Oral human papillomavirus infection among drug users in Puerto Rico.

OBJECTIVE: The prevalence of human papillomavirus (HPV) in the oral cavity has not been as well studied as genital infection and its prevalence among drug users is uncertain. This study describes the prevalence and correlates of oral HPV infection among a sample of drug users in Puerto Rico (PR). METHODS: Cross-sectional study of 271 drug users aged 18-35 years, not undergoing substance abuse treatment, living in the San Juan metropolitan area. Oral samples were collected through an oral rinse and HPV infection status was detected through PCR and HPV typing. Information on covariates was obtained through face-to-face interviews and serum analyses. RESULTS: A total of 34 participants were positive for any HPV type (12.5%), whereas 13 individuals (4.8%) were positive for one of the 38 type-specific HPV probes evaluated. Among those HPV positive, the most common HPV type detected was non-oncogenic HPV 72 (11.8%, n = 4). Oncogenic HPV types detected were 35 (5.9%) and 56 (2.9%). Factors associated with oral HPV infection included binge drinking (OR = 3.85, 95% CI = 1.40, 10.58), HIV positivity (OR = 4.67, 95% CI = 1.58, 13.74) and ever having engaged in commercial sex (OR = 3.55, 95% CI = 1.46, 8.67); infection did not differ by age or gender. CONCLUSION: Consistent with previous studies in the genital and oral tract, HIV infection, alcohol abuse and commercial sex practices were strongly associated with oral HPV infection. Future studies should assess the implications of oral HPV infection on oral cancer risk in this population.

Polydrug use and attempted suicide among Hispanic adolescents in Puerto Rico.

This study was aimed at examining the relationship between suicidal attempts, polydrug use, and depression in adolescents. A sample of 691 adolescents and their parents were interviewed. Subjects who met the criteria for depression and those who used alcohol were significantly more likely to be suicidal attempters (OR = 6.8, p < 0.001; OR = 7.5, p < 0.001). Polydrug users were significantly more likely to attempt suicide (OR = 8.8, p = 0.032). Adolescents with mothers who met the criteria for depression were more likely to report suicide attempts (OR = 2.4, p = 0.069). Health professionals need to screen for polydrug use and depression to prevent future suicidal behaviors.

Predictors of school dropout among adolescents in Puerto Rico.

OBJECTIVE: This research aims to understand the circumstances associated with school dropout in a cohort of Puerto Rican adolescents. METHODS: The study collected data from adolescents and their parents. Information related to school dropout among adolescents was obtained from the second year follow-up data from the longitudinal study funded by NIDA "Risky Families Embedded in Risky Environments" (Grant No. R01 DA 15301). Data was collected employing a self-administered and a face-to-face interview protocol. Prediction of school dropout was assessed throughout adolescent characteristics, family background, school experiences and behaviors. RESULTS: During the second follow-up, two years after the baseline assessment, approximately 6.2% of the adolescents reported dropping out from school. Logistic regression analysis indicates that older adolescents (OR = 6.6, 1.37-31.67), whose mother used drugs during pregnancy (OR = 4.9, 1.31-17.91), who reported high rates of absenteeism (OR = 4.8, 1.63-14.13), high school grade retention (OR = 3.7, 1.14-12.05), and attended school where teachers were attacked or wounded by students (O R =7.0, 1.44-34.17) were more likely to dropout of school. DISCUSSION: : These findings emphasize the need to further understand the effects of different elements of adolescents' environment such as family and school. It has been posited that dropping out of school is a process whose characteristics can be detected long before it occurs. The fact that students who dropout are more likely to report skip classes and grade retention can be relevant elements in prevention and early intervention for teachers and other school personnel.

Neighborhood disorganization, substance use, and violence among adolescents in Puerto Rico.

This study investigates the role of neighborhoods in adolescent violence in poor neighborhoods in San Juan, Puerto Rico. The study is part of a larger longitudinal project examining risk and resilience in adolescents' ages 12 to 15 years old and their caregivers. Using a cross-sectional design, a self-completion questionnaire, and an interviewer questionnaire, the authors assessed violent behaviors among participants across demographics, characteristics, and neighborhood social disorganization using the concepts of physical disorders and social disorder. Adolescent violence was positively associated with social disorder. The finding that adults in these neighborhoods walk around with visible firearms and engage in fighting, may have led adolescents to perceive that violence is an accepted behavior. Furthermore, socially disorganized neighborhoods might be less likely to organize on their own behalf because the occurrence of negative experience limits the amount of social support and resources that are available in the neighborhood.

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.

Severe anxiety symptomatology and HIV risk behavior among Hispanic injection drug users in Puerto Rico.

Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.

Prevalence and correlates of hepatitis C virus infection among street-recruited injection drug users in San Juan, Puerto Rico.

Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico.

Homelessness and HIV risk behaviors among drug injectors in Puerto Rico.

This report examines associations between homelessness and HIV risk behaviors among injection drug users (IDUs) in Puerto Rico. The study sample consisted of 557 IDUs who were not in treatment, recruited in inner-city neighborhoods of the North Metro Health Care Region. Subjects were categorized into three groups by residential status (last 30 days): housed, transitionally housed (living with friends, family, or others but considering themselves homeless), and on-the-street homeless (living on the street or in a shelter). Multiple logistic regression models were fitted to assess effects of residential status on each HIV risk behavior after adjusting for sociodemographic and drug-use related covariates. Transitionally housed and on-the-street homeless subjects made up 16% of the total sample. On-the-street homeless IDUs were more likely to test positive for HIV than were transitionally housed and housed IDUs. In the adjusted analysis, on-the-street homeless subjects were significantly more likely to share needles, share rinse water, and practice back loading than the other two groups. Sexual risk behaviors (last 30 days) were not significantly associated with residential status after adjustment. Findings from this study present an added challenge to drug treatment and HIV prevention and treatment programs, to provide services that can address the additional needs of drug users suffering the stressors of homelessness.

Factors associated with drug treatment dropout among injection drug users in Puerto Rico.

This study examined factors associated with drug treatment dropout among injection drug users (IDUs) in Puerto Rico, a group that has contributed significantly to the self-sustaining AIDS epidemic in the island since the mid-1980s. A total of 557 IDUs were recruited from communities in a semirural region of Puerto Rico, as part of a longitudinal study testing the efficacy of a two-facet intervention model, based on motivational interviewing. Of 124 IDUs who had entered drug treatment at follow-up, 33 (26.6%) dropped out before completing all recommended sessions. Multiple logistic regression analysis showed that age, homelessness, and speedball use were significantly associated with drug treatment dropout. Conversely, participants who received the two-facet intervention were significantly less likely to drop out of drug treatment. Receiving psychiatric services also reduced the odds of treatment dropout. Improving adherence to drug treatment and reducing dropout rates are complex processes that need to be addressed at the individual behavioral and social support levels, as well as the program process and resource levels.

HIV risk behaviors and alcohol intoxication among injection drug users in Puerto Rico.

This paper reports results of an analysis of the association between alcohol intoxication and injection and sexual HIV risk behaviors among 557 Hispanic heroin and cocaine injectors, not in treatment, who were recruited in poor communities in Puerto Rico. Subjects were part of a longitudinal prevention-intervention study aimed at reducing drug use and HIV risk behaviors. Participants reported a high prevalence of co-occurring conditions, particularly symptoms of severe depression (52%) and severe anxiety (37%), measured by Beck's Depression Index and Beck's Anxiety Index, respectively. Alcohol intoxication during the last 30 days was reported by 18% of participants. Associations were found between alcohol intoxication and both injection and sexual risk behaviors. In the bivariate analysis, subjects reporting alcohol intoxication were more likely to inject three or more times per day, pool money to buy drugs, share needles, and share cotton. They were also significantly more likely to have a casual or paying sex partner and to have unprotected sex with these partners. After adjustment, sharing needles and cotton, having sex with a paying partner or casual partner, and exchanging sex for money or drugs were significantly related to alcohol intoxication. HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors.

Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: a randomized controlled study.

This study examined the effectiveness of a combined counseling and case management behavioral intervention, using motivational interviewing strategies, in engaging Hispanic injection drug users in treatment and reducing drug use and injection-related HIV risk behaviors. Follow up data are presented on 440 (79.0%) of 557 randomized participants, 6 months after the initial interview. Subjects in the experimental arm were significantly less likely to continue drug injection independent of entering drug treatment, and were also more likely to enter drug treatment. Subjects in both arms who entered drug treatment were less likely to continue drug injection. Among subjects who continued drug injection, those in the experimental arm were significantly less likely to share needles. Confirming the outcomes of this study in other Hispanic sites and populations could be a critical step towards reducing factors that contribute to the self-sustaining HIV/AIDS epidemic in Puerto Rico and communities in the U.S. mainland.

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.

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.

Incarceration history as a risk factor for HIV infection among Puerto Rican injection drug users

This study assesses factors associated with incarceration history and HIV seropositivity among 1,700 out-of-treatment drug injectors recruited in Puerto Rico between 1989-1990 from health care centers, emergency rooms, copping areas, shooting galleries, bars, billiard rooms and street corners. Analysis links incarceration history with criminal involvement and chronic drug use. After controlling for sociodemographics and previously reported correlates of HIV status, regression analysis shows incarceration history significantly relates to HIV status. The only predictor of incarceration history not related to HIV status was illegal activity as a major source of income. Analysis emphasizes HIV prevention programs within the penal system

Human immunodeficiency virus infection and risk behaviors among injection drug users in four Puerto Rican communities

This study compares the prevalence of human immunodeficiency virus (HIV) infection and HIV risk behaviors among 1,702 injection drug users (IDUs) recruited within four catchment areas in metropolitan San Juan (79.9 per cent male and 20.1 per cent female). To assess the impact of different antecedent variables on intercommunity risk differences, we constructed separate logistic regression models for each one of the catchment areas in the analysis. Old San Juan/Santurce has the highest rate of HIV seropositivity. Furthermore, Old San Juan/Santurce IDUs were more likely to have had incarceration experience, to report using drugs only by injection, and to have been injecting drugs for 16 years or more. Also, this group was more likely to report practicing prostitution and to have been diagnosed with sexually transmitted diseases (STDs) than their peers from the other sites. The need of preventive programs in specific communities within metropolitan urban areas is discussed

HIV risk behaviors and HIV seropositivity among young injection drug users

Although injection drug use (IDU) is the major risk category for HIV infection in Puerto Rico and injection drug users start their drug injection careers very young, there is little information related to drug injection patterns of young IDUs. In this paper we report on factors found to be associated with HIV seropositivity among 255 young IDUs (16-24 years old). Overall, 23.5 per cent subjects were HIV seropositive. Being 22 to 24 years old, having dropped out of school, having a history of incarceration, and having been diagnosed with STDs, and initiating drug use injection before 17 years of age were the factors significantly related to HIV seropositivity. Findings suggest that prevention programs should begin early in the development of youngsters. Special HIV and STD preventive programs for youngsters at risk of leaving school before completing high school should be a priority

AIDS risk behavior patterns among intravenous drug users in Puerto Rico and the United States

En este análisis se entrevistaron y analizaron 385 usuários de droga intravenosas reclutados en varios vecindarios del área metropolitana de San Juan. Los usuarios de drogas intravenosas (UDI), independientemente de raza, grupo étnico o medio ambiente geográfico, continúan practicando conductas de riesgo para el contagio del virus de inmuodeficiencia humana (VIH). En general los UDI incluídos en este análisis son jóvenes. Sin embargo, se encontró que los grupos de puertorriqueños e hispanos tenían un nivel de escolaridad menor al de los blancos y negros de los Estados Unidos. El hecho de que casi la mitad de los UDI puertorriqueños reidiendo en los Estados Unidos Continentales reportaran actividades ilegales como fuente de ingreso, sorprendió a los investigadores. Tal y como fuera hipotetizado, casi la mitad de los UDI puertorriqueños en la isla informaron vivir con sus padres. Los UDI en la isla de Puerto Rico continúan practicando conductas de riesgo, se inyectan drogas y utilizan los "hospitalillos" con más frecuencia y son menos propensos a desinfectar las agujas y a utilizar condone que los UDI puertorriqueños, blancos y los negros que residen en los Estados Unidos. Los UDI son el grupo de mayor riesgo para el contagio del síndrome de inmunodeficiencia adquirida (SIDA) entre los puertorriqueños que residen en Puerto Rico y en Estados Unidos. Los UDI son también el grupo con mayor riesgo de contagio heterosexual y la mayor fuente de contagio perinatal de la enfermedad. Por lo tanto, los recursos para prevenir el SIDA en Puerto Rico son más necesarios entre los UDI, donde el 44.5% de los sujetos han obtenido resultados positivos en la prueba del VIH