Diffusion of Effective Behavioral Interventions and Hispanic/Latino populations.

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.

Peer norms and sharing of injection paraphernalia among Puerto Rican injection drug users in New York and Puerto Rico.

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.

A longitudinal study of syringe acquisition by Puerto Rican injection drug users in New York and Puerto Rico: implications for syringe exchange and distribution programs.

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.

Drug treatment disparities among Hispanic drug-using women in Puerto Rico and New York City.

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.

HIV transmission behaviors in jail/prison among puerto rican drug injectors in New York and Puerto Rico.

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.

Egocentric HIV risk networks among Puerto Rican crack users in New York and in Puerto Rico: impact on sex risk behaviors over time.

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.

HIV incidence among high-risk Puerto Rican drug users: a comparison of East Harlem, New York, and Bayamón, Puerto Rico.

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.

Determinants of health care use among Puerto Rican drug users in Puerto Rico and New York City.

This study was conducted to identify factors accounting for differences in health care and drug treatment utilization between Puerto Rican drug users residing in 2 separate locations. Survey findings from 334 drug users in Puerto Rico and 617 in New York City showed that those in Puerto Rico were 6 times less likely than their counterparts in New York to have used inpatient medical services and 13 to 14 times less likely to have used outpatient medical services or methadone. They also were less likely to have health insurance or past drug treatment. After site was controlled for, health insurance and previous use of physical or mental health services remained significant predictors of health care and drug treatment utilization during the study period. Although Puerto Rican drug users in Puerto Rico are not an ethnic minority, they reported significant disparities in health services use compared with Puerto Rican drug users in New York.

Puerto Rican drug users experiences of physical and sexual abuse: comparisons based on sexual identities.

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.

The use of the Puerto Rican Biculturality Scale with Puerto Rican drug users in New York and Puerto Rico.

This study examines the psychometric properties of an acculturation scale specifically developed for Puerto Ricans with a sample of substance abusers residing in Puerto Rico and New York. In line with current conceptual models of acculturation, this instrument departs from a mutually exclusive or zero-sum conceptualization of acculturation by assessing involvement in both American and Puerto Rican cultures independently of each other. Findings from this study permitted comparisons of acculturation as experienced by Puerto Rican injection drug users in Puerto Rico and New York. Results supported the notion of independence of individuals' involvement in American and Puerto Rican cultures, thus confirming the complex nature of biculturalism. This article also examines the relevance of the study of acculturation scales that can assist in identifying the influences of the cultures of origin and destination on substance abuse and HIV risk behaviors.

Migration and HIV risk behaviors: Puerto Rican drug injectors in New York City and Puerto Rico.

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.

The utility of the PRECEDE model in predicting HIV risk behaviors among Puerto Rican injection drug users.

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.

Drug-scene roles and HIV risk among Puerto Rican injection drug users in East Harlem, New York and Bayamón, Puerto Rico.

This article describes and compares distributions of drug-scene roles, frequency of engaging in role behaviors, and relationships of role-holding to high-risk behaviors and sexual partnerships among Puerto Rican injection drug users in New York and Puerto Rico. For this study 561 street-recruited injection drug users in East Harlem, New York, and 312 in Bayamón, Puerto Rico were asked the number of days (in the last 30) in which they earned money or drugs in each of seven drug-scene roles; and about behaviors and egocentric risk partner characteristics in the last 30 days. East Harlem subjects were more likely to get resources by selling drugs and syringes, and buying drugs for someone else; Bayamón subjects were more likely to be "hit doctors," buy needles for others, operate a shooting gallery, or escort others to shooting galleries. All roles were part-time except shooting gallery management in East Harlem. About 27% of respondents at each site engaged in two or more roles. Many roles were associated with increased odds of injecting more than twice a day, receptive syringe sharing, distributive syringe sharing, receptive paraphernalia sharing, and having a drug-injecting sex partner. Drug-scene role structures vary between cities. Most roles are part-time pursuits. Role-holders have higher-risk behaviors and sexual partnerships than other drug injectors. Although further research is needed, drug-scene role-holders should be targeted for interventions to affect their own risk and their communications with others.