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BACKGROUND: The ethnic and geographical variations of AIDS prevalence among injection drug users (IDU) have highlighted the need to understand the role of the relevant risk factors in specific subpopulations of IDU. In this study we examine the factors related to seropositivity among IDU entering drug detoxification facilities in metropolitan San Juan, Puerto Rico. METHODS: From October 1990 until August 1991, 390 IDU were interviewed. Four groups of risk factors were examined: sexual practices, drug injection behaviours, risk behaviours while in US Mainland cities, and while incarcerated. A stepwise logistic regression model was used to simultaneously assess the independent effects of the behavioural risk factors on HIV seropositivity. RESULTS: Of the 342 IDU who were tested for HIV antibodies, 29.5% were seropositive. The behaviours found to be associated with seropositivity were: having sex with an IDU in the last 6 months; having injected drugs for over 5 years; and injecting with used needles while incarcerated. DISCUSSION: Public health programmes will need to establish more effective collaborative links with correctional institutions in order to reduce the spread of HIV among IDU in Puerto Rico.

PIP: In Puerto Rico between October, 1990 and August, 1991, 342 intravenous (IV) drug users at 3 detoxification clinics serving San Juan and its environs were interviewed, and blood samples were taken. Researchers wanted to determine the behavioral risk factors linked to HIV infection in a population of IV drug users in drug treatment. Most (84.9%) of the IV drug users were male. The HIV seropositivity rate was 29.5% (28.7% for males and 34% for females), which was lower than that for out-of- treatment IV drug users in metropolitan San Juan (47.5%). A stepwise logistic regression model revealed that having sexual intercourse with an IV drug user within the last 6 months (42.5% vs. 26%; adjusted odds ratio [AOR] = 1.9; p = .046), having used IV drugs for more than 5 years (32.4% for 6-10 years and 47.5% for 10 years vs. 8.8%; AOR = 4.69 and 9.64, respectively; p .001), and shooting up with used needles while imprisoned (56.8% vs. 26.2%; AOR = 3.59; p = .002) were significant behavioral risk factors of HIV infection. The significant risk factor of having sex with an IV drug user within the last 6 months suggests that sexual transmission of HIV among IV drug users in Puerto Rico is becoming as important an HIV-transmission mode as needle sharing. Since a considerable proportion of this IV drug use population in a treatment program (54.9%) has been incarcerated, and since needle sharing while in prison has an independent significant effect on HIV transmission, public health officials in Puerto Rico need to implement innovative and aggressive interventions in correctional institutions to induce risk reduction behaviors particular to IV drug inmates.

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Cases of AIDS among women of reproductive age have increased dramatically since 1981; nearly a third of all cases among females were reported in 1990 alone. Surveillance of human immunodeficiency virus (HIV) infection among women is essential for monitoring the spread of HIV over time and identifying specific populations and geographic areas in need of HIV counseling, testing, and prevention services. Blinded (unlinked) serologic surveys were conducted in the United States and Puerto Rico in sentinel clinics providing reproductive health services to women, including family planning, prenatal care, and abortion services. Seventy-eight of 94 clinics (83%) in 30 cities conducting surveys during 1988 and 1989 detected at least one HIV-positive woman. Clinic-specific prevalence ranged from 0-2.28% (median 0.22%), with rates over 1% occurring in clinics predominantly on the East Coast and in Puerto Rico. Seroprevalence varied by primary type of service, race-ethnicity, and age group. Median rates were higher in clinics offering prenatal services and lower in abortion and family planning clinics in the same cities. In general, women 25-29 years of age showed the highest median rate of infection (0.32%), and rates were higher among black women (median 0.34%) than among Hispanic (median 0.11%) and white women (median 0%). Our data indicate the need to educate women about recognizing and reducing their risk of HIV infection. Reproductive health clinics with high seroprevalence should implement voluntary HIV counseling and testing with appropriate follow-up clinical evaluation and referral for infected women. Clinics with low prevalence should seize the opportunity to enhance HIV education and prevention efforts.

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