Immediate Impact of Hurricane Sandy on People Who Inject Drugs in New York City

Abstract

Over the eight months following Hurricane Sandy, of October 2012, we interviewed 300 people who inject drugs in New York City. During the week after the storm, 28% rescued others or volunteered with aid groups; 60% experienced withdrawal; 27% shared drug injection or preparation equipment, or injected with people they normally would not inject with; 70% of those on opioid maintenance therapy could not obtain sufficient doses; and 43% of HIV-positive participants missed HIV medication doses. Although relatively brief, a hurricane can be viewed as a Big Event that can alter drug environments and behaviors, and may have lasting impact. The study's limitations are noted and future needed research is suggested.

Keywords :

• people who inject drugs
• Hurricane Sandy
• disasters
• complex emergencies
• HIV
• Big Events

THE AUTHORS

Enrique Rodriguez Pouget, PhD, is an epidemiologist whose work is focused on social determinants of health and racial/ethnic health disparities. His research includes studies of mental disorders, substance use, and transmission of HIV and other infectious diseases. He is an experienced methodologist and quantitative analyst, with expertise in scale development and assessment; clinical trials; survival analysis; mixed effects modeling; meta analysis; and agent-based modeling.

Milagros Sandoval, BA, ethnographic data and analysis coordinator, has worked at the National Development and Research Institute, Inc. (New York, USA) since 1996 and has more than 20 years of community work experience with the high-risk population.

Georgios K. Nikolopoulos, PhD, has received a post-doctoral research fellowship from the International AIDS Society and the National Institute on Drug Abuse and is now leading the Transmission Reduction Intervention Project (principal investigator: Dr Samuel Friedman) in Athens, Greece. He earned a PhD in the epidemiology of infectious diseases at the School of Medicine of the Athens University in Greece and has served at the Greek public health agency for almost one decade, focusing on HIV surveillance. Dr. Nikolopoulos also has expertise in the conduct of systematic reviews and meta-analyses with useful contributions to the evolving domain of genetic epidemiology.

Samuel R. Friedman, PhD, is director of Infectious Disease Research at National Development and Research Institutes, Inc. and the director of the Interdisciplinary Theoretical Synthesis Core in the Center for Drug Use and HIV Research, New York City. Dr. Friedman is an author of about 450 publications on HIV/hepatitis C/STIs, and drug use epidemiology and prevention. Honors include an NIDA Avant Garde Award (2012), the International Rolleston Award of the International Harm Reduction Association (2009), the first Sociology AIDS Network Award for Career Contributions to the Sociology of HIV/AIDS (2007), and a Lifetime Contribution Award, Association of Black Sociologists (2005).

GLOSSARY

Backloading/piggybacking: Using an individual syringe to withdraw drugs from a common syringe containing drugs prepared for more than one person.

PWID: People who inject drugs.

Distributive (syringe or drug preparation equipment) sharing: Another person injecting with a syringe, or using drug preparation equipment (such as a drug container, filter, or rinse water) after it was used by the participant.

Receptive (syringe or drug preparation equipment) sharing: Injecting with a syringe, or using drug preparation equipment previously used to inject or prepare drugs by another person.

Notes

This relatively new term, introduced into the intervention literature by Friedman, Rossi, and Flom (2006), refers to major events such as mega-disasters, natural as well as man-made, famine, conflict, genocide, disparities in health, epidemics, mass migrations, economic recessions, etc. which effect adaptation, functioning, and quality-of-life of individuals as well as systems. Existential threat, instability, and chaos are major dimensions and loss of control over one's life is experienced.

The reader is reminded that the concepts of “risk factors,” “vulnerability” as well as “protective factors” are often noted in the literature without adequately noting their dimensions (linear, nonlinear; rates of development and decay; anchoring or integration, cessation, etc.), their “demands,” and the critical necessary conditions (endogenously as well as exogenously; from a micro- to a meso- to a macro-level) which are necessary for either of them to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to and whether their underpinnings are theory-driven, empirically based, individual and/or systemic stake holder-bound, based upon “principles of faith doctrinaire positions “personal truths,” historical observation, precedents and traditions that accumulate over time, conventional wisdom, perceptual and judgmental constraints, “transient public opinion,” or what. This is necessary to consider and to clarify whether these term are not to remain as yet additional shibboleth in a field of many stereotypes, tradition-driven activities, “principles of faith,” and stakeholder objectives. Editor's note.

³ The reader is reminded that “Hispanic” is an often used misleading ethnic nosology which “homogenizes” a broad range of heterogeneous peoples and processes such as identification, acculturation, cultural manifestations, etc. Editor's note

⁴ The reader interested in the complexities of “stakeholders,” their roles as barriers as well as enablers of needed interventions, their agendas, objectives, style of operation, sources of influence, etc. are referred to Thom, Duke, Frank, and Bjerge (2013). Editor's note.

⁵ The reader interested in this complex process and issue is referred to four stimulating analyses: Miller (2010), Ormerod (2005), and Tilly (2006, 2008). Editor's note.