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Divisional Report: Division of International Health and Cross Cultural Medicine: 2006

The year 2006 was a very productive one for the Division of International Health and Cross Cultural Medicine at UCSD. In 2006, two new division members joined our team: a postdoctoral fellow (Dr. Lydia Drumright) and one new Assistant Professor (Dr. Maria Zuniga). Our research and educational programs are active in several countries, including the U.S., Mexico, Canada, India, Afghanistan and Uzbekistan.

A total of 60 peer-reviewed papers were published in scholarly journals by our division members, which is an impressive benchmark of our teamÕs productivity and impact on the prevention and treatment of diseases of global importance (see list of published papers, below).

Our faculty members also participated in a number of local, national and international meetings and conferences, and were interviewed by an impressive array of news media, most notably for our work on HIV and TB in the Mexico-U.S. border region. A summary of our faculty research activities is provided below.

Research Grants funded in 2006:

Dr. Garfein was awarded a grant from USAID to develop a screening and diagnostic program for identifying TB in high risk populations in Tijuana who typically fall outside the health care system. This grant represents a partnership between UCSD and NGO partners in Mexico.

Dr. Strathdee was awarded a grant by the Fogarty International Center at the U.S. National Institutes of Health to develop a Program in Global Health, along with 45 other participating faculty from UCSD and San Diego State University. This program is one of 16 other academic centers in the US who have a global health program supported by NIH.

Dr. Garfein was awarded a cooperative agreement award from the U.S. Centers for Disease Control and Prevention to develop and assess the feasibility of an intervention to prevent high risk behaviors among men who have sex with men and use methamphetamine. Collaborators on this project are Drs. Strathdee and Patterson.

Dr. Todd was awarded a two-year Doris Duke Clinical Scientist Development Award to establish and evaluate an HIV counseling and testing program at a needle exchange program in Kabul, Afghanistan.

Dr. Zúñiga was awarded a three-year contract from the California Department of Health Services, Office of AIDS, Epidemiologic Studies Section to identify barriers to HIV care among HIV-positive persons in California who have never accessed HIV care.

Drs. Strathdee and Zúñiga were awarded a grant by the Hispanic Serving Health Professional Schools to fund 4 Hispanic students in border health research for six-month training internships, each of whom will receive a monthly stipend and be paired with a UCSD mentor in 2007.

UCSD's Center for AIDS Research was renewed for five years by the National Institute of Health. A central component of this grant is an International Health Program, co-directed by Dr. Strathdee that offers pilot grant funds, travel grants and a Visiting Scholars Program.

Highlights:

In March 2006, Dr. Brouwer and several other members of our division published a paper which estimated that at up to 1 in 125 adults aged 15-49 in Tijuana is HIV-positive. This paper received considerable attention in the USA and Mexico, including a number of featured articles in the press and spurred a number of related efforts to stem the tide of this epidemic.

Dr. Strathdee was invited to attend a meeting with Baja Governor Elorduy and San Diego Mayor Jerry Sanders to provide recommendations in an effort to improve surveillance for HIV, TB and STDs in the U.S-Mexico border region.

Our division donated a mobile van to a non-governmental organization in Tijuana, to assist with subject recruitment for 'Proyecto El Cuete' and to assist with their HIV prevention activities. This mobile unit, the 'prevemovihl', has attracted attention all over Mexico and was upheld as the prototype for all of Mexico by the National AIDS Program, CENSIDA. CENSIDA has commissioned similar versions of these mobile units to be constructed so that each of Mexico's 32 states will be able to put a similar program into action.

Our division's USAID-funded TIES program, a cross-border training program in HIV prevention that represents a partnership between UCSD, SDSU and two Mexican universities, trained over 150 Mexican and American students in its first year. One of our trainees is now the Director of a new HIV/AIDS clinic in Tijuana that opened in November, 2006.

In partnership with colleagues at SDSU, Dr. Strathdee developed a proposal for a joint doctoral program in Global Health which is expected to be launched in September 2007. This program will offer PhD degrees in public health with an emphasis on global health and is unique in its capacity to offer hands-on experience to students in a developing country setting as part of their training. Dr. Strathdee is the Co-Director of this program.

Our division had an impressive showing at the International AIDS Conference in Toronto, Canada in July, 2006, a meeting where over 18,000 people attended and less than 1% of submitted papers were selected for an oral presentation. Our team had four oral presentations at this meeting. Dr. Strathdee gave an oral presentation unveiling the findings from her NIDA-funded STRIVE intervention trial that showed the intervention was efficacious in decreasing HIV and HCV transmitting behaviors among HCV-infected injection drug users. Dr. Garfein had three poster presentations providing results from two behavioral intervention trials and an evaluation of recent California legislation legalizing non-prescription syringe sales for HIV prevention. Dr. Pollini presented, and Dr. Zúñiga presented a poster on Barriers to HIV Care in the Context of Cross-Border Health Care Utilization in HIV+ Persons Living in the California/Baja California US-Mexico Border Region. Dr. Drumright presented the results of her research on methamphetamine use among recently HIV infected gay men, which she conducted as part of her Doctoral thesis. Dr. Robert Deiss , a medical student working with our team, presented a paper on high risk behaviors and avenues for intervention among men in Tijuana who have sex with other men.

As part of Dr. Garfein's USAID-funded study of TB in Tijuana, he negotiated a donation of equipment and training to establish the only laboratory in Northern Mexico capable of conducting an new diagnostic test for TB infection which is more accurate and reliable than the TB skin test that has been used for over a the past century. The laboratory will not only provide testing for Dr. Garfein's studies, but will also provide a valuable new tool for physicians and TB control programs in the Tijuana region.

In February, 2006 Dr. Zúñiga received a UCSD Equal Opportunity/Affirmative Action and Diversity Award for her commitment to serving Latino and other communities in San Diego.

Press:

Our faculty and many of their projects have been highlighted by the following media (see division website for links to articles and .wav files) from UCSD Health Magazine, Science KPBS, CNN, San Diego Tribune, United Press International, Health Behavior News Service. La Frontera, Grupo Acir Lider Nacional en Radio, El Universal Servicio de Noticias de la Mujer de Latinoamérica

Dr. Brouwer and Strathdee were interviewed by KPBS, San Diego Tribune, and KUSI about the rising rates of HIV in Tijuana.

In December 2006, Dr. Garfein was interviewed by Carol LeBeau, anchorwoman from KUSI News in San Diego, about his USAID-funded TB study in Tijuana. The extended news story is scheduled to be aired in early February 2007.

Drs. Strathdee and Garfein co-authored an Op-Ed letter that was published in the San Diego Union Tribune, which provided the scientific basis to support San Diego Mayor Gerry Sander's decision to ask the city counsel to approve the re-opening of a syringe exchange program. In addition, Dr. Garfein provided an oral statement during the city counsel's meeting, which ultimately approved the bill to allow syringe exchange in the City of San Diego.

Over the past year Dr. Zúñiga has been interviewed on three occasions by Mexican media (print and radio) about her research on HIV/AIDS in populations living in the US-Mexico border region. Her most recent interview "HIV/AIDS: an issue not only of health but of culture" ("VIH/sida: Un asunto cultural y no sólo de salud") was published in December 2006.

Future Plans:

Our division has been very successful in obtaining external funding at a time when the NIH budget is shrinking, which has allowed for modest growth. However, to continue to grow into new areas and to make an impact on diseases of global importance, we need to replenish our internal resources to enable us to continue to leverage additional funding. Below, we highlight the key areas we hope to develop in the next five years.

  • Further develop a Global Health Program at UCSD that capitalizes upon our binational partnerships and proximity to Latin America.
  • Continue to recruit top-notch faculty working in state-of-the-art disciplines important to global health, especially avian influenza, and health economics.
  • Develop an internationally renowned training and education program for undergraduate, pre-doctoral and post-doctoral researchers.
  • Identify funding sources for scholarships for predoctoral and postdoctoral students who wish to dedicate their studies to problems of global health significance.
  • Identify contiguous space on-campus to foster collaboration and ensure that faculty and trainees can work together.
Publications: 2006
  1. Alibayeva G, Todd CS, Khakimov MM, Giyasova GM, Botros BA, Carr JK, Bautista CT, Sanchez JL, Earhart KC. STD symptom management behaviors among female sex workers in Tashkent, Uzbekistan. International Journal of STD & AIDS (in press).

  2. Azim T, Chowdhury EI, Reza M, Ahmed M, Tasleemuddin M, Khan R, Ahmed G, Rahman M, Khondokar I, Khan SI, Sack DA, Strathdee SA. Vulnerability to HIV infection among female injecting drug users in Dhaka, Bangladesh. Harm Reduction Journal. 2006; 3:33.

  3. Bharti AR, Chuquiyauri R, Brouwer KC, Stancil J, Lin J, Lopez V, Llanos-Cuentas A, Vinetz JM. Experimental infection of the neotropical malaria vector Anopheles Darlingi by human patient-derived Plamodium Vivax in the Peruvian Amazon. American Journal of Tropical Medicine & Hygiene. 2006; 75(4): 610-616.

  4. Brouwer KC, Case P, Ramos R, Magis-Rodriguez C, Bucardo J, Patterson TL, Strathdee SA. Trends in production, trafficking and consumption of cocaine and methamphetamine in Mexico. Substance Use Misuse 2006; 41(5):707-27.

  5. Brouwer KC, Mirel LB, Yang C, Kolczak MS, Lal RB, Van Eijk AM, Ayisi J, Otieno J, Nahlen BL, Steketee R, Lal AA. The effect of Plasmodium Falciparum infection on HIV-1 viral load in infants. Emerging Infectious Diseases. 2007; 13(2). (in press).

  6. Brouwer KC, Strathdee SA, Magis-Rodriguez C, Bravo-Garcia, E, Gayet, C, Patterson, TL, Bertozzi, SM, Hogg, RS. Estimated numbers of men and women infected with HIV/AIDS in Tijuana, Mexico. Journal of Urban Health 2006; 83(2):299-307.

  7. Campbell JV, Hagan H, Latka M, Garfein RS, Golub ET, Coady MH, Thomas DL, Strathdee SA. High prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities. Drug Alcohol Depend. 2006; 81(3):259-65.

  8. Case P, Ramos R, Brouwer KC, Firestone-Cruz M, Pollini RA, Fraga MA, Patterson TL, Strathdee SA. At the borders, on the edge: Use of injected methamphetamine in Tijuana and Ciudad Juarez, Mexico. Journal of Immigrant and Minority Health (in press).

  9. Cornelius, JL, Lloyd, JJ, Bishai, D, Latkin, CA, Huettner, S, Brown, M, Havens, JR, Ricketts, EP, Rapp, CA, Strathdee SA. The treatment retention intervention: A case study of an evaluation of a case management intervention to improve treatment outcomes for injection drug users. Journal of the Association of Academic Minority Physicians. (in press).

  10. Davey M, Latkin CA, Hua W, Tobin KA, Strathdee SA. Individual and social network factors that predict entry to drug treatment. American Journal Addictions (in press).

  11. Drumright, L, Little, SA, Strathdee SA, Gorbach, P. Unprotected anal intercourse and substance use before and after HIV diagnosis among recently HIV infected men who have sex with men. Sexually Transmitted Diseases (in press).

  12. Drumright LN, Patterson TL, Strathdee SA. Club drugs as causal risk factors for HIV acquisition among MSM: A Review. Substance Use Misuse (in press).

  13. Drumright LN, Strathdee SA, Little SJ, Araneta MRG, Slymen DJ, Malcarne VL, Daar ES, Gorbach PM. Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection. J Acquir Immune Defic Syndr (in press).

  14. Eyzaguirre L, Nadai Y, Brouwer K.C , Patterson TL, Strathdee SA, Ramos R, Firestone-Cruz M, Orozovich P, Carr JK. First molecular surveillance report of HIV in injecting drug users and female sex sorkers along the US-Mexico border. AIDS Research and Human Retroviruses (in press).

  15. Firestone-Cruz M, Mantsios A, Ramos R, Case P, Brouwer KC, Ramos ME, Fraga WD, Latkin CA, Miller CL, Strathdee SA. A qualitative exploration of gender in the context of injection drug use in two US-Mexico border cities. AIDS and Behavior. (in press)

  16. Frost SDW, Brouwer KC, Firestone MA, Ramos R, Ramos ME, Lozada RM, Magis-Rodriguez C, Strathdee SA. Respondent driven sampling of injection drug users in two US-Mexico border cities: recruitment networks and syphilis prevalence. J Urban Health. 2006; 83 Suppl 7:83-97.

  17. Ganoza CA, Matthias MA, Collins-Richards D, Brouwer KC, Cunningham CB, Segura ER, Gilman RH, Gotuzzo E, Vinetz JM. Environmental assessment of pathogenic Leptospira and risk of severe Leptospirosis. PLoS Medicine. 2006; 3(8):1329-1340.

  18. Hagan H, Campbell J, Thiede H, Strathdee SA, Ouellet L, Farzana K, Hudson S, Garfein R. Awareness of hepatitis C virus antibody status and risk behavior in young injectors. Public Health Rep. (in press).

  19. Hagan H, Latka M, Campbell J, Golub ET, Garfein RS, Thomas DT, Kapadia F, Strathdee SA for the STRIVE Project. Eligibility for treatment of hepatitis C virus infection among young injection drug users in three US cities. Clinical Infectious Diseases 2006; 42(5):669-72.

  20. Havens JR, Cornelius L, Ricketts EP, Latkin CA, Bishai D, Lloyd JJ, Huettner S, Strathdee SA. The effect of case management on drug treatment entry among treatment-seeking injection drug users with and without comorbid antisocial personality disorder. J Urban Health (in press).

  21. Havens JR, Sherman SG, Sapun M, and Strathdee SA. Prevalence and correlates of suicidal ideation among young injection versus non-injection drug users. Substance Use Misuse 2006; 41(2):245-54.

  22. Kaida, A, Andia, I, Maier, M, Strathdee SA, Bangsberg, DR, Spiegel, J, Hogg, R. The potential impact of antiretroviral therapy on fertility in sub-Saharan Africa. Current HIV/AIDS Reports. 2006;(3):177-184

  23. Kapadia F, Latka MH, Hagan H, Golub E, Campbell JV, Coady MH, Garfein RS, Thomas DL, Strathdee SA. A randomized behavioral intervention trial to reduce transmission behaviors and promote health care utilization among hepatitis C virus positive injection drug users. Journal of Urban Health (in press).

  24. Kerr T, Stoltz J, Strathdee SA, Li K, Hogg R , Montaner J, Wood E. The impact of sex partnersÕ HIV seroconversion in a prospective cohort of injection drug users. AIDS 2006; 41;1:119-23.

  25. Kerrigan D, Malta M, DaCunha C, Bastos FI, Pilotto JH, Strathdee SA. The search for social validation and the sexual behavior of people living with HIV in Rio de Janeiro, Brazil: understanding the role of treatment optimism in context. Soc. Sci. Med. 2006; 62(10):2386-96.

  26. Kuo I, ul-Hassan S, Galai N, Thomas DL, Zafar T, Ahmed MA, Strathdee SA. HIV and HCV seropositivity among injection drug users in two Pakistani cities. Harm Reduction Journa.l (in press).

  27. Kuo I, ul-Hassan S, Zafar T, Galai N, Sherman SG, Strathdee SA. Factors associated with recent onset injection in two Pakistani cities. Substance Use and Misuse. (in press).

  28. Lloyd, JJ, Ricketts, EP, Havens, JR, Cornelius, LJ, Bishai, D, Huettner, S, Latkin, C, Strathdee, SA. The relationship between lifetime abuse and suicidal ideation in a sample of injection drug users. J Psychoactive Drugs (in press).

  29. Malta M, Bastos FI, Perreira Koller EM, Cunha MD, Marquez C, Strathdee SA. A qualitative assessment of long distance truckersÕ vulnerability to HIV infection in Itajai, Southern Brazil. AIDS Care 2006; 18(5):489-96.

  30. Mehta, SH, Vlahov D, Celentano D, Strathdee SA, Nelson KE. HIV Incidence in a cohort of injection drug users in Baltimore, MD: 1988-2004. J Acquir Immune Defic Syndr (in press).

  31. Miller CA, Spittal P, Strathdee SA, Kerr T, Li K, Schechter MT, Wood E. Elevated rates of HIV infection among young aboriginal injection drug users in a Canadian setting. Harm Reduction Journal 2006; 8; 3-9.

  32. Miller CA, Strathdee SA, Kerr T, Li K, Wood E. Factors associated with early adolescent initiation into injection drug use: Implications for injection drug use intervention programs. Journal Adolescent Health. 2006; 38(4):462-4.

  33. Ompad DC, Strathdee SA, Celentano DD, Latkin C, Poduska J, Kellam S, Lalongo N. Predictors of early initiation of vaginal and oral sex among urban young adults in Baltimore, Maryland. Arch. Sex. Res. 2006; 35(1):53-65.

  34. O'Toole TP, Pollini RA, Ford D, Bigelow G. Physical health as a motivator for substance abuse treatment among medically ill adults: Is it enough to keep them in treatment? Journal of Substance Abuse Treatment 2006; 31:143-150.

  35. O'Toole TP, Pollini RA, Gray P, Jones T, Bigelow G, Ford D. Factors identifying high and low frequency health services utilization among substance using adults. Journal of Substance Abuse Treatment (in press).

  36. Patterson TL, Semple SJ, Fraga M, Bucardo J, de la Torre A, Salazar J, Orozovich P, Staines H, Amaro H, Magis-Rodriguez C, Strathdee SA. A sexual risk reduction intervention for female sex workers in Mexico: Design and baseline characteristics. HIV/AIDS and Social Work (in press). Also appears as a book chapter in: Outreach and Care Approaches to HIV/AIDS along the US.-Mexico Border. Haworth Press.

  37. Patterson TL, Semple SJ, Fraga M, Bucardo J, de la Torre A, Salazar J, Orozovich P, Staines H, Amro H, Magis Rodriguez C, Strathdee SA. Comparison of sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, Mexico. Substance Use and Misuse. 2006; 41(10):1535-49.

  38. Pollini RA, McCall L, Mehta S, Vlahov D, Strathdee SA. Inappropriate responses among injection drug users witnessing drug overdoses in Baltimore, Maryland. American Journal Preventive Medicine. 2006; 31(3):261-4.

  39. Pollini RA, McCall L, Mehta S, Vlahov D, Strathdee SA. Non-fatal overdose and subsequent drug treatment among injection drug users. Drug Alcohol Depend. 2006; 83(2):147-56.

  40. Pollini RA, OÕToole TP, Ford D, Bigelow G. Does this patient really want treatment? Factors associated with baseline and evolving readiness for change among hospitalized substance using adults interested in treatment. Addictive Behaviors. 2006; 31:1904-1918.

  41. Purcell DW, Mizuno Y, Metsch LR, Garfein R, Tobin K, Knight K, Latka MH. Unprotected sexual behavior among heterosexual HIV-Positive injection drug using men: Associations by partner type and partner serostatus. Journal of Urban Health. 2006; 83(4):656-68.

  42. Sanchez JL, Todd CS, Bautista CT, Botros BA, Khakimov MM, Giyasova GM, Yakubov SK, Abdulaeva MA, Saad MD, Graham RR, Carr JK, Earhart KC. High HIV prevalence and risk factors among injection drug users in Tashkent, Uzbekistan, 2003-2004. Drug Alcohol Depend. 2006 82(4) Suppl 1:S15-22.

  43. Santibanez SS, Garfein RS, Swartzendruber A, Purcell DW, Paxton LA, Greenberg AE. Update and overview of practical epidemiologic aspects of HIV/AIDS among injection drug users in the United States. Journal of Urban Health. 2006; 83(1):86-100

  44. Shah NG, Galai N, Celentano DD, Vlahov D, Strathdee SA. Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988-2000. Drug Alcohol Depend. 2006; 83(2):147-56.

  45. Shrestha S, Smith MW, Broman KW, Farzadegan H, Vlahov D, Strathdee SA. A molecular epidemiological study of multi-person-use of syringes among injection drug users attending a Baltimore Needle Exchange Program. J Acquir Immune Defic Syndr 2006; 43(3):335-43.

  46. Shrestha S, Strathdee SA, Galai N, Oleksyk T, Fallin D, Schaid D, Vlahov D, Thomas D, OÕBrien S, Smith MW. Behavior risk exposure and host genetics of susceptibility to HIV-1 infection. Journal Infectious Diseases 2006; 193(1):16-26.

  47. Shrestha S, Strathdee SA, Browman K, Smith MW. Unknown biological mixtures evaluation using STR analytical quantification. Electrophoresis 2006; 27(2):409-15.

  48. Stachowiak JA, Tishkova FK, Strathdee SA, Stibich MA, Mogilnii V, Beyrer C. Marked ethnic differences in HIV prevalence and risk behaviors among injecting drug users in Dushanbe, Tajikistan, 2004. Drug Alcohol Depend 2006; 82 Suppl 1:S7-S14.

  49. Stopka TJ, Garfein RS, Ross A, Truax SR. Increasing syringe access and HIV prevention in California: Findings from a survey of local health jurisdiction key personnel. Journal of Urban Health (in press).

  50. Strathdee SA, Patterson TL. Behavioral Interventions for HIV-seropositive and HCV-seropositive drug users. AIDS and Behavior 2006; 12; 3;1-16.

  51. Strathdee SA, Ricketts EP, Huettner S, Cornelius L, Bishai D, Havens JR, Beilenson P, Rapp C, Lloyd J, Latkin CA. Facilitating entry into drug treatment among injection drug users referred from needle exchange program: Results from a community-based behavioral intervention trial. Drug Alcohol Depend 2006; 83(3):225-32.

  52. Todd CS, Alibayeva G, Sanchez JL, Bautista CT, Carr JK, Earhart KC. Utilization of contraception and abortion and its relationship to HIV infection among female sex workers in Tashkent, Uzbekistan. Contraception. 2006; 74(4):318-23.

  53. Todd CS, Alibayeva G, Khakimov MM, Sanchez JL, Bautista CT, Earhart KC. Prevalence and correlates of condom use and HIV testing among female sex workers in Tashkent, Uzbekistan: Implications for HIV transmission. AIDS Behav. (in press).

  54. Todd CS, Khakimov MM, Alibayeva G, Abdullaeva M, Giyasova GM, Saad MD, Botros BA, Bautista CT, Sanchez JL, Carr JK, Earhart KC. Prevalence and correlates of human immunodeficiency virus infection among female sex workers in Tashkent, Uzbekistan. Sex Transm Dis. 2006; 33(8):496-501.

  55. Washington TA, Galai N, Cohn S, Celentano D, Vlahov D, Strathdee SA. A comparison of self-report sexual orientation and male sexual behavior among male injection drug users. Arch. Sex. Res. 2006; 35(1):67-74.

  56. Wood E, Kerr T, Palepu A, Zhang R, Strathdee SA, Tyndall MW, Montaner JS, Hogg RS. Slower uptake of HIV antiretroviral therapy among Aboriginal injection drug users. Journal Infect. 2006; 52(4):233-6.

  57. Wood E, Lloyd-Smith E, Li K, Strathdee SA, Small W, Tyndall MW, Montaner JSG, Kerr T. Frequent needle exchange use and HIV incidence in Vancouver, Canada. American Journal Medicine. (in press).

  58. Zúñiga ML, Baldwin H, Uhler D, Brennan J, Olshefsky AM, Oliver E, Mathews WC. Supporting positive living and sexual health (SPLASH): A clinician and behavioral counselor risk-reduction intervention in a university-based HIV clinic. AIDS and Behavior. (in press).

  59. Zúñiga ML, Organista KC, Scolari R, Olshefsky AM, Schulhof R, Col—n, M. Exploring care access issues for HIV+ Mexican-origin Latinos living in the San Diego/Tijuana border region. Journal of HIV/AIDS and Social Services, 2006; 5(2):37-54.

  60. Zúñiga ML, Sidelinger DE, Blaschke GS, Silva FA, Broyles SL, Nader PR, Reznik V.. Evaluation of residency training in the delivery of culturally effective care. Medical Education, 2006; 40: 1192Ð1200.
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