Gender differences in risk behaviors and health outcomes due to methamphetamine use in a Mexico-U.S. border city

BACKGROUND: Methamphetamine (meth) is a stimulant known to affect the central nervous system (CNS). When individuals are under the influence of meth, their judgment is impaired which can lead them to make irrational decisions and engage in high-risk behaviors, such as having unprotected sex and needle sharing. Thus the behaviors of meth users can place them at high risk of contracting infectious diseases such as human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). Few studies highlight gender differences in meth use, fewer studies address high-risk behaviors and health outcomes attributed to meth use by gender. El Paso, TX is on the border across from Ciudad (Cd.) Juarez, Chihuahua, Mexico. El Paso is at risk of a meth outbreak because of social dislocation, an established drug trafficking route, stimulant use patterns, and base of drug users. AIM: This study will (1) describe a randomly selected sample of meth users in terms of their sociodemographic characteristics by gender; (2) describe the patterns of use of meth and other drugs by gender; (3) describe risk behaviors and health outcomes of meth use by gender; and (4) determine gender differences in high-risk behaviors and health outcomes. METHODS: This is a secondary data analysis of a dataset from a cross-sectional pilot study among 150 current meth users age 21 years or older with a history of meth use in the 3 months prior to study participation; and living in Cd. Juarez at the time of the study. All participants had abstained from alcohol and drug use one hour before signing informed consent. Face-to-face interviews were conducted and included questions on sociodemographic characteristics, meth use and other drug use, as well as drug using and sexual risk behaviors and health outcomes (physiological problems, psychological effects, infectious diseases, and other heath outcomes) attributed to meth use. ANALYSIS: To assess the association between gender differences in these factors, univariate, bivariate, and multivariate analyses were tested for significance (p-value\u3c0.05). Multivariate analyses were adjusted for age, marital status, type of participant, and duration of meth use. RESULTS: The sample population included 49 women, one trans-woman, and 100 men with a mean age of 30.9 years. Significant gender differences were noted for lifetime meth use. Men snorted meth more by nose (71.0% vs. 50.0%; p=.012) and used higher rates of meth powder (70.0% vs. 48.0%; p-value=.009), and rock (58.0% vs. 34.0%; p-value=.006) than women/trans-women who more frequently used meth in pill form (72.0% vs. 55.0%; p-value=.045). Men had higher rates of risk behaviors that persisted after adjustment, such as driving a vehicle after using meth (63.0% vs. 6.0%; p-value=.029) and giving meth or money in exchange for sex (19.6% vs. 4.0%; p-value=.008) than women/trans-women who consumed meth more with principal sex partner (42.0% vs. 21.0%;p-value=.013). Regarding health outcomes, rates of paranoia or persecution delusion were higher for men than women/trans-women (67.0% vs. 50.0%; p-value=.014). CONCLUSIONS AND RECOMMENDATIONS: Given that Cd. Juarez is vulnerable to a meth outbreak, the findings of this study are useful in designing intervention programs to reduce the spread of meth use and its effects. Meth reduction programs and treatment centers along the Mexico-U.S. border, should address gender individually. Addressing self-image problems among women who report using meth in pill form can help reduce initiation into meth as a motivator to lose weight. For men living along the Mexico-U.S. border region, applying a strong emphasis on family commitment during motivational interventions (MI) can encourage them to seek drug treatment to improve their own quality of life and of their families