# Ethno-epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN DIEGO · 2022 · $1,260,610

## Abstract

This study will characterize trends in incidence of HIV, HCV and OD associated with binational drug
markets and drug tourism (DT) between San Diego (SD) and Tijuana (TJ), Mexico. TJ sits on a major
drug trafficking route whereby heroin, fentanyl, meth & cocaine are trafficked to the US. After Mexico
partially decriminalized small amounts of drugs in 2009, 1 in 6 people who inject drugs (PWID) in SD
reported injecting drugs in TJ, where drugs were “cheaper and easier to buy”. Since Mexico recently
relaxed its opiate prescription laws, disparities in drug availability and price between SD and TJ will
likely widen, fueling increased DT that will impact the above health outcomes. We hypothesize that
greater penetration of fentanyl into local drug markets will be associated with riskier behaviors that
increase HIV and HCV incidence. Our study is timely since retail drug markets are changing in Tijuana
with drug tourists likely to be acquiring riskier behaviors. Health outcomes in these border cities likely
serve as a ‘bellwether’ for other U.S. cities. The specific aims for our proposed study, called La Línea
(“The Line”) are: AIM 1. To prospectively characterize cross-border DT between SD and TJ and its
association with retail drug market characteristics. AIM 2. To characterize retail drug market trends in
TJ versus SD by conducting epidemiologic and ethnographic surveillance, triangulating quantitative and
qualitative findings and DEA administrative data. AIM 3. To study real-time HCV and HIV cross-border
transmission among PWID with molecular epidemiology. AIM 4. To characterize OD incidence and its
associations with drug retail markets and DT. AIM 5. To conduct dynamic modeling of future HIV, HCV
and OD incidence among PWID in SD in the context of changing drug retail markets to inform
prevention interventions. La Línea will conduct prospective quantitative and qualitative surveillance of
retail drug markets in both SD and TJ, coupled with epidemiologic data collection of 600 PWID (200
drug tourists from SD; 200 non-drug tourists from SD and 200 non-drug tourists from TJ) and an
ethnographic sub-cohort (N=75; 25 per group). We will analyze PWIDs’ HIV and HCV sequencing data
to prospectively assess cross-border transmission. We will incorporate longitudinal data on binational
retail drug markets and HIV and HCV sequencing data into dynamic mathematical models to forecast
future HIV, HCV and OD incidence trends. Since the direction of cross-border HIV transmission is now
occurring from Mexico to the US for the first time and HIV incidence among PWID in TJ is high,
monitoring trends in HIV and HCV incidence in the border region is critical to avoid future US
outbreaks. This study addresses both the NIDA’s HEAL initiative and the Trans-NIH plan of the OAR,
by conducting time-sensitive research to inform implementation of timely interventions to reduce
incidence of HIV, HCV and OD.

## Key facts

- **NIH application ID:** 10347367
- **Project number:** 5R01DA049644-03
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN DIEGO
- **Principal Investigator:** STEFFANIE A. STRATHDEE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1,260,610
- **Award type:** 5
- **Project period:** 2020-04-01 → 2025-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10347367

## Citation

> US National Institutes of Health, RePORTER application 10347367, Ethno-epidemiology of HCV, HIV and Overdose associated with Drug Markets and Drug Tourism (5R01DA049644-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10347367. Licensed CC0.

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