[show abstract][hide abstract] ABSTRACT: During the last decade, the veterinary anesthetics have gained popularity as recreational drugs. The aim of this study was to document the use of "anestecia de caballo" (xylazine) and its consequences among drug users in Puerto Rico. The study combined a cross-sectional survey with 89 drug users and two focus groups conducted in Mayagüez with frontline drug treatment providers. Drug users were recruited from communities of the San Juan metropolitan area using a variety of ethnographic and outreach strategies. A short questionnaire developed for the study collected information on sociodemographics, xylazine use, and its consequences. The two focus groups were conducted to discuss the details related to xylazine use, its consequences, and utilization awareness. The sample comprised 63 males (70.8%) and 26 females with a mean age of 37.2 years. The mean number of years of drug use was 14.3, with a mean frequency of drug use of 5.9 times daily. More than 65% reported speedball as the principal drug of use. The prevalence of xylazine use was 80.7%. More than 42% of the sample used xylazine in a mixture with speedball. The main route of administration of xylazine was injection but 14% reported the use of xylazine by inhalation. More than 35% of the sample reported skin lesions and 21.1% reported at least one overdose episode. Multiple logistic regression analysis revealed that males (OR = 3.47, CI = 1.10-12.00) and those who reported speedball as their main drug of use (OR = 9.34, CI = 2.51-34.70) were significantly more likely to be xylazine users. Focus groups revealed that drug users claimed to recognize the presence of xylaxine in a mixture of speedball based on its effects, taste, the color of the drug (dark brown), and its odor. In conclusion, the use of xylazine among drug users in Puerto Rico seems to be an emerging trend with potentially serious health consequences.
Journal of Urban Health 03/2012; 89(3):519-26. · 1.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: Many barriers to the use of HIV medications have been identified. Research findings have also shown a gender disparity in HIV care behaviors. However, interaction effects of gender with the potential barriers to use of HIV medications among HIV-positive minority drug users remain under-studied. This study examined interaction effects of gender with potential moderating factors (i.e., individual and network characteristics) on the use of HIV medications. Analyses were based on 260 HIV-positive Puerto Rican heroin and cocaine users, recruited in New York (N=178) and Puerto Rico (N=82) in 1998-2003. HIV status was assessed using OraSure, and heroin or cocaine use was verified by urinalysis. All participants were tested and interviewed at baseline and six-month follow-up (183 males; 77 females). In predicting use of HIV medications at follow-up (HIVMEDF), use of HIV medications at baseline (HIVMED), individual characteristics (e.g., depression), network characteristics (e.g., having an intravenous drug user [IDU] sex partner), recruitment site, and interaction effects of these variables with gender, were examined in multiple logistic regression analysis. Use of HIV medications was low (29% at baseline; 40% at follow-up). HIVMED, recruitment site, gender, and depression had significant main effects on HIVMEDF. Depression also had a significant interaction effect with gender on HIVMEDF. Unlike men, women with depression were less likely than women without depression to use the medications. The findings indicate that gender-specific issues should be addressed by treatment programs for HIV-positive drug users, with particular efforts needed to enhance use of medications for depressed women.
AIDS Care 11/2011; 23(11):1467-71. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was aimed at examining the relationship between suicidal attempts, polydrug use, and depression in adolescents. A sample of 691 adolescents and their parents were interviewed. Subjects who met the criteria for depression and those who used alcohol were significantly more likely to be suicidal attempters (OR = 6.8, p < 0.001; OR = 7.5, p < 0.001). Polydrug users were significantly more likely to attempt suicide (OR = 8.8, p = 0.032). Adolescents with mothers who met the criteria for depression were more likely to report suicide attempts (OR = 2.4, p = 0.069). Health professionals need to screen for polydrug use and depression to prevent future suicidal behaviors.
Archives of suicide research: official journal of the International Academy for Suicide Research 04/2011; 15(2):151-9.
[show abstract][hide abstract] 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.
[show abstract][hide abstract] ABSTRACT: With the introduction of highly active antiretroviral therapy, the hepatitis C virus (HCV) infection has become a primary health problem among individuals suffering from HIV/ AIDS in Puerto Rico, principally those who are injecting drug users (IDUs). A multimedia educational intervention, based on the Health Beliefs Model and Social Cognitive Theory was developed and implemented to reduce HCV-associated risk behaviors among IDUs.
A pre- and post- intervention study evaluated the knowledge and behavioral changes in a group of HIV-infected persons recruited from February 2006 through December 2008.
A total of 110 participants were recruited: all were IDUs; 82% were men; 86.3% were HIV/HCV co-infected and 24.5% had active injected drugs in the month prior to recruitment. The group mean age was 42.2 +/- 9.2 years and mean educational level was 10th grade. Knowledge of HCV risk behaviors, perception of HCV susceptibility, and perception of disease severity increased after the intervention. Knowledge of HCV clinical manifestations and HIV co-infection complications and treatment also improved. In addition, HCV risk behaviors and injecting drug practice decreased significantly among IDUs.
This new multimedia intervention captured and maintained the participants' attention and interest, facilitating their educational process. Thus, greater attention and interest leads to greater knowledge and prevention improvement.
[show abstract][hide abstract] ABSTRACT: Injection drug users (IDUs) contaminate preparation materials with blood-borne pathogens by using syringes as measuring and dispensing devices. In collaboration with IDUs, we developed a preventive intervention consisting of four new preparation practices aimed at avoiding the use of syringes in the preparation, and reducing the contamination of the materials. This report describes the results of a pilot trial introducing the new practices to ascertain their adoption potential and their potential efficacy in reducing contamination. Participants comprised 37 active IDUs among whom the new practices were promoted during 16 weeks. In addition to self-reported behaviors, the study collected cookers and plastic caps from shooting galleries and tested them for the presence of blood residues. Adoption rates were: (1) cleaning of skin area with hand sanitizer--65.6%; (2) directly pouring water with a dropper into the cooker--56.3%; (3) drawing drug solution with a preparation syringe and syringe filter--34.4%; and, (4) backload rinsing syringes--53.1%. Rates of blood residues detected in cookers and plastic caps were 41.7% prior to the trial, 28.6% at week 8, 24.6% at week 14, and 12.0% at week 18. We believe the results of the pilot trial are compelling and suggest that this intervention merits further formal testing.
AIDS and Behavior 04/2009; 13(3):523-31. · 3.49 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examined gender-specific effects of social bonds, network characteristics, and other factors on drug treatment enrollment among Puerto Rican drug users.
Participants (425 women; 1,374 men) were recruited in New York and Puerto Rico in 1998-2003.
Gender differences were found: education (< high school/GED) and having a sex partner who is an injection drug user (IDU) were significantly related to current enrollment in drug treatment (EDT) for women; for men, having an IDU friend (negatively) had a main effect on EDT, and having an IDU friend also had a significant interaction effect with their own injection drug use on EDT. For both women and men, recruitment site (New York), having health insurance, and prior methadone treatment were significant predictors of EDT.
The findings may be useful in developing gender-differentiated drug counseling and treatment efforts that engage women's sex partners and men's friendship networks to build support for drug treatment.
The American Journal of Drug and Alcohol Abuse 02/2009; 35(2):73-9. · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Reducing sex risk behaviors among high-risk injection drug users (IDUs) and crack smokers is a continuing challenge for HIV prevention. Based on a longitudinal study of sexually active Puerto Rican IDUs and crack smokers in New York (n = 573) and Puerto Rico (n = 264), baseline predictors of changes in sex risk (number of unprotected sex acts) at 6- and 36-month follow-up interviews were examined. In New York, predictors of higher sex risk were being younger, having primary partners, having more other sex partners, never exchanging sex, having lower self-efficacy for reducing sex risk behaviors and being HIV-negative, and these predictors were significant at both postbaseline periods. In Puerto Rico, short-term predictors included being male, having primary partners, never exchanging sex, lower sex risk norms and lower self-efficacy. However, only having primary partners was significant in longer-term behaviors. Results indicated the need for enhancing self-efficacy and for developing risk reduction strategies related to community differences.
AIDS Education and Prevention 09/2008; 20(4):325-37. · 1.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamón, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs recruited in the two locations by outreach workers. Multiple logistic regression was conducted using sociodemographic and other control variables (e.g., education, frequency of injection, pooling money to buy drugs, use of needle exchange program, injection in galleries and syringe sharing behaviors) and two types of norms related to sharing of injection paraphernalia-encouraging risk norms (what others approve) and objecting to risk norms (what others disapprove). One type of norms, encouraging or approval norms, was associated with indirect sharing in New York but not in Puerto Rico. Pooling money to buy drugs, use of shooting galleries and syringe sharing was associated with indirect sharing in both locations. Prevention programs to reduce indirect sharing behaviors should take into consideration different types of risk norms in order to reduce indirect sharing risk behaviors.
AIDS Education and Prevention 07/2008; 20(3):249-57. · 1.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study investigates the role of neighborhoods in adolescent violence in poor neighborhoods in San Juan, Puerto Rico. The study is part of a larger longitudinal project examining risk and resilience in adolescents' ages 12 to 15 years old and their caregivers. Using a cross-sectional design, a self-completion questionnaire, and an interviewer questionnaire, the authors assessed violent behaviors among participants across demographics, characteristics, and neighborhood social disorganization using the concepts of physical disorders and social disorder. Adolescent violence was positively associated with social disorder. The finding that adults in these neighborhoods walk around with visible firearms and engage in fighting, may have led adolescents to perceive that violence is an accepted behavior. Furthermore, socially disorganized neighborhoods might be less likely to organize on their own behalf because the occurrence of negative experience limits the amount of social support and resources that are available in the neighborhood.
Journal of Interpersonal Violence 04/2008; 23(11):1499-512. · 1.64 Impact Factor
[show abstract][hide abstract] 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.
[show abstract][hide abstract] ABSTRACT: Hepatitis C (HCV) and HIV coinfection has emerged as a major health problem in Puerto Rico, particularly among injection drug users (IDUs). We developed and implemented a multimedia educational intervention for HIV-infected IDUs, based on the Health Belief Model and social cognitive theory.
To evaluate the program's acceptability, a group of 42 participants completed a written questionnaire immediately after each intervention component.
Participants were 85% male, the mean age was 41.6 years (standard deviation 9.2 years), and mean educational level was ninth grade. More than 73% of respondents reported that the computer-based program was very easy to operate. More than 83% agreed that the audio and video tools highly facilitated their learning process, and > 71% agreed that the sessions were long enough. Additionally, they reported a high incremental increase in perceived knowledge regarding HIV/HCV co-infection, HCV infection risk behaviors, HCV complications, HCV preventive measures, and HCV diagnosis and therapy. Most of the participants favored the dissemination of this intervention.
The study found a very good acceptability and feasibility of the computerized intervention in the study group. This new technology that includes audiovisual tools in its design kept the participants' attention and interest, while increasing HIV/HCV co-infection knowledge. Subsequent studies will evaluate the efficacy of this intervention, investigating changes in knowledge and risk behaviors among HIV-infected persons.
[show abstract][hide abstract] ABSTRACT: During the 1990s non-injected heroin use (NIHU) increased notably in several countries. However, very few studies have examined the drug-using practices and other problem behaviors of NIHUs. In this study, we compared male and female NIHUs from Puerto Rico across a number of domains.
Recruitment proceeded through visits to drug-copping areas and the local hangouts in their vicinity. Subjects were eligible if they were 18 to 25 years old, had never injected any drugs, and had recently used heroin or cocaine. Study participants were administered a computer-assisted personal interview.
Of the 412 NIHUs recruited at the time of this study, 74 (18.0%) were females. Female NIHUs were more likely to report sexual assaults and more likely to manifest severe symptomatology of post-traumatic stress disorder than male NIHUs (35.1% vs. 3.6%, p<.01, and 40.5% vs. 25.7%, p=.01, respectively). Females were less likely to report a source of emotional support than males (86.5% vs. 95.3%, p<.01). Close to one in four of the females (23.0%) reported a history of sexually transmitted infections, compared to three percent of the males (p<.01). HIV seroprevalence among females was 4.3% compared to 0.6% among males (p=.01).
Female heroin users seem to present a host of different needs compared to male heroin users. Given the scarcity of existing programs for female drug users in Puerto Rico, designing supportive systems that effectively address the specific needs of drug-using women should become a high-priority public health issue.
Puerto Rico health sciences journal 09/2007; 26(3):205-11. · 0.71 Impact Factor
[show abstract][hide abstract] ABSTRACT: We analyzed early sexual activity among Hispanic 14 to 15-year-old adolescents residing in a poor neighborhood in Puerto Rico.
Information from a sample of 325 adolescents was collected from a randomized sample of community households. Logistic regression analysis was used to identify the variables that help explained adolescents' sexual behavior.
Adolescents whose parents reported poor communication and poor parent control were more likely to engage in early sexual activity that those peers that did not report this type of family relationship. Adolescents who reported poor parent bonding and lack of discipline were more likely to engage in early sexual relationships.
Intervention and prevention programs need to be aware and address the role of the Hispanic culture in gender differences in early sexual activity in adolescence. If sexual norms related to gender role are changing in Puerto Rico, is a question that needs to be answered in future research.
Puerto Rico health sciences journal 07/2007; 26(2):119-26. · 0.71 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examined mobility on the airbridge between New York (NY) and Puerto Rico (PR) for Puerto Rican drug users and its relationship to HIV risk. Over 1,200 Puerto Rican injection drug users (IDUs) and crack smokers were recruited by outreach workers in NY and PR; interview data included questions on mobility (lifetime residences and recent trips). Two-thirds of the NY sample had lived in PR; one-quarter of the PR sample had lived in NY; the most commonly sited reasons for moving were family-related. Fewer than 10% had visited the other location in the prior 3 years. Variables related to risk were number of moves, recent travel, and having used drugs in PR (all with p < 0.05). Implications included the need to enhance risk reduction efforts for IDUs in PR and address sexual risk among mobile drug users.
Journal of Urban Health 03/2007; 84(2):243-54. · 1.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.
AIDS and Behavior 02/2007; 11(1):145-50. · 3.49 Impact Factor
[show abstract][hide abstract] ABSTRACT: More than half of all AIDS cases among Puerto Ricans have been attributed to injection drug use. Predictors of injection drug use cessation were examined among Puerto Rican injection drug users (IDUs) in New York and Puerto Rico. Analysis of baseline and 6-month follow-up data from 670 IDUs in NY and 316 in PR showed that 47% NY and 20% in PR reported cessation of injection at follow-up (p < .001). In multivariate analyses, having been in drug treatment since baseline was the only significant predictor of cessation for both sites (NY: AOR = 1.80; PR: AOR = 3.10). Increasing availability of methadone maintenance treatment, especially in PR, was indicated.
The American Journal of Drug and Alcohol Abuse 01/2007; 33(2):291-9. · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Research suggests that sexual silence, family loyalty, and homophobia foster health-compromising behaviors among adult Latino gay males, but little is known about the effect of these sociocultural factors on the lives of Latino children and young teens characterized by gender nonconformity and homosexual orientation. This exploratory study of Puerto Rican men who have sex with men (MSM) used multisession qualitative interviews to examine early life experiences related to gender identity and homosexual orientation, and the place of drug use and risky sexual behavior in sexual identity formation. Gay male and transsexual female participants described at least one sympathetic family member, usually a female, who accepted cross-gender behavior and/or homosexual orientation. Half of the participants experienced unwanted sex as minors, and all were subjected to bullying by schoolmates. As pubescent youth, participants frequented adult gay venues where they were exposed to high-risk sexual and drug-related behaviors. Interventions for sexually questioning and gay/transsexual Puerto Rican youth are proposed.
Youth & Society 01/2007; 39(3):362-384. · 1.82 Impact Factor
[show abstract][hide abstract] ABSTRACT: Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY-HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR-HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.
Journal of Urban Health 12/2006; 83(6):1114-26. · 1.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.
Journal of Urban Health 12/2006; 83(6):1105-13. · 1.89 Impact Factor