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Evaluating the impact of Mexico’s drug policy reforms on people who inject drugs in Tijuana, B.C., Mexico, and San Diego, CA, United States: a binational mixed methods research agenda

Angela M Robertson12, Richard S Garfein3, Karla D Wagner3, Sanjay R Mehta4, Carlos Magis-Rodriguez5, Jazmine Cuevas-Mota3, Patricia Gonzalez Moreno-Zuniga3, Steffanie A Strathdee3* and Proyecto El Cuete IV and STAHR II

Author Affiliations

1 Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue Kresge Building, Room 911, Boston, MA 02115, USA

2 The Fenway Institute, Fenway Health, 1340 Boylston St, 8th floor, Boston, MA 02215, USA

3 Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA

4 Division of Infectious Diseases, School of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0711, USA

5 Centro Nacional para la Prevención y Control del VIH y el SIDA, Secretaría de Salud de México, México

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Harm Reduction Journal 2014, 11:4  doi:10.1186/1477-7517-11-4

Published: 12 February 2014



Policymakers and researchers seek answers to how liberalized drug policies affect people who inject drugs (PWID). In response to concerns about the failing “war on drugs,” Mexico recently implemented drug policy reforms that partially decriminalized possession of small amounts of drugs for personal use while promoting drug treatment. Recognizing important epidemiologic, policy, and socioeconomic differences between the United States—where possession of any psychoactive drugs without a prescription remains illegal—and Mexico—where possession of small quantities for personal use was partially decriminalized, we sought to assess changes over time in knowledge, attitudes, behaviors, and infectious disease profiles among PWID in the adjacent border cities of San Diego, CA, USA, and Tijuana, Baja California, Mexico.


Based on extensive binational experience and collaboration, from 2012–2014 we initiated two parallel, prospective, mixed methods studies: Proyecto El Cuete IV in Tijuana (n = 785) and the STAHR II Study in San Diego (n = 575). Methods for sampling, recruitment, and data collection were designed to be compatible in both studies. All participants completed quantitative behavioral and geographic assessments and serological testing (HIV in both studies; hepatitis C virus and tuberculosis in STAHR II) at baseline and four semi-annual follow-up visits. Between follow-up assessment visits, subsets of participants completed qualitative interviews to explore contextual factors relating to study aims and other emergent phenomena. Planned analyses include descriptive and inferential statistics for quantitative data, content analysis and other mixed-methods approaches for qualitative data, and phylogenetic analysis of HIV-positive samples to understand cross-border transmission dynamics.


Investigators and research staff shared preliminary findings across studies to provide feedback on instruments and insights regarding local phenomena. As a result, recruitment and data collection procedures have been implemented successfully, demonstrating the importance of binational collaboration in evaluating the impact of structural-level drug policy reforms on the behaviors, health, and wellbeing of PWID across an international border.


Our prospective, mixed methods approach allows each study to be responsive to emerging phenomena within local contexts while regular collaboration promotes sharing insights across studies. The strengths and limitations of this approach may serve as a guide for other evaluations of harm reduction policies internationally.

Injection drug use; HIV; Hepatitis C virus; M. tuberculosis; Drug policy reform; Structural interventions; Decriminalization; Mixed methods; International collaboration; Mexico