This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p <. 001), and more New York IDUs lived in their own home (30% vs. 14%, p <. 001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.
"Results show that HIV risk profiles of our middle-aged participants are similar to younger IDUs. Numerous studies have also identified homelessness as a risk factor for HIV drug risk (Andıá et al., 2001; Coady et al., 2007; Corneil et al., 2006; Salazar et al., 2007). Our multiple logistic regression analyses show that homelessness is not significantly associated with sexual behaviors (e.g., having multiple sex partners, and having unprotected sex with a casual or an exchange partner at last sex) although by simple logistic regression, homelessness is strongly associated with sexual behaviors. "
[Show abstract][Hide abstract] ABSTRACT: Abstract Recent studies have reported a clustered pattern of high-risk drug using and sexual behaviors among younger injection drug users (IDUs), however, no studies have looked at this clustering pattern in relatively older IDUs. This analysis examines the interplay and overlap of drug and sexual HIV risk among a sample of middle-aged, long-term IDUs in Houston, Texas. Our study includes 452 eligible IDUs, recruited into the 2009 National HIV Behavioral Surveillance project. Four separate multiple logistic regression models were built to examine the odds of reporting a given risk behavior. We constructed the most parsimonious multiple logistic regression model using a manual backward stepwise process. Participants were mostly male, older (mean age: 49.5±6.63), and nonHispanic Black. Prevalence of receptive needle sharing as well as having multiple sex partners and having unprotected sex with a partner in exchange for money, drugs, or other things at last sex were high. Unsafe injecting practices were associated with high-risk sexual behaviors. IDUs, who used a needle after someone else had injected with it had higher odds of having more than three sex partners (odds ratio (OR)=2.10, 95% confidence interval (CI): 1.40-3.12) in last year and who shared drug preparation equipment had higher odds of having unprotected sex with an exchange partner (OR=3.89, 95% CI: 1.66-9.09) at last sex. Additionally, homelessness was associated with unsafe injecting practices but not with high-risk sexual behaviors. Our results show that a majority of the sample IDUs are practicing sexual as well as drug-using HIV risk behaviors. The observed clustering pattern of drug and sexual risk behavior among this middle-aged population is alarming and deserve attention of HIV policy-makers and planners.
AIDS Care 10/2012; 25(7). DOI:10.1080/09540121.2012.733333 · 1.60 Impact Factor
"In 2002, 45% of Puerto Rican IDUs in New York City were infected with HIV along with 44% of Black IDUs and 32% of White IDUs . Among Puerto Rican IDUs, access to sterile syringes , incarceration , residential status , drug scene roles , and sexual identity  have been previously identified as important factors that influence HIV transmission. Comparatively, Mexican Americans have been shown to have higher rates of drug injection and lower rates of sharing injection paraphernalia than Puerto Ricans [17, 18]. "
[Show abstract][Hide abstract] ABSTRACT: Latinos in the United States are an ethnically diverse group disproportionately affected by HIV/AIDS. We describe HIV seroprevalence, HIV risk behaviors and utilization of health services among Mexican American injection drug users (IDUs) in California (n = 286) and compare them to White (n = 830) and African American (n = 314) IDUs. Study participants were recruited from syringe exchange programs (n = 24) in California. HIV seroprevalence among Mexican Americans (0.5%) was dramatically lower than Whites (5%) and African Americans (8%). Mexican Americans reported fewer sex-related risks than Whites and African Americans though injection-related risks remained high. Compared to Whites, Mexican Americans were more likely to participate in drug treatment during a 6 month period (AOR 1.5, 95% CI 1.1, 2.0) but less likely to receive any health care (AOR 0.6, 95% CI 0.5, 0.8). Exploring cultural and structural factors among Mexican American IDUs may offer new insights into how to maintain low rates of HIV seroprevalence and reduce barriers to health care utilization.
AIDS and Behavior 12/2009; 15(1):95-102. DOI:10.1007/s10461-009-9614-2 · 3.49 Impact Factor
"For HCV, the lack of significance may also be due in part to the high transmissibility of HCV in settings with moderate prevalence. Consistent with the literature, we found that frequent alcohol use, methamphetamine use, backloading, shooting gallery use and sex work were associated with being both homeless and equivocally housed (Andia et al., 2001; Deren et al., 2003; Diaz et al., 2001; Gleghorn et al., 1998; Koester et al., 2005; Metraux et al., 2004; O'Toole et al., 2004; Semple et al., 2004). What was unique about this study was that we found these same associations to be true for younger IDUs as well. "
[Show abstract][Hide abstract] ABSTRACT: Using cross-sectional analysis we examined residential status and associated differences in HIV risk behaviors among 3266 young IDUs enrolled in an HIV prevention trial. A three-level outcome (homeless (37%), equivocally housed (17%), housed (46%)) was defined based on responses to two questions assessing subjective and objective criteria for homelessness: "equivocally housed" participants were discordant on these measures. In multivariate analysis, antecedents of homelessness were having lived in an out-of-home placement, been thrown out of the home or in juvenile detention, and experienced childhood abuse; while correlates included receiving income from other and illegal sources, drinking alcohol or using methamphetamine at least daily, using shooting galleries, backloading, and sex work. A subset of these variables was associated with being equivocally housed. HIV risk varies by housing status, with homeless IDUs at highest risk. Programs for IDUs should utilize a more specific definition of residential status to target IDUs needing intervention.
AIDS and Behavior 12/2007; 11(6):854-63. DOI:10.1007/s10461-007-9248-1 · 3.49 Impact Factor
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