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ABSTRACT: Efforts to translate, package, and diffuse HIV/AIDS research into practice have gained momentum with the Centers for Disease Control and Prevention's (CDC's) launch of three projects: the Prevention Research Synthesis Project, which identifies evidence-based interventions studies; the Replicating Effective Programs Project, which supports the translation of evidence-based interventions into materials suitable for use in local prevention programs; and the Diffusion of Effective Behavioral Interventions Project, which moves behavioral interventions into full-scale practice across the United States. This article describes the CDC's fast-track process of translation, packaging, and diffusion of an HIV intervention for Hispanic/Latino injection drug users, the Modelo de Intervención Psicomédica conducted by the Diffusion of Effective Behavioral Interventions Project in collaboration with a CBA organization and the original researchers.
AIDS education and prevention: official publication of the International Society for AIDS Education 10/2009; 21(5 Suppl):171-85. · 1.51 Impact Factor
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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
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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.
Harm Reduction Journal. 01/2008;
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ABSTRACT: A cross sectional study was conducted from 2002-2004 to record the evolution of HIV-1 infection in Puerto Rico by monitoring the expression of antiretroviral resistance-associated mutations.
Samples were analyzed by using the TRUGENE HIV-1 Genotyping Kit and the OpenGene DNA Sequencing System.
Mutations in the HIV-1 virus were detected in 92.7% of men and 94.8% of women. Of these, 75.1% of men and 72.4% of women had HIV-1 with resistance to at least one medication. The average number of HIV mutations was 6.1 in men and 5.3 in women. In 2002 and 2003, strains were most frequently resistant to the antiretroviral drugs zalcitabine, lamivudine and didanosine, while in 2004, strains were most frequently resistant to zalcitabine, lamivudine, and efavirenz. The most prevalent mutations in the reverse transcriptase gene were M184V, K103N, T215Y, and M41L. The most prevalent mutations in the protease gene were L63P, M361, L90M, A71V, and L101.
Significant differences between men and women were recorded in the levels of HIV-1 expressed mutations and resistance. When comparing these results with data from 2000 and 2001, results indicate that expression of resistant mutations has remained constant.
Ethnicity & disease 01/2008; 18(2 Suppl 2):S2-132-6. · 0.90 Impact Factor
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ABSTRACT: Delivery of services to Hispanic drug users remains a great challenge, as shown by low service access and retention, and disproportionate negative consequences of drug abuse in the Hispanic population. This paper provides a critical analysis of current services research on Hispanics with drug abuse problems, identifies gaps in the knowledge, and offers recommendations for scientific opportunities to address these gaps, focusing on four central needs: (1) the need to understand the circumstances of Hispanics in their own communities (i.e., community context); (2) the need to develop and test service delivery models tailored to Hispanics' circumstances and special needs; (3) the need to remove client, provider, and system barriers to utilization; and (4) the need to establish links between drug abuse services, social services, and other service sectors to optimize treatment outcomes. The authors suggest an approach that begins with a focus on the local Hispanic community and builds understanding of the cultural context, inclusion of indigenous resources, recognition of barriers to enrollment and retention, and coordination of related services.
Drug and Alcohol Dependence 10/2006; 84 Suppl 1:S76-84. · 3.38 Impact Factor
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ABSTRACT: This study examined HIV risk behavior in jail/prison among Puerto Rican drug injectors in New York (NY, n = 300) and Puerto Rico (PR, n = 200), and its relationship with later drug and sex risk behaviors. During 3 years prior to interview, 66% of NY and 43% of PR samples were incarcerated at least once. While incarcerated, 5% of NY and 53% of PR injected drugs. Few reported engaging in sex inside jail/prison (5% in both sites). Of those who engaged in risk behaviors in jail/prison, almost all reported having unprotected sex and sharing injection equipment. The impact of jail/prison risk behaviors on risk behaviors after release differed between the two sites: they were more related to subsequent sex risk behaviors in NY, and subsequent injection risk behaviors in PR. The findings indicate a need for effective drug treatment programs inside jail/prisons to reduce HIV-related risk behaviors among drug injectors during incarceration and after release.
AIDS and Behavior 10/2005; 9(3):377-86. · 3.49 Impact Factor
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ABSTRACT: This study examined risk network characteristics of Puerto Rican crack users and the relationship between the network and HIV-related sex risk behavior over time. The participants (N = 383 in New York; N = 165 in Puerto Rico), recruited through street outreach, were interviewed at both baseline and 6-month follow-up. The majority of crack users (88%, New York; 92%, Puerto Rico) in the sample named one or more personal risk network members. As compared with New York participants, crack users in Puerto Rico reported larger risk networks and were more likely to engage in sex risk behaviors with strangers or acquaintances. In multivariate analyses, a significant variable in predicting sex risk behaviors at follow-up in both sites was the baseline measure of the dependent variable. Significant network variables were: having any known crack use member less than 6 months and having acquaintance/stranger in network in New York; communicating with network members about using condoms in Puerto Rico. More attention to sex risk behaviors are needed in HIV/AIDS prevention and education programs.
AIDS Education and Prevention 03/2005; 17(1):53-67. · 1.59 Impact Factor
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ABSTRACT: This study examined the impact of changes in self-efficacy over time on HIV-related injection and sex risk behaviors among Puerto Rican drug injectors and crack smokers. Baseline (T1) and 6-month follow-up (T2) data were collected between 1998 and 2000 in New York and Puerto Rico (follow-up rate=79%, 952/1199). Differences in scores on self-efficacy (for risk behaviors) between T1 and T2 were first computed and dichotomized (negative change vs. no/positive change). Those with negative change in self-efficacy were more likely than those with no/positive change to engage in HIV injection and sex risk behaviors at T2. The relationships were significant in multiple logistic regressions after controlling for the effects of potential confounding variables. The findings indicate that improving perceived self-efficacy for risk reduction can help reduce HIV transmission behaviors in high-risk drug users. HIV/AIDS prevention programs should include a focus on enhancing self-efficacy for reducing risk behaviors.
Addictive Behaviors 06/2004; 29(3):567-74. · 2.09 Impact Factor
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ABSTRACT: This study examined HIV injection- and sex-related risk behaviors among Puerto Rican drug injectors by gender, separately for those who were aware of being HIV positive and those who believed they were seronegative or were unaware of their serostatus. The participants (N = 873: 561 in New York; 312 in Puerto Rico) were recruited from January 1998 to July 1999 in the two sites by street outreach workers. Of the participants, 81% were males and 19% self-reported that they were previously told that they had been infected with HIV. Significant gender differences existed in injection and sexual risk behaviors in bivariate analyses. The factors related to HIV risk behaviors between males and females differed after controlling for the impacts of other variables in multivariate analyses. Self-efficacy for risk behaviors was significantly related to all of the HIV risk behaviors. Components of HIV prevention programs should include enhancing self-efficacy for reducing risk behaviors.
AIDS and Behavior 08/2001; 5(3):241-249. · 3.49 Impact Factor
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ABSTRACT: This article describes and compares distributions of drug-scene roles, frequency of engaging in role behaviors, and relationships of role-holding to high-risk behaviors and sexual partnerships among Puerto Rican injection drug users in New York and Puerto Rico. For this study 561 street-recruited injection drug users in East Harlem, New York, and 312 in Bayamón, Puerto Rico were asked the number of days (in the last 30) in which they earned money or drugs in each of seven drug-scene roles; and about behaviors and egocentric risk partner characteristics in the last 30 days. East Harlem subjects were more likely to get resources by selling drugs and syringes, and buying drugs for someone else; Bayamón subjects were more likely to be "hit doctors," buy needles for others, operate a shooting gallery, or escort others to shooting galleries. All roles were part-time except shooting gallery management in East Harlem. About 27% of respondents at each site engaged in two or more roles. Many roles were associated with increased odds of injecting more than twice a day, receptive syringe sharing, distributive syringe sharing, receptive paraphernalia sharing, and having a drug-injecting sex partner. Drug-scene role structures vary between cities. Most roles are part-time pursuits. Role-holders have higher-risk behaviors and sexual partnerships than other drug injectors. Although further research is needed, drug-scene role-holders should be targeted for interventions to affect their own risk and their communications with others.
Journal of psychoactive drugs 34(4):363-9. · 1.10 Impact Factor
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ABSTRACT: This study examines the psychometric properties of an acculturation scale specifically developed for Puerto Ricans with a sample of substance abusers residing in Puerto Rico and New York. In line with current conceptual models of acculturation, this instrument departs from a mutually exclusive or zero-sum conceptualization of acculturation by assessing involvement in both American and Puerto Rican cultures independently of each other. Findings from this study permitted comparisons of acculturation as experienced by Puerto Rican injection drug users in Puerto Rico and New York. Results supported the notion of independence of individuals' involvement in American and Puerto Rican cultures, thus confirming the complex nature of biculturalism. This article also examines the relevance of the study of acculturation scales that can assist in identifying the influences of the cultures of origin and destination on substance abuse and HIV risk behaviors.
Journal of psychoactive drugs 35(2):197-207. · 1.10 Impact Factor
