RESUMO
The national HIV/AIDS prevention program, the Diffusion of Effective Behavioral Interventions (DEBI), is described in the context of addressing Hispanics/Latinos at risk for HIV/AIDS in the United States and Puerto Rico. The eight-step DEBI model is referenced in terms of the interventions and Division of HIV/AIDS Prevention/Capacity Building Branch (DHAP/CBB) Latino Diffusion Team activities. A summary of activities and examples addressing diffusion needs for the diverse Hispanic/Latino populations is discussed. Challenges and successes in diffusion and partner collaborations are also presented, with comment on future directions such as translations and trainings to serve the needs of the Hispanic/Latino-serving community-based organizations and their communities.
Assuntos
Difusão de Inovações , Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Promoção da Saúde , Hispânico ou Latino , Disseminação de Informação , Centers for Disease Control and Prevention, U.S. , Infecções por HIV/etnologia , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Humanos , Estudos de Casos Organizacionais , Desenvolvimento de Programas , Porto Rico , Comportamento de Redução do Risco , Estados UnidosRESUMO
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.
Assuntos
Infecções por HIV/transmissão , Uso Comum de Agulhas e Seringas/psicologia , Grupo Associado , Abuso de Substâncias por Via Intravenosa , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Porto Rico/etnologia , Medição de Risco , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Seringas/virologiaRESUMO
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.
Assuntos
Programas de Troca de Agulhas/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Seringas , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Feminino , Dependência de Heroína/epidemiologia , Humanos , Lactente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Porto Rico/epidemiologia , Fatores SocioeconômicosRESUMO
Significant differences in HIV-related risk behaviors have been found between Puerto Rican drug users in New York City (NY) and Puerto Rico (PR). An examination of HIV incidence rates and characteristics of seroconverters in each location was undertaken. Baseline and follow-up interviewing and HIV testing were conducted in 1998 to 2002 with seronegative Puerto Rican injection drug users (IDUs) and crack smokers from East Harlem, NY (n = 455) and Bayamón, PR (n = 268). There were a total of 32 seroconverters, 9 in NY and 23 in PR, for seroconversion rates of 0.88/100 person-years at risk (pyr; 95% CI, 0.31-1.45) in NY and 3.37/100 pyr (95% CI, 2.02-4.72) in PR (P < 0.001). In PR, variables significantly related to seroconversion were younger age and using shooting galleries. Being in methadone treatment was protective against seroconversion. In NY, crack use was significantly related to seroconversion. The higher seroconversion rate found in PR indicates a need to enhance HIV prevention efforts, including increasing methadone treatment and access to sterile syringes. The need to address sexual risk behaviors in both locations was also indicated. Resources focusing on reducing HIV transmission in the Caribbean should include efforts to target the drug use-HIV epidemic in PR.
Assuntos
Infecções por HIV/epidemiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Soropositividade para HIV/epidemiologia , Hispânico ou Latino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
This study integrates the results of quantitative and qualitative methods to elucidate the association between sexual identity and physical and sexual abuse among Puerto Rican drug users. A structured questionnaire was administered to 800 subjects in New York and 399 in Puerto Rico. A total of 93 subjects (7.9%) self-identified as homosexual or bisexual. Gay males were significantly more likely than heterosexual males to report first occurrence of physical abuse by a family member in childhood. Both gay and bisexual males were more likely than their heterosexual counterparts to report first experiencing unwanted sex in childhood and intimate partner physical abuse later in life. Lesbians were more likely than female heterosexuals to report unwanted sex in childhood. Qualitative data were collected through in-depth life histories with 21 subjects and suggest that gay and lesbian subjects perceive antihomosexual prejudice on the part of family members as one cause of childhood physical and sexual abuse.
Assuntos
Abuso Sexual na Infância , Transtornos Relacionados ao Uso de Cocaína/etnologia , Transtornos Relacionados ao Uso de Cocaína/psicologia , Cocaína Crack , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , Adulto , Anedotas como Assunto , Bissexualidade/etnologia , Bissexualidade/psicologia , Criança , Abuso Sexual na Infância/psicologia , Feminino , Homossexualidade Feminina/etnologia , Homossexualidade Feminina/psicologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Cidade de Nova Iorque , Porto Rico/etnologia , Assunção de Riscos , Parceiros Sexuais/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Infecções por HIV/etnologia , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/etnologia , Adolescente , Adulto , Feminino , Infecções por HIV/etiologia , Pessoas Mal Alojadas , Humanos , Drogas Ilícitas/classificação , Masculino , Uso Comum de Agulhas e Seringas/efeitos adversos , Cidade de Nova Iorque/epidemiologia , Razão de Chances , Porto Rico/epidemiologia , Porto Rico/etnologia , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
The PRECEDE model for health promotion proposes three types of influences on health behaviors: Predisposing, Enabling, and Reinforcing factors. This model was used to examine a range of influences on HIV risk behaviors (sharing syringes and other injection-related paraphernalia) among Puerto Rican injection drug users (IDUs). A total of 698 IDUs were interviewed (438 in East Harlem, New York, and 260 in Bayamón, Puerto Rico). Both types of risk behaviors were more prevalent in Puerto Rico. Similarities in influences on syringe sharing behaviors were found in the two sites and included self-efficacy (for reducing injection-related sharing) and norms. Influences on the sharing of other injection-related paraphernalia were primarily Enabling factors in both communities, and purchasing drugs with others was the strongest predictor of paraphernalia sharing. The need to address risks associated with joint drug purchasing in both locations and to enhance efforts to reduce risks among IDUs in Puerto Rico is indicated.