Syringe Acquisition and Use of Syringe Exchange Programs by Puerto Rican Drug Injectors in New York and Puerto Rico: Comparisons Based on Quantitative and Qualitative Methods
ABSTRACT Quantitative and qualitative data are used to compare alternative sources of syringes, including syringe exchange programs (SEPs), accessed by 165 Puerto Rican injection drug users (IDUs) in East Harlem, New York (NY), and 115 in Bayamn, Puerto Rico (PR). IDUs in PR obtained, on average, 45.2% of their syringes from syringe sellers, 18.0% from pharmacies, and 17.6% from a SEP. By contrast, IDUs in NY obtained 55.0% of their syringes from SEPs and 22.9% from syringe sellers. Compared to their island counterparts, IDUs in NY received significantly more syringes from SEPs (NY, 104.5; PR, 9.2) in the prior 30 days, and were more likely to be referred by SEPs to drug treatment and HIV/TB-testing services. The results of this study suggest the need in Puerto Rico to eliminate restrictive syringe exchange policies, reform drug paraphernalia laws to protect SEP clients, and address police harassment related to carrying syringes.
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ABSTRACT: Injection drug users (IDU) who use methamphetamine (MA) are at an increased risk of HIV infection due to engagement in injection-related risk behavior including syringe sharing. In this cohort study of young IDU aged 18-30, we investigated the relationship between injection MA use and syringe sharing, and whether difficulty accessing sterile syringes mediated this association. Behavioral questionnaires were completed by 384 IDU in Vancouver, Canada between October 2005 and May 2008. Generalized estimating equations were used to estimate direct and indirect effects. The median age of participants was 24 (IQR: 22-27) and 214 (55.7%) were male. Injecting MA was independently associated with syringe sharing. Mediation analyses revealed that difficulty accessing sterile syringes partially mediated the association between injecting MA and syringe sharing. Interventions to reduce syringe sharing among young methamphetamine injectors must address social and structural barriers to accessing HIV prevention programs.AIDS and Behavior 01/2011; 15(7):1546-53. · 3.49 Impact Factor
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ABSTRACT: Latinos, and Puerto Ricans in particular, have been disproportionately impacted by HIV/AIDS. Severe mental illness (SMI) is associated with an increase in HIV risk. Relatively little research has focused on the role of SMI among Puerto Rican injection drug users (IDUs) and non-IDUs in susceptibility to and transmission of HIV and there are few published reports on HIV risk among Latina SMI. We conducted a longitudinal mixed methods study with 53 Puerto Rican women with schizophrenia, bipolar disorder, or major depression to examine the cultural context of HIV risk and HIV knowledge, beliefs, and behaviors among a larger study with Puerto Rican and Mexican women with serious mental illness (SMI). There was a high prevalence of past and current substance use and a high prevalence of substance use-associated HIV risk behaviors, such as unprotected sexual relations with an IDU. The violence associated with substance use frequently increased participants' HIV risk. Choice of substance of abuse depended on cost, availability, and use within the individual participant's network. Participants attributed their substance use to the need to relieve symptoms associated with their mental illness, ameliorate unpleasant feelings, and deaden emotional pain. HIV prevention interventions for poorer Puerto Rican women with SMI must target the individuals themselves and others within their networks if the women are to be supported in their efforts to reduce substance use-related risk. The content of any intervention must address past and current trauma and its relationship to substance use and HIV risk, as well as strategies to prevent HIV transmission.Journal of Immigrant and Minority Health 02/2011; 13(4):681-9. · 1.16 Impact Factor
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ABSTRACT: This paper presents findings from the Alliance for Research in El Barrio and Bayamón (ARIBBA) research study, which compared HIV-related risk behaviors, HIV infection rates, and mortality rates of 800 Puerto Rican injection drug users and crack smokers in East Harlem, New York, with 399 of their counterparts in Bayamón, Puerto Rico. The study was conducted from 1996 to 2004 and is among the most comprehensive ever undertaken on HIV risk behaviors of drug users in Puerto Rico. This paper presents the main findings, many of which have been published in scientific journals. The study found that drug users in Puerto Rico became infected with HIV at a rate almost 4 times higher than Puerto Rican drug users in New York, and they died at a rate that was more than 3 times as high. The findings indicate that drug users in Puerto Rico are more likely than Puerto Rican drug users in New York to engage in injection drug use and sexual behaviors that put them at risk of becoming infected with HIV. In addition, they have fewer prevention resources available to them. HIV prevention programs are scarce in Puerto Rico and the availability of drug treatment programs in Puerto Rico declined by over one third during the period examined. Additionally, significantly fewer HIV-positive drug users in Puerto Rico were taking HIV-related medications than in New York. The paper concludes with recommendations and lessons learned from the study.Journal of the International Association of Physicians in AIDS Care (JIAPAC) 03/2011; 10(4):248-59.