Profile: Fogarty Fellow Javier Cepeda studies benefits of police education program in Tijuana, Mexico
July / August 2021 | Volume 20 Number 4
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Tijuana is a border city in Mexico with a thriving red-light district that is a popular destination for drug and sex tourists traveling from the U.S. This to-and-fro traffic has contributed to an HIV epidemic, with prevalence as high as 10% among people who inject drugs (PWID). Policing practices such as syringe confiscation and arrest can be significant drivers of infection risk, while police referrals to treatment and other services can improve health and reduce drug-related harm. An innovative police education program is attempting to protect officers from occupational needlestick injuries while simultaneously harmonizing law enforcement and public health priorities. During his Fogarty fellowship, Dr. Javier Cepeda began studying the program’s results and evaluating whether changing policing practices through police education is cost effective, in terms of reducing HIV incidence. If so, he and his colleagues believe it may hold promise as a strategy to reduce HIV transmission among people who inject drugs in locations around the world.
Cepeda said he hopes his work will inform evidence-based decisions. “I thought economic modeling would be a really good way to bridge the science with policymaking.” By providing a cost-effectiveness analysis, the public health value could be demonstrated. “You can make the logical argument that if you change policing behavior—so they’re no longer confiscating syringes and instead referring people to drug treatment instead of prison—here’s the impact you would have on HIV transmission, which would drop because drug users are no longer sharing syringes and can get treated for substance use,” he noted. Policymakers can compare the cost of the intervention versus the disease burden if no action is taken.
As a first step, Cepeda and his colleagues conducted a baseline survey of 1,319 police officers who had reported syringe contact in Tijuana, where possession of syringes has never been illegal. Nearly half said they always or sometimes confiscated syringes, about 43% had made arrests for heroin possession and 37% had referred drug users to health and social programs. The officers’ knowledge of drug laws was low, with more than a third incorrectly believing syringe possession was a criminal offense and nearly three-quarters unaware that possession of small amounts of heroin had been decriminalized. Cepeda said the mathematical modeling and economic evaluation skills he acquired during his Fogarty fellowship are now being applied to other settings. “For instance, in the U.S., there are interesting decriminalization proposals being discussed in Baltimore—if low-level drug offenders are no longer incarcerated, how much could be saved and spent on public health instead? The skills can be quite broadly applied, and that was very much thanks to Fogarty.”
The fellowship also helped him develop as a manager, Cepeda observed. Overseeing his first independent research project was like running a small business. He is now applying those lessons learned in key leadership roles. In March 2021, he was appointed assistant professor at Johns Hopkins and serves on the International Journal of Drug Policy’s editorial board and on the Lancet Commission Health and Human Rights.
Using the Fogarty fellowship data and training as his foundation, Cepeda went on to secure funding from the NIH’s National Institute on Drug Abuse (NIDA) to continue his work in Tijuana, which has also been supported by the NIH’s National Institute of Allergy and Infectious Diseases. More recently, he has been funded by NIDA to study HIV stigma in Kyrgyzstan.
“It’s important to step outside your comfort zone,” he said, adding that he advises his mentees to apply for the year-long Fogarty Fellowship. “You’ll be so much better as a researcher with more skills plus you’ll become a more resilient person as well. When you’re out in the field, you’re driving a lot of the work and you have to learn how to be really independent.”
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