Hepatitis C in Puerto Rico: a time for public health action

Studies investigating the seroprevalence of HCV infection have been carried out in diverse populations, showing an estimated worldwide prevalence of 3%. A seroprevalence survey conducted among randomly selected non-institutionalized adults aged 21-64 years in San Juan, Puerto Rico in 2001-2002 revealed that 6.3% were positive for HCV antibodies. These data suggest that Puerto Ricans are burdened with a significantly greater prevalence of HCV infection compared to the general United States population aged 20-69 years (0.9%-4.3%). This article illustrates data from different sources that taken together establish the need to start addressing HCV infection in Puerto Rico with prompt and decisive public health actions. Some of these include (1) establish hepatitis C prevention as a priority for state and municipal public health authorities, (2) raise awareness and educate target populations about HCV transmission and prevention, (3) increase clinician awareness of the HCV reporting system and the epidemiology and management of hepatitis C, (4) increase availability of diagnosis and treatment facilities, (5) increase access to effective drug treatment services, and (6) develop appropriate control measures to help reduce continued transmission in correctional settings.

Gender differences in drug use and sexual risk behaviors among non-injecting heroin users in Puerto Rico

INTRODUCTION: During the 1990s non-injected heroin use (NIHU) increased notably in several countries. However, very few studies have examined the drug-using practices and other problem behaviors of NIHUs. In this study, we compared male and female NIHUs from Puerto Rico across a number of domains. METHODS: Recruitment proceeded through visits to drug-copping areas and the local hangouts in their vicinity. Subjects were eligible if they were 18 to 25 years old, had never injected any drugs, and had recently used heroin or cocaine. Study participants were administered a computer-assisted personal interview. RESULTS: Of the 412 NIHUs recruited at the time of this study, 74 (18.0%) were females. Female NIHUs were more likely to report sexual assaults and more likely to manifest severe symptomatology of post-traumatic stress disorder than male NIHUs (35.1% vs. 3.6%, p<.01, and 40.5% vs. 25.7%, p=.01, respectively). Females were less likely to report a source of emotional support than males (86.5% vs. 95.3%, p<.01). Close to one in four of the females (23.0%) reported a history of sexually transmitted infections, compared to three percent of the males (p<.01). HIV seroprevalence among females was 4.3% compared to 0.6% among males (p=.01). DISCUSSION: Female heroin users seem to present a host of different needs compared to male heroin users. Given the scarcity of existing programs for female drug users in Puerto Rico, designing supportive systems that effectively address the specific needs of drug-using women should become a high-priority public health issue.

Correlates of early sexual activity among Hispanic children in middle adolescence

OBJECTIVE: We analyzed early sexual activity among Hispanic 14 to 15-year-old adolescents residing in a poor neighborhood in Puerto Rico. METHODS: Information from a sample of 325 adolescents was collected from a randomized sample of community households. Logistic regression analysis was used to identify the variables that help explained adolescents' sexual behavior. RESULTS: Adolescents whose parents reported poor communication and poor parent control were more likely to engage in early sexual activity that those peers that did not report this type of family relationship. Adolescents who reported poor parent bonding and lack of discipline were more likely to engage in early sexual relationships. CONCLUSIONS: Intervention and prevention programs need to be aware and address the role of the Hispanic culture in gender differences in early sexual activity in adolescence. If sexual norms related to gender role are changing in Puerto Rico, is a question that needs to be answered in future research.

Risk and protective factors associated with youth violence among secondary school students in a nationally representative sample in Puerto Rico

During the past decade, youth violence has received increasing attention as a major public health issue in Puerto Rico as well as in the United States. This study sought to identify risk and protective factors of youth violence in a representative sample of school adolescents in Puerto Rico. Risk and protective factors were grouped into five domains: individual, family, peer group, school and community. From a total of 2,385 participants, 10.7 reported at least one violent behavior and 3.4 reported two or more violent behaviors. In multiple regression analysis the risk factors identified were male gender, junior grade students, having a favorable attitude towards antisocial behavior, use of ecstasy, involvement with antisocial peers and reporting antisocial parents. Participation in family decisions was the only protective factor associated with violence. Findings from this study could have important implications for the development of preventive programs for the adolescent population in Puerto Rico

Mortality among Hispanic drug users in Puerto Rico

This paper assesses mortality rate for a cohort of drug users in Puerto Rico compared with that of the Island's general population, examining causes of death and estimating relative risk of death. Date and cause of death were obtained from death certificates during 1998. Vital status was confirmed through contact with subjects, family, and friends. HIV/AIDS was the major cause of death (47.7%), followed by homicide (14.6%), and accidental poisoning (6.3%). Females had higher relative risk of death than males in all age categories. Not living with a sex partner and not receiving drug treatment were related to higher mortality due to HIV/AIDS. Drug injection was the only variable explaining relative risk of death due to overdose. Puerto Rico needs to continue developing programs to prevent HIV/AIDS among drug users. Special attention should be given to young women, who appear to be in greatest need of programs to prevent early mortality.

Prevalence and correlates of DSM-IV substance use disorders in Puerto Rico

We report the basic findings of a survey aimed at estimating rates of substance disorders in a probability sample of 4,709 household residents aged 15 to 64 years old. Lifetime use of alcohol was reported by 77.2, and 10.7 reported ever using illicit drugs. Overall, 14.7 of the sample met criteria for a lifetime substance disorder, and 4.9 for a past year disorder. The rates of lifetime disorders were 13.1 for alcohol and 4.1 for illicit drug. Past year abuse/dependence was 4.3 for alcohol and 1.3 for illicit drugs. Alcohol use disorders were associated with male gender, higher family annual income, being employed, and being married. Illicit drug use disorders were associated with male gender and younger age. Only 13.0 of respondents with a past year disorder reported using services for their disorder. A program of continuous monitoring of substance using disorders is critical to establishing and monitoring effective policies

El ambiente interno y externo del adolescente puertorriqueño en el uso del alcohol, las drogas y la violencia / Internal and external environment of the Puerto Rican adolescent in the use of alcohol, drugs and violence

PURPOSE: Identify risk factors associated to violent behavior among adolescent students. METHODS: A survey was conducted using a two-staged stratified cluster sampling design. It represents all junior and high school students of Puerto Rico. Students from 117 schools were administered an anonymous questionnaire. RESULTS: Alcohol use was reported by 78.7 of students, and 14 reported illegal drug use. About 25 committed one violent act during the previous year, and 22 committed two acts or more. Drug use, alcohol use, not getting along with their parents, being a male, school failure and drug use by siblings were identified as risk factors for violent behavior. Church attendance was identified as a protective factor. DISCUSSION: Primary physicians can play an important role in violence prevention through early identification of family violence

HIV/AIDS risk factors among adolescent students in Puerto Rico, 1994

PURPOSE: Identify several HIV risk behaviors among adolescent students. METHODS: The sample (n = 3,648) was selected using a two-staged stratified cluster sampling design, and weighted to represent all junior high and high school students. RESULTS: About 28.8 of the students reported ever having sexual activity. Less than half of the sexually active (44.5) used condoms during their last sexual activity; 27.6 used them always. Only 54.7 knew correctly > 75 of the HIV knowledge questions. A HIV risk scale was constructed using five risk factors. About 15.9 of the students did not have any risk factor, 36.2 had one, 47.9 had two or more. Males and high school students had significantly more risk factors. Half of the students will abstain from having sex next year because they don't want to get HIV/AIDS. CONCLUSIONS: It is important to implement effective HIV prevention programs for adolescents in order to change their attitudes and behaviors

Risk factors for shooting gallery use among drug injectors in Puerto Rico

Needle sharing is one of the principal risk behaviors leading to HIV transmission among injection drug users (IDUs). Shooting galleries, a social context where IDUs rent, share, and borrow needles, are locations usually found near drug markets. This study, which interviewed 1,700 IDUs from May 1989 to June 1990, assesses sociodemographic characteristics and HIV risk behaviors among shooting gallery users in Puerto Rico. Multivariate analyses showed that shooting gallery use is associated with speedball (a concoction of heroin and cocaine) injection, income from illegal activities and previous drug treatment. Shooting gallery users were more likely to rent, share, and borrow needles, and less likely to always use bleach and water to clean needles. Strategies to reduce shooting gallery use among drug injectors are discussed

Crack use in Puerto Rico: evidence of a recent epidemic

This study examines the prevalence of crack use among out-of-treatment drug users in the San Juan metropolitan area. Of the sample of 849 drug users, 310 (36.5 percent) were crack users only, 179 (21.1 percent) were drug injectors and crack users, and 360 (42.4 percent) were drug injectors only. To study the characteristics of crack users we selected the subjects who reported the use of crack only. Of the 310 subjects, 193 (62.3 percent) men and 117 (37.7 percent) women, the mean age was 29 years. Significant differences were observed by gender. Females reported higher education, living in a nuclear family, crack/cocaine as the first drug used, history of sexually transmitted diseases and higher rates of HIV seropositivity. Males were more likely to report income from illegal activities, incarceration, use of multiple drugs, and more years of drug use. Among those sexually active, females were more likely to practice unprotected vaginal sex, have multiple sex partners, engage in prostitution (exchange of sex for money and/or drugs) and use condoms

Mycobacterium tuberculosis infection among crack and injection drug users in San Juan, Puerto Rico

This study aims to determine the prevalence of Mycobacterium tuberculosis infection and its association with HIV and other health risk factors among drug users. A sample of 716 IDUs and crack users were enrolled from community sites. Consenting subjects were tested for HIV serum antibody status. Drug users with an unknown PPD status were administered a PPD skin test and an anergy panel of three antigens (Candida, mumps and tetanus). Overall, 68 (10.3 percent) were reactive to the PPD skin test, 240 (34.7 percent) were HIV positive and 195 (29.5 percent) showed cutaneous anergy. Participants infected with tuberculosis (TB) were more likely to be HIV seropositive, and to have a history of incarceration and residential drug treatment than those not infected. In addition, TB infection was more prevalent among intravenous drug users (IDUs) and shooting gallery managers. These findings suggest that drug users should be considered at high risk for TB and HIV infection. Innovative programs to monitor both infections among drug users are needed to arrest what can become a dual epidemic of HIV and TB in the near future

HIV/AIDS risk perception, HIV risk behaviors, and HIV seropositivity among injection drug users in Puerto Rico

This paper assesses the factors related to self perception of developing AIDS among a group of 1,568 Puerto Rican injection drug users (IDUs). Incarceration history, years of drug injection, sharing needles, renting and borrowing needles, sharing rinse water or cooker, and having an IDU sex partner yielded a moderate association with HIV/AIDS risk perception. Use of sterile needles, shooting drugs alone, having had previous treatment episodes, and all the variables related to health status were also moderately associated with HIV/AIDS risk perception. A logistic regression model based on backwards elimination procedure, which included statistically significant variables in the bivariate analyses, yielded the variables living with children, sex with an IDU partner, shooting drugs alone, perception of health, having had a sexually transmitted disease, and results of HIV testing as statistically significant (p < 0.05)