untested assumptions suggests a... more Respondent-driven sampling's (RDS) widespread use and reliance on untested assumptions suggests a need for new exploratory/diagnostic tests. We assessed geographic recruitment bias and outcome-correlated recruitment among 1048 RDS-recruited people who inject drugs (Tijuana, Mexico). Surveys gathered demographics, drug/sex behaviors, activity locations, and recruiter-recruit pairs. Simulations assessed geographic and network clustering of active syphilis (RPR titers≥1:8). Gender-specific predicted probabilities were estimated using logistic regression with GEE and robust standard errors. Active syphilis prevalence was 7% (crude: men=5.7% and women=16.6%; RDS-adjusted: men=6.7% and women=7.6%). Syphilis clustered in the Zona Norte, a neighborhood known for drug and sex markets. Network simulations revealed geographic recruitment bias and non-random recruitment by syphilis status. Gender-specific prevalence estimates accounting for clustering were highest among those living/working/injecting/buying drugs in the Zona Norte and directly/ indirectly connected to syphilis cases (men:15.9%, women:25.6%) and lowest among those with neither exposure (men:3.0%, women:6.1%). Future RDS analyses should assess/account for network and spatial dependencies.

Pulmonary Medicine, 2012

We analyzed data from a longitudinal cohort study of persons who inject drugs (PWID) in Tijuana, ... more We analyzed data from a longitudinal cohort study of persons who inject drugs (PWID) in Tijuana, Mexico, to explore whether cigarette smoking increases the risk of interferon gamma release assay (IGRA) conversion. PWID were recruited using respondent driven sampling (RDS). QuantiFERON-TB Gold In-Tube (QFT) assay conversion was defined as interferon-gamma concentrations <0.35 IU/mL at baseline and ≥0.7 IU/mL at 18 months. We used multivariable Poisson regression adjusted for RDS weights to estimate risk ratios (RRs). Of 129 eligible participants, 125 (96.9%) smoked at least one cigarette during followup with a median of 11 cigarettes smoked daily, and 52 (40.3%) had QFT conversion. In bivariate analysis, QFT conversion was not associated with the number of cigarettes smoked daily (P=0.716). Controlling for age, gender, education, and alcohol use, the RRs of QFT conversion for smoking 6–10, 11–15, and ≥16 cigarettes daily compared to smoking 0–5 cigarettes daily were 0.9 (95% confi...

Sexually Transmitted Diseases, 2008

Revista Panamericana de Salud Pública, 2012

Journal of Immigrant and Minority Health, 2011

Background-Circular migration and injection drug use increase the risk of HIV transmission in sen... more Background-Circular migration and injection drug use increase the risk of HIV transmission in sending communities. We describe female sex workers who are injection drug users' (FSW-IDUs) circular migration and drug use behaviors. Methods-Between 2008-2010, 258 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. Results-24% of FSW-IDUs were circular migrants. HIV prevalence was 3.3% in circular migrants and 6.1% in non-circular migrants; 50% of circular and 82% of non-circular migrants were unaware of their HIV infection. Among circular migrants, 44% (n=27) consumed illicit drugs in their birthplace; 70% of these (n=20) injected drugs and one-half of injectors shared injection equipment in their birthplace. Women reporting active social relationships were significantly more likely to return home. Discussion-Circular migrant FSW-IDUs exhibit multiple HIV risks and opportunities for bridging populations. Regular HIV testing and treatment and access to substance use services is critical for FSW-IDUs and their sexual/drug-using contacts.

Journal of Adolescent Health, 2010

Purpose-To examine correlates of early initiation into sex work in two Mexico-U.S. border cities.... more Purpose-To examine correlates of early initiation into sex work in two Mexico-U.S. border cities. Methods-Female sex workers (FSWs) ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez who had recent unprotected sex with clients underwent baseline interviews. Correlates of initiation into sex work before age 18 were identified with logistic regression. Results-Of 920 FSWs interviewed in Tijuana (N=474) and Ciudad Juarez (N=446), 9.8% (N=90) were early initiators (<18 years) into sex work. Median age of entry into sex work was 26 years (range: 6-58). After adjusting for age, compared to older initiators, early initiators were more likely to use inhalants (21.1% vs 9.6%, p=0.002), initiate sex work to pay for alcohol (36.7% vs 18.4%, p<.001), report abuse as a child (42.2% vs 18.7%, p<.0001), and they were less likely to be migrants (47.8% vs 62.3%, p=0.02). Factors independently associated with early initiation included inhalant use (adjOR=2.39), initiating sex work to pay for alcohol (adjOR=1.88) and history of child abuse (adjOR=2.92). Factors associated with later initiation included less education (adjOR=0.43 per 5year increase), migration (adjOR=0.47), and initiating sex work for better pay (adjOR=0.44) or to support children (adjOR=0.03).

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Objective-To investigate individual, interpersonal, and social-structural factors associated with... more Objective-To investigate individual, interpersonal, and social-structural factors associated with involuntary sex exchange among female sex workers (FSWs) along the Mexico-U.S. border. Methods-In 2010-2011, 214 FSWs from Tijuana (n=106) and Ciudad Juarez (n=108) aged ≥18 who reported lifetime use of heroin, cocaine, crack, or methamphetamine, having a stable partner, and having sold/traded sex in the past month completed quantitative surveys and HIV/STI testing. Logistic regression was used to identify correlates of involuntary sex exchange among FSWs. Results-Of 214 FSWs, 31 (14.5%) reported involuntary sex exchange. These women were younger at sex work entry (Adjusted odds ratio [AOR]: 0.84/1 year increase, 95% CI: 0.72-0.97) and were significantly more likely to service clients whom they perceived to be HIV/STI-infected (AOR: 12.41, 95% CI: 3.15-48.91). Additionally, they were more likely to have clients who used drugs (AOR: 7.88, 95% CI: 1.52-41.00), report poor working conditions (AOR: 3.27, 95% CI: 1.03-10.31), and report a history of rape (AOR: 4.46, 1.43-13.91).] Conclusions-Involuntary sex exchange is disproportionate among FSWs who begin to exchange sex at a younger age, and these women experience elevated risk of violence and HIV/ STIs related to their clients' behaviors and their working conditions. These data suggest the critical need for evidence-based approaches to preventing sexual exploitation of women and girls and to reducing harm among current sex workers. Multi-level interventions for sex workers and their clients that target interpersonal and social-structural risks (e.g., measures to improve safety and reduce exploitation within the workplace) are needed.

Global Public Health, 2012

Background-Prior studies estimate HIV prevalence of 4% among injection drug users (IDUs), compare... more Background-Prior studies estimate HIV prevalence of 4% among injection drug users (IDUs), compared with 0.8% in the general population of Tijuana, Mexico. However, data on HIV prevalence and correlates among non-injecting drug users (NIDUs) are sparse. Methods-Individuals were recruited through street outreach for HIV testing and behavioral risk assessment interviews to estimate HIV prevalence and identify associated sexual risk behaviors among NIDUs in Tijuana. Descriptive statistics were used to characterize "low-risk" NIDUs (drug users who were not commercial sex workers or men who have sex with men). Results-HIV prevalence was 3.7% among low-risk NIDUs. During the prior six months, 52% of NIDUs reported having ≥1 casual partner; 35% reported always using condoms with a casual partner; and 13% and 15% reported giving or receiving something in exchange for sex, respectively. Women were significantly more likely than men to have unprotected sex with an IDU (p<0.01). Conclusions-The finding that HIV prevalence among NIDUs was similar to that of IDUs suggests that HIV transmission has occurred outside of traditional core groups in Tijuana. Broad interventions including HIV testing, condom promotion and sexual risk reduction should be offered to all drug users in Tijuana.

The International journal on drug policy, 2010

In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for pe... more In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users' (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy.

American Journal of Public Health, 2008

Objectives. We examined the efficacy of a brief behavioral intervention to promote condom use amo... more Objectives. We examined the efficacy of a brief behavioral intervention to promote condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico. Methods. We randomized 924 female sex workers 18 years or older without known HIV infection living in Tijuana and Ciudad Juarez who had recently had unprotected sex with clients to a 30-minute behavioral intervention or a didactic control condition. At baseline and 6 months, women underwent interviews and testing for HIV, syphilis, gonorrhea, and chlamydia. Results. We observed a 40% decline in cumulative sexually transmitted illness incidence (P = .049) in the intervention group. Incidence density for the intervention versus control groups was 13.8 versus 24.92 per 100 person-years for sexually transmitted illnesses combined (P = .034) and 0 versus 2.01 per 100 person-years for HIV (P < .001). There were concomitant increases in the number and percentage of protected sex acts and decreases in the number of unprotected sex ac...

AIDS and Behavior, 2009

We examined relationships between clientperpetrated emotional, physical, and sexual abuse, inject... more We examined relationships between clientperpetrated emotional, physical, and sexual abuse, injection drug use, and HIV-serostatus among 924 female sex workers (FSWs) in Tijuana and Ciudad Juarez, two large Mexico-US border cities. We hypothesized that FSWs' injection drug use would mediate the relationship between client-perpetrated abuse and HIV-seropositivity. The prevalence of client-perpetrated emotional, physical, and sexual abuse in the past 6 months was 26, 18, and 10% respectively; prevalence of current injection drug use and HIV was 12 and 6%, respectively. Logistic regression analyses revealed that client-perpetrated sexual abuse was significantly associated with HIV-seropositivity and injection drug use, and that injection drug use was positively associated with HIV-seropositivity. Injection drug use partially mediated the relationship between client-perpetrated sexual abuse and HIV-seropositivity. Results suggest the need to address client-perpetrated violence and injection drug use when assessing HIV risk among FSWs.

AIDS, 2012

Objective-To systematically review factors associated with HIV disease progression among illicit ... more Objective-To systematically review factors associated with HIV disease progression among illicit drug users, focusing on exposures exogenous to individuals that likely shape access and adherence to HIV treatment. Design-A systematic review of peer-reviewed English-language studies among HIVseropositive illicit drug users with at least one of these endpoint of interest: a diagnosis of AIDS; death; changes/differences in CD4 cell counts; or changes/differences in plasma HIV-1 RNA levels. Methods-Articles were included if they reported factors associated with an outcome of interest among a group of illicit drug users. Studies were identified, screened and selected using systematic methods. Results-Of 2,668 studies matching the search criteria, 58 (2%) met the inclusion criteria, all but one from North America or Western Europe. Overall, 41 (71%) studies contained significant individual-level clinical characteristics or behaviours (e.g., illicit drug use) associated with disease progression. Fifteen studies (26%) identified significant social, physical, economic or policy-level exposures, including incarceration, housing status or lack of legal income. Conclusion-While past studies demonstrate important environmental exposures that appear to shape access to care and subsequent disease progression, the limited literature to examine these factors demonstrates the need for future research to consider risk environment characteristics and the role they may play in shaping health outcomes from HIV infection among drug users through determining access and adherence to evidence-based care.

Emerging Infectious Diseases, 2010

Because there is little routine tuberculosis (TB) screening in Mexico, the prevalence of latent T... more Because there is little routine tuberculosis (TB) screening in Mexico, the prevalence of latent TB infection (LTBI) is unknown. In the context of an increasing HIV epidemic in Tijuana, Mexico, understanding prevalence of LTBI to anticipate emergence of increased LTBI reactivation is critical. Therefore, we recruited injection drug users, noninjection drug users, female sex workers, and homeless persons for a study involving risk assessment, rapid HIV testing, and TB screening. Of 503 participants, the overall prevalences of TB infection, HIV infection, and TB/HIV co-infection were 57%, 4.2%, and 2.2%, respectively; no signifi cant differences by risk group (p>0.05) were observed. Two participants had TB (prevalence 398/100,000). Incarceration in Mexico (odds ratio [OR] 2.28), age (OR 1.03 per year), and years lived in Tijuana (OR 1.02 per year) were independently associated with TB infection (p<0.05). Frequent LTBI in marginalized persons may lead to increases in TB as HIV spreads.

Addiction, 2010

Introducción: Las hernias lumbares son resultado de un defecto en la pared posterior abdominal. S... more Introducción: Las hernias lumbares son resultado de un defecto en la pared posterior abdominal. Son infrecuentes en niños, en quienes se han informado sólo 45 casos: 19 fueron de naturaleza congénita. Es común que se acompañen de otras malformaciones. Caso clínico: Niña de 45 días de edad con hernia lumbar congénita y síndrome lumbocostovertebral; con agenesia de la novena a la doceava costillas del lado de la hernia, deformidad de la columna dorsolumbar y agenesia renal unilateral. Se corrigió quirúrgicamente mediante la colocación de una malla de fibra de poliéster. Discusión: Las hernias lumbares congénitas son más comunes en varones y en el lado izquierdo. El caso que se presenta tenía la hernia en el lado derecho. La colocación de la malla protésica fue necesaria debido a la friabilidad de los bordes musculares. Se recomienda la corrección quirúrgica durante el primer año de vida para evitar la encarcelación de la hernia.

Http Dx Doi Org 10 1080 17441692 2013 779386, Mar 27, 2013

In Tijuana, Mexico, sex work is regulated by the municipal government, through registration cards... more In Tijuana, Mexico, sex work is regulated by the municipal government, through registration cards issued to female sex workers (FSWs) for an annual fee. Registration has been associated with decreased drug use and increase condom use and HIV testing. Previously, it was demonstrated that FSWs operating in bars were more likely than street-based FSWs to be registered. This implies that certain venues may be more accessible to local authorities for the enforcement of this type of programme. Taking a novel multilevel approach, we examined whether venue characteristics of bars reflecting greater organised management and visibility affect registration status of FSWs. In an analysis of venue-level characteristics, predictors of being registered were availability of free condoms at work and distance to the main sex strip; however, these were not independently associated after inclusion of FSWs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; income, illicit drug use and history of HIV testing. Our findings suggest that sex work regulations may inadvertently exclude venues in which the more vulnerable and less visible FSWs, such as injection drug users and those with limited financial resources, are situated. Efforts to revise or reconsider sex work regulations to ensure that they best promote FSWs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; health, human and labour rights are recommended.

American Journal of Public Health, Oct 3, 2011