A longitudinal study of syringe acquisition by Puerto Rican injection drug users in New York and Puerto Rico: implications for syringe exchange and distribution programs.
ABSTRACT Increasing access to sterile syringes and new drug preparation materials is an effective means of reducing HIV transmission among injection drug users (IDUs), and a fundamental component of harm reduction ideology. The purpose of this study is to examine changes during a three-year period in syringe acquisition by street-recruited Puerto Rican IDUs characterized by frequent drug injection and high HIV seroprevalence. At baseline (1998-1999) and 36-month follow-up, 103 IDUs recruited in East Harlem, New York (NY), and 135 from Bayamón, Puerto Rico (PR) were surveyed about syringe sources and HIV risk behaviors in the prior 30 days. A majority of participants in both sites were male (NY 78.6%, PR 84.4%), were born in Puerto Rico (NY 59.2%, PR 87.4%), and had not completed high school (NY 56.3%, PR 51.9%). Compared to PR IDUs at follow-up, NY IDUs injected less (3.4 vs. 7.0 times/day, p < .001), and re-used syringes less (3.1 vs. 8.0 times, p < .001). Between baseline and follow-up, in NY the proportion of syringes from syringe exchange programs (SEPs) increased from 54.2% to 72.9% (p = .001); syringes from pharmacies did not increase significantly (0.2% to 2.5%, p = .095). In PR, the proportions of syringes from major sources did not change significantly: private sellers (50.9% to 50.9%, p = .996); pharmacies (18.6% to 19.0%, p = .867); SEP (12.8% to 14.4%, p = .585). The study indicates that NY SEPs became more dominant, while NY pharmacies remained a minor source even though a law enacted in 2001 legalized syringe purchases without prescription. Private sellers in PR remained the dominant and most expensive source. The only source of free syringes, the SEP, permitted more syringes to be exchanged but the increase was not statistically significant. Implications for syringe exchange and distribution programs are discussed.
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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
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ABSTRACT: Injection drug users (IDUs) in San Juan, Puerto Rico are characterized by high rates of daily injecting, injection of shared drugs, re-use of injection syringes, and use of shooting galleries. They lack adequate access to new injection syringes and drug preparation equipment, and experience elevated rates of HIV and HCV infection. Between April and August, 2006, researchers and active IDUs collaborated in the development of an experimental HIV/HCV intervention aimed at identifying drug preparation items and practices that will enable IDUs to make drug solutions without potentially contaminated injection syringes contacting materials used to prepare drugs. The collaboration involved discussing and testing a variety of drug preparation items and practices in office and community settings. The process was repeated until concerns that had been raised were resolved, and a tentative set of intervention items and practices to be evaluated in a community field trial was identified. Throughout, a strong emphasis was placed on the capacity of an item or practice to address common problems confronted by IDUs (blunted needles, clogged syringes, injected particles) in addition to the core aim of reducing contamination of preparation materials by blood in injection syringes. This report describes the final selection of items and practices: 1) A small water bottle that permits IDUs to add approximately .05 cc water drops directly to drug powder in cookers; 2) A preparation syringe (a type of ancillary equipment not used for injecting) that permits IDUs to pull up a measurable amount of water to add to drug powder, an alternative to producing water drops; 3) A filtering device, the Sterifilt filter, attached to a preparation syringe, which eliminates the need for cotton or cigarette filters; 4) Use of a preparation syringe to distribute drug solution by backloading to injection syringe(s); 5) A small water bottle enabling IDUs to clean injection syringes by backload rinsing. The overarching aim of this experimental HIV/HCV intervention was to promote the safe re-use of drug preparation and injection items, and to impact the large number of IDUs in San Juan who maintain personal injection syringes, but currently use communal ancillary equipment in shooting galleries and inject drug solutions prepared with other IDUs' injection syringes.Harm Reduction Journal 02/2008; 5:14. DOI:10.1186/1477-7517-5-14 · 1.26 Impact Factor
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ABSTRACT: This study explored whether place of birth and residence was associated with needle sharing for Puerto Rican injection drug users (IDUs) (N = 348). In-person interviews were conducted in Puerto Rico and Massachusetts during 2005-2007. Multivariate regression analyses revealed IDUs born and living in Puerto Rico were four times more likely to have shared needles compared to those residing in Massachusetts. Respondents residing in Massachusetts were 76% less likely to have ever shared needles with an HIV-positive individual, controlling for covariates. Findings highlight the increased HIV-risk of Puerto Rican IDUs born and residing in Puerto Rico. Prevention and treatment needs are discussed.Substance Use & Misuse 05/2010; 45(10):1605-22. DOI:10.3109/10826081003682842 · 1.23 Impact Factor