Social and economic factors associated with recent and lifetime incarceration among Puerto Rican drug users.

Using a sample of 280 Puerto Rican drug users with a history of incarceration residing in Massachusetts, we explore whether a significant association exists between social and economic factors (maintaining social network contacts, receiving public assistance) and lifetime incarceration. Analysis of survey data using regression methods shows that respondents who live in their own home, receive public assistance, and have recent familial contact are significantly less likely to have been incarcerated in the past 6 months. Among study participants, men and those who initiated heroin use at younger ages are more likely to have greater lifetime incarceration totals. Practice implications are discussed.

The association between acculturation and needle sharing among Puerto Rican injection drug users.

BACKGROUND: Base-line data from a community-based HIV outreach effort serving Puerto Rican injection drug users (IDUs) in Massachusetts identified that approximately half of their clients were born on the mainland and half on the island. METHODS: Logistic regression methods examined the relationship between place of birth, primary language spoken, primary residence of family and needle sharing for a sample of 200 Puerto Rican IDUs residing in Massachusetts. Focus groups were used to interpret quantitative findings. RESULTS: A logistic regression model indicated that Puerto Rican IDUs born on mainland USA were 2.1 times more likely to share needles than IDUs born in Puerto Rico, after controlling for gender, age, education, drug overdose, incarceration history and psychiatric status. Also, Puerto Rican IDUs who were older had overdosed on drugs in the past year, had been incarcerated in their lifetime, and were homeless were significantly more likely to report having shared needles in the past 6 months compared to their counterparts. Focus group interviews with Puerto Rican outreach workers and individuals in recovery suggested that differences in needle sharing by mainland versus island born IDUs may be due to cultural differences in interpretation of the interview questions. IMPLICATIONS: Researchers examining HIV risk behaviors among culturally diverse substance abusers need to conduct more mixed-method studies to identify if different cultural groups understand quantitative measures differently. Incarceration may be a significant risk factor in the continued spread of HIV among IDUs and expanded HIV prevention efforts need to be developed that specifically target this high-risk group.

Factors associated with emergency room use among injection drug users of African-American, Hispanic and White-European background.

This study examined the relationship between substance abuse treatment use, health services use, HIV status, and emergency room/hospital use for 507 injection drug users (IDUs). Logistic regression models showed that mental health status, severity of drug use and private health insurance were significantly associated with having used emergency room/hospital services in the past six months. History of substance abuse treatment use, positive HIV/AIDS diagnosis, mental health service use, ethnic/racial background, gender, age, education and homelessness were not significant at either the bivariate or the multivariate level. These results point to the need to improve mental health screening and referrals through emergency room medical systems.

Preclinical and clinical performance of the Efoora test, a rapid test for detection of human immunodeficiency virus-specific antibodies.

Barriers to effective diagnostic testing for human immunodeficiency virus type 1 (HIV-1) infection can be reduced with simple, reliable, and rapid detection methods. Our objective was to determine the accuracy, sensitivity, and specificity of a new rapid, lateral-flow immunochromatographic HIV-1 antibody detection device. Preclinical studies were performed using seroconversion, cross-reaction, and interference panels, archived clinical specimens, and fresh whole blood. In a multicenter, prospective clinical trial, a four-sample matrix of capillary (fingerstick) whole-blood specimens and venous whole blood, plasma, and serum was tested for HIV-1 antibodies with the Efoora HIV rapid test (Efoora Inc., Buffalo Grove, IL) and compared with an enzyme immunoassay (EIA) (Abbott Laboratories) licensed by the Food and Drug Administration. Western blot and nucleic acid test supplemental assays were employed to adjudicate discordant samples. Preclinical testing of seroconversion panels showed that antibodies were often detected earlier by the rapid test than by a reference EIA. No significant interference or cross-reactions were observed. Testing of 4,984 archived specimens yielded a sensitivity of 99.2% and a specificity of 99.7%. A prospective multicenter clinical study with 2,954 adult volunteers demonstrated sensitivity and specificity for the Efoora HIV rapid test of 99.8% (95% confidence interval [CI], 99.3 and 99.98%) and 99.0% (95% CI, 98.5 and 99.4%), respectively. Reactive rapid HIV-1 antibody detection was confirmed in 99.6% of those with a known HIV infection (n = 939), 5.2% of those in the high-risk group (n = 1,003), and 0.1% of those in the low-risk group (n = 1,012). For 21 (0.71%) patients, there was discordance between the results of the rapid test and the confirmatory EIA/Western blot tests. We conclude that the Efoora HIV rapid test is a simple, rapid assay for detection of HIV-1 antibodies, with high sensitivity and specificity compared to a standardized HIV-1 EIA.