Higher HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Now that HIV prevention and treatment advances have reduced HIV among PWID in the US, researchers from New York University's Center for Drug Use and HIV Research (CDUHR) examined HIV-related data for PRPWID in Puerto Rico (PR) and Northeastern U.S. (NE) to assess whether disparities among PRPWID continue.
The study, "Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the Need for a Multi-Region Approach," published in the American Journal of Public Health (on-line ahead of print, Sept. 11, 2014) described 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 Dr. Sherry Deren, senior research scientist at NYU College of Nursing, and director of CDUHR. "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."
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. Furthermore, 48.7 percent of Hispanics in the U.S. 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 U.S. (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 over two times greater (20.4 percent) than in the rest of the U.S.
Despite the fact Puerto Ricans comprise only 9 percent of the U.S. Hispanic population, nearly 23 percent of HIV cases among Hispanics are among those born in Puerto Rico. Researchers also noted that heterosexual HIV transmission has now surpassed injecting-related HIV transmission in Puerto Rico (40.7 percent vs 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," cautions Deren.
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 transmissionis well established. The 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 the average budgets of those in Puerto Rico ($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," says Deren. "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."
The researchers note that the continuing ban on the use of U.S. federal funds toward needle exchanges contributes to the inability to grow such public health programs in Puerto Rico to meet the public health need. Additionally, while there are still gaps in drug treatment program availability across the US, Puerto Rico has been shown to have a narrower range of such services.
"In light of the lack of available resources in Puerto Rico, many individuals migrate to the North East seeking drug treatment," Deren notes. "Many of those coming to the Northeast, however, do not become engaged in evidence-based drug treatment."
The researchers recommend that these disparities, in addition to the many other challenges afflicting Puerto Rican people who inject drugs, be addressed by the development of a federally-supported Northeast/Puerto Rico collaborative initiative to facilitate and coordinate efforts throughout these regions. The researchers also emphasize the need for the development and implementation of culturally appropriate HIV prevention interventions.
This work was supported by the National Institute on Drug Abuse grant # P30DA011041 (Center for Drug Use and HIV Research), S. Deren, PI.