RESUMO
High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast-Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.
Assuntos
Infecções por HIV/etiologia , Hispânico ou Latino , Abuso de Substâncias por Via Intravenosa/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Disparidades nos Níveis de Saúde , Humanos , Incidência , Programas de Troca de Agulhas , New England/epidemiologia , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Porto Rico/etnologia , Fatores de Risco , Centros de Tratamento de Abuso de Substâncias , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/prevenção & controleRESUMO
Peer outreach models have been successful in addressing HIV risk behaviors of drug users. Patients in methadone maintenance treatment programs who were migrants from Puerto Rico and/or familiar with drug use there were trained to conduct HIV-related peer outreach. A group randomized design was implemented; patients in the Experimental (E) condition (n = 80) received training and conducted 12 weeks of outreach. Half of the patients completed the training and outreach. At follow-up, patients in the E condition who conducted outreach felt they were more helpful to their community, showed a trend for engaging in more vocational activities, and were more likely to talk with others about HIV, compared to those who did not conduct outreach and those in the Control condition (n = 78). Drug treatment patients who are migrants can be trained as peer outreach workers and short-term benefits were found. Longer term maintenance of benefits should be assessed.
Assuntos
Infecções por HIV/prevenção & controle , Hispânico ou Latino , Metadona/uso terapêutico , Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Grupo Associado , Adulto , Relações Comunidade-Instituição , Emigrantes e Imigrantes , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Cidade de Nova Iorque/etnologia , Porto Rico/etnologia , Assunção de Riscos , Comportamento Sexual , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Resultado do TratamentoRESUMO
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.
Assuntos
Atitude Frente a Saúde , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtorno Depressivo/psicologia , Usuários de Drogas/psicologia , Infecções por HIV/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Adulto , Antirretrovirais/administração & dosagem , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , New York/epidemiologia , Porto Rico/etnologia , Fatores SexuaisRESUMO
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.
Assuntos
Infecções por HIV , Abuso de Substâncias por Via Intravenosa , Infecções por HIV/prevenção & controle , Humanos , Porto Rico , Comportamento Sexual , Transtornos Relacionados ao Uso de SubstânciasRESUMO
The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/etnologia , Adulto , América Central/etnologia , República Dominicana/etnologia , Usuários de Drogas , Feminino , Hispânico ou Latino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Porto Rico/etnologia , Risco , Assunção de RiscosRESUMO
Hispanic patients were recruited from methadone maintenance treatment programs in 2005-2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey. Following training, they conducted outreach in their communities for 12 weeks. This paper describes the challenges encountered during the recruitment, training, and outreach phases of the project, from the field perspective. Recommendations for future efforts in training drug treatment patients as outreach workers are provided.
Assuntos
Relações Comunidade-Instituição , Usuários de Drogas , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Educação em Saúde , Seleção de Pessoal , Humanos , New Jersey , New York , Grupo Associado , Porto Rico/etnologia , Assunção de Riscos , Inquéritos e Questionários , MigrantesRESUMO
BACKGROUND: Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term "migrant" was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey). METHODS: A total of 290 drug users who had previously used drugs in PR were recruited in NY and New Jersey and interviewed regarding drug use history and HIV risk behaviors. RESULTS: Participants engaged in high risk behaviors, e.g., 39% shared injection paraphernalia and 62% reported unprotected sex. Multivariate analyses found that predictors of injection-related risk included being born in PR and purchasing drugs jointly with other drug users; predictors of sex-related risk included younger age and homelessness. DISCUSSION: Addressing risk reduction among those drug users who were born in Puerto Rico and are younger or homeless was indicated, and efforts to reach those at highest risk through NEPs was recommended.
Assuntos
Infecções por HIV/epidemiologia , Drogas Ilícitas/efeitos adversos , Assunção de Riscos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Migrantes/estatística & dados numéricos , Adulto , Feminino , Infecções por HIV/etiologia , Humanos , Masculino , Análise Multivariada , Porto Rico/etnologia , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Estatística como Assunto , Transtornos Relacionados ao Uso de Substâncias/complicações , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: This study examined gender-specific effects of social bonds, network characteristics, and other factors on drug treatment enrollment among Puerto Rican drug users. METHOD: Participants (425 women; 1,374 men) were recruited in New York and Puerto Rico in 1998-2003. RESULTS: 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. CONCLUSION: 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.
Assuntos
Apoio Social , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Escolaridade , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Metadona/uso terapêutico , Entorpecentes/uso terapêutico , New York/epidemiologia , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Porto Rico/etnologia , Fatores Sexuais , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto JovemRESUMO
Biculturality refers to two independent processes of acculturation, one to the host society's culture and another to the culture of origin. This study examined the relationship between biculturality and HIV-related risk behaviors in a sample of injecting and noninjecting Puerto Rican drug users (N = 259), recruited in New York City in 2005-2006. Biculturality was measured by two scales: involvement in (i) American culture (AMBIC) and (ii) Puerto Rican culture Biculturality (PRBIC). The majority (78%) of the participants were males, with a mean age of 42 years. About half were born in Puerto Rico, and the average length of stay in the United States was 26 years. In multiple logistic-regression analysis, AMBIC was significantly related to lower injection risk after controlling for other factors including gender, age, and MMTP enrollment, while PRBIC was a significant predictor of higher sex risk. Involvement in the host culture and the culture of origin differed in their relationship to risk behaviors, indicating that incorporating assessments of biculturality may be useful in assessing and addressing migrants' behaviors, including HIV-risk behaviors. The study's limitations have been noted.
Assuntos
Infecções por HIV/etnologia , Infecções por HIV/psicologia , Hispânico ou Latino/psicologia , Assunção de Riscos , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Aculturação , Adulto , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Porto Rico/etnologia , AutoeficáciaRESUMO
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.
Assuntos
Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Estudos Transversais , Feminino , Hispânico ou Latino , Humanos , Estudos Longitudinais , Masculino , New York/epidemiologia , Porto Rico/epidemiologiaRESUMO
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
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.
Assuntos
Abuso de Substâncias por Via Intravenosa/reabilitação , Adolescente , Adulto , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Masculino , Análise Multivariada , Cidade de Nova Iorque , Prognóstico , Porto Rico/etnologiaRESUMO
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.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Infecções por HIV/etnologia , Hispânico ou Latino/psicologia , Dinâmica Populacional/estatística & dados numéricos , Assunção de Riscos , Viagem/estatística & dados numéricos , Adolescente , Adulto , Análise de Variância , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Hispânico ou Latino/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Porto Rico/etnologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/etnologia , Abuso de Substâncias por Via Intravenosa/virologia , Inquéritos e Questionários , Migrantes/estatística & dados numéricos , Sexo sem Proteção/etnologiaRESUMO
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.
Assuntos
Abuso de Substâncias por Via Intravenosa/etnologia , Abuso de Substâncias por Via Intravenosa/mortalidade , Adulto , Fatores Etários , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Fatores Sexuais , Fatores SocioeconômicosRESUMO
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
This study compared the associations between social support and HIV injection risk among Puerto Rican migrant (n = 221) and nonmigrant (n = 340) injection drug users in New York City. Practical and emotional support scales were developed from 8 items and examined by migrant status as predictors of risk. Bivariate and regression analysis were conducted with drug shooting gallery use, sharing needles, paraphernalia, and number of monthly injections as dependent variables. Migrants had lower emotional (2.82 vs. 3.19, p = .002) and practical (1.87 vs. 2.05; p = .051) support than nonmigrants. Controlling for age, sex and homelessness, emotional support was negatively associated to injection frequency and (standardized coefficient = -.168, p = .020) gallery use (adjusted odds ration [AOR] = .76, confidence interval [CI] = .62-.94, p = .011) among migrants and to an almost two fold increase in sharing syringes (AOR= 1.87, CI = 1.02-3.43; p = .041) among nonmigrants. The findings suggest that though migrants have less support than nonmigrants do, their support reduces risk and thus their likelihood of injection-related HIV infection.
Assuntos
Infecções por HIV , Assunção de Riscos , Apoio Social , Abuso de Substâncias por Via Intravenosa , Migrantes/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Cidade de Nova Iorque , Porto Rico/etnologiaRESUMO
This paper reports findings on 334 out-of-treatment drug users in Puerto Rico and 617 in New York City, at the 6-month follow-up interview of a Longitudinal Survey. Main outcomes were health care and drug treatment utilization since baseline, assessed by asking participants if they had received physical or mental health services (including HIV medications), and if they had been in methadone maintenance, inpatient or outpatient drug treatment, or drug treatment while incarcerated. Chi-square tests were used to evaluate associations between gender and the various correlates. Logistic regression was used to calculate the contribution of each variable in predicting use of drug treatment. The analysis suggests that women in both sites were likely to suffer from disparities in both health care and drug treatment utilization when compared with men, albeit women in New York utilized more drug treatment resources and were more embedded in the immediate family than their female peers in Puerto Rico. Further research to specify the impact of contextual factors at the organizational and community levels, among members of the same ethnic group residing in different sites, may prove valuable in identifying the health needs and the factors that impede or facilitate drug-using women in obtaining the most appropriate treatment. Findings from these studies can help in developing appropriate public health policy and science-based drug treatment programs to eliminate disparities such as the ones detected in this study.
Assuntos
Acessibilidade aos Serviços de Saúde , Hispânico ou Latino , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Cidade de Nova Iorque , Porto Rico/etnologiaRESUMO
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.
Assuntos
Infecções por HIV/transmissão , Prisioneiros , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/complicações , Adolescente , Adulto , Feminino , Humanos , Masculino , New York , Prisões , Porto Rico , Comportamento SexualRESUMO
Migrant populations have been found to be at risk of HIV/AIDS. The growth in immigrant and migrant Hispanic populations in the United States increases the need to enhance understanding of influences on their HIV-risk behaviors. Four challenges to conducting research among these populations were identified: (1) the need to use multilevel theoretical frameworks; (2) the need to differentiate between Hispanic subgroups; (3) challenges to recruitment and data collection; and (4) ethical issues. This article describes how two studies of Hispanic immigrants and migrants in the New York area addressed these challenges. One study focused on new immigrants from Mexico, the Dominican Republic, El Salvador, Honduras and Guatemala, and a second study focused on Puerto Rican drug users. Both studies incorporated qualitative and quantitative methods to study these hard-to-reach populations. Continued study of the sociocultural and contextual factors affecting HIV risk for mobile populations, and addressing the research challenges, is crucial to developing effective intervention programs.
Assuntos
Atitude Frente a Saúde/etnologia , Emigração e Imigração , Infecções por HIV/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Hispânico ou Latino/psicologia , Migrantes , Adolescente , Adulto , Pesquisa Comportamental , Cultura , Hispânico ou Latino/classificação , Humanos , América Latina/etnologia , New York/epidemiologia , Porto Rico/etnologia , Projetos de Pesquisa , Fatores SocioeconômicosRESUMO
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.