Migration and HIV Risk Behaviors: Puerto Rican Drug Injectors in New York City and Puerto Rico

Central University of the Caribbean, Bayamon, Cidra, Puerto Rico
American Journal of Public Health (Impact Factor: 4.55). 06/2003; 93(5):812-6. DOI: 10.2105/AJPH.93.5.812
Source: PubMed


We compared injection-related HIV risk behaviors of Puerto Rican current injection drug users (IDUs) living in New York City and in Puerto Rico who also had injected in the other location with those who had not.
We recruited Puerto Rican IDUs in New York City (n = 561) and in Puerto Rico (n = 312). Of the former, 39% were "newcomers," having previously injected in Puerto Rico; of the latter, 14% were "returnees," having previously injected in New York. We compared risk behaviors within each sample between those with and without experience injecting in the other location.
Newcomers reported higher levels of risk behaviors than other New York IDUs. Newcomer status (adjusted odds ratio [OR] = 1.62) and homelessness (adjusted OR = 2.52) were significant predictors of "shooting gallery" use; newcomer status also predicted paraphernalia sharing (adjusted OR = 1.67). Returnee status was not related to these variables.
Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.

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Available from: Jonny Andia, Jan 09, 2015
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    • "Research conducted among other migrant groups has shown that IDUs migrating from an environment characterized by high-risk drug use may maintain risky substance use practices in their destination environment. Studies of injection-drug-using Puerto Rican migrants to NYC, for example, have demonstrated that migrants who had previously used drugs in Puerto Rico had higher levels of injection-related risk behaviors, including greater injection frequency, shooting gallery use and sharing of injection paraphernalia, relative to both Puerto Ricans who had not used drugs in Puerto Rico and other groups of IDUs in NYC [31,32]. Thus, persuasive evidence suggests that social norms structuring substance use and injection behavior established in a high-risk originating environment can endure within migrant groups after relocation to an environment of lower risk (i.e., one with less risky behavioral norms and more harm reduction resources). "
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    ABSTRACT: Several former Soviet countries have witnessed the rapid emergence of major epidemics of injection drug use (IDU) and associated HIV/HCV, suggesting that immigrants from the former Soviet Union (FSU) may be at heightened risk for similar problems. This exploratory study examines substance use patterns among the understudied population of opioid-using FSU immigrants in the U.S., as well as social contextual factors that may increase these immigrants' susceptibility to opioid abuse and HIV/HCV infection. In-depth interviews were conducted with 10 FSU immigrants living in New York City who initiated opioid use in adolescence or young adulthood, and with 6 drug treatment providers working with this population. Informed by a grounded theory approach, interview transcripts were inductively coded and analyzed to identify key themes. The "trauma" of the immigration/acculturation experience was emphasized by participants as playing a critical role in motivating opioid use. Interview data suggest that substance use patterns formed in the high-risk environment of the FSU may persist as behavioral norms within New York City FSU immigrant communities - including a predilection for heroin use among youth, a high prevalence of injection, and a tolerance for syringe sharing within substance-using peer networks. Multiple levels of social context may reproduce FSU immigrants' vulnerability to substance abuse and disease such as: peer-based interactional contexts in which participants typically used opioids; community workplace settings in which some participants were introduced to and obtained opioids; and cultural norms, with roots in Soviet-era social policies, stigmatizing substance abuse which may contribute to immigrants' reluctance to seek disease prevention and drug treatment services. Several behavioral and contextual factors appear to increase FSU immigrants' risk for opioid abuse, IDU and infectious disease. Further research on opioid-using FSU immigrants is warranted and may help prevent increases in HIV/HCV prevalence from occurring within these communities.
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    • "Because human xylazine use has been reported in other locations and not just in Puerto Rico (e.g., Philadelphia) it stands that this substance could also emerge as an adulterant in other markets to the levels currently experienced in Puerto Rico. Surely, the scarcity of treatment services for drug users on the island in comparison to the state-side [9] and the current trend of local elected official in Puerto Rico relocating IDU to the state-side for drug treatment services does not aid to contain this situation to the island. Yet, ignoring the emergence of a substance like xylazine will not result in sound public health responses and will only add to the detriment of drug users and society as a whole. "
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    ABSTRACT: Human xylazine use in Puerto Rico merits particular attention for its unprecedented scale and depth. Although Puerto Rican injecting drug users (IDUs) have reported using this drug since the early 2000s, little is being done in the research and service delivery sectors as it is claimed that xylazine severely impacts the health of its users. This report provides information on xylazine use and its associated harms. Data from one semi-structured interview collected in New York City (2007-2008) as part of a larger research study with migrant Puerto Rican drug users is presented as a case study. Xylazine, a veterinary sedative, is an adulterant and complement to other drugs and its chronic use is reported to be associated with physical deterioration. Because human xylazine use has been reported in other locations outside of Puerto Rico, this substance could also emerge as an adulterant in other markets to the levels currently experienced in Puerto Rico. Research and interventions are needed to provide adequate services on the island, better understand how the use of xylazine affects its users, and to reduce the possibility of increased xylazine use on the state-side.
    Full-text · Article · Apr 2011 · Substance Abuse Treatment Prevention and Policy
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    • "IDU populations are noted for their high level of mobility related to searching for work, safety, and access to illicit drugs, which has been associated with an elevated risk of acquiring and transmitting blood-borne infections [10]. For example, shooting gallery use and sharing of injection equipment was elevated among IDUs who had recently migrated from Puerto Rico to New York City [11]. Another study found associations between various drug scene roles, such as selling drugs and needles, and risky injection behaviors among Puerto Rican IDUs with high levels of mobility who travelled between the US and Puerto Rico [12]. "
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    ABSTRACT: We examined correlates of ever injecting drugs in Mexico among residents of San Diego, California. From 2007 to 2010, injecting drug users (IDUs) in San Diego underwent an interviewer-administered survey. Logistic regression identified correlates of injection drug use in Mexico. Of 302 IDUs, 38% were Hispanic, 72% male and median age was 37; 27% ever injected in Mexico; 43% reported distributive syringe sharing there. Factors independently associated with ever injecting drugs in Mexico included being younger at first injection, injecting heroin, distributive syringe sharing at least half of the time, and transporting drugs over the last 6 months. One-quarter of IDUs reported ever injecting drugs in Mexico, among whom syringe sharing was common, suggesting possible mixing between IDUs in the Mexico-US border region. Prospective studies should monitor trends in cross-border drug use in light of recent Mexican drug policy reforms partially decriminalizing drug possession.
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