Puerto Ricans who inject drugs at high risk for HIV

Despite the fact Puerto Ricans comprise only 9 percent of the US Hispanic population, nearly 23 percent of HIV cases among Hispanics are people born in Puerto Rico, says Sherry Deren. "Injection drug use as a risk for HIV continues to be over-represented among Puerto Ricans." (Credit: Markus Grossalber/Flickr)

Puerto Rican people who inject drugs and live in the Northeast United States and in Puerto Rico are among Latinos at the highest risk of contracting HIV.

A new study suggests that the development of a coordinated, multi-region campaign should be integrated into any effort to end the HIV/AIDS epidemic.

Higher HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs since early in the HIV epidemic.

The new research, published online in the American Journal of Public Health, describes the epidemic and the availability of HIV prevention and treatment programs in areas with a high concentration of Puerto Ricans, in order to provide recommendations to reduce HIV in the population.

“We reviewed HIV-related data for PRPWID living in Puerto Rico and Northeastern US, which contains the highest concentration of Puerto Ricans out of any US region,” says Sherry Deren, senior research scientist at New York University College of Nursing, and director of the Center for Drug Use and HIV Research.

“Injection drug use as a risk for HIV continues to be over-represented among Puerto Ricans. Lower availability of HIV prevention tools (syringe exchange and drug treatment) and ART treatment challenges, for PWID in PR, contribute to higher HIV risk and incidence for PRPWID in both locations.”

Most new infections in US Northeast

In 2010, the Northeast had the highest reported rates of new AIDS diagnoses, with Hispanics accounting for 27 percent of those diagnosed in the region.

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Furthermore, 48.7 percent of Hispanics in the US with a diagnosis of HIV were located in the Northeast.  The Northeast also had more new infections attributed to injection drug use (15.8 percent) than other regions of the US (8.8 percent).  As prevalent as this was in the Northeast, in 2010 the rate of HIV diagnoses attributed to injection drug use in Puerto Rico was more than two times greater (20.4 percent) than in the rest of the US.

Despite the fact Puerto Rican people comprise only 9 percent of the US Hispanic population, nearly 23 percent of HIV cases among Hispanics are among those born in Puerto Rico. Researchers also note that heterosexual HIV transmission has now surpassed injecting-related HIV transmission in Puerto Rico (40.7 percent versus 20.4 percent).

“Controlling heterosexual transmission of HIV will require controlling HIV infection among people who inject drugs, as those who inject drugs and are sexually active will serve as a continuing reservoir for future heterosexual transmission if injecting-related HIV transmission is not brought under control,” Deren says.

Needle exchange

Syringe exchange and drug treatment programs are the two primary methods responsible for reducing the rate of infection among people who inject drugs. The efficacy of such programs in reducing HIV transmission is well established, but evidence indicates that these services are much less available in Puerto Rico.

In a 2011 survey of syringe exchange programs in the Northeast and Puerto Rico, the researchers found that the annual budget for such programs in the Northeast averaged more than $400,000, more than five times of those in Puerto Rico where the average budget is $80,000.

“The differences in the annual budgets have very important implications for reducing HIV transmission and other health problems among people who inject drugs,” Deren says.  “Larger budgets for such programs allows for a greater number of syringes to be exchanged, and for programs to offer other services in addition to the exchange, such as HIV screenings.”

Continuing the ban on the use of US federal funds towards needle exchanges contributes to the inability to add such public health programs in Puerto Rico.  Additionally, while there are still gaps in drug treatment program availability across the US, Puerto Rico has a narrower range of such services.

“In light of the lack of available resources in Puerto Rico, many individuals migrate to the Northeast seeking drug treatment,” Deren says.  “Many of those coming to the Northeast, however, do not become engaged in evidence-based drug treatment.”

To deal with the problem, the researchers call for the development of a federally supported Northeast/Puerto Rico collaborative initiative and emphasize the need for the development and implementation of culturally appropriate HIV prevention interventions.

The National Institute on Drug Abuse supported the study.

Source: New York University