Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City

ABSTRACT

Background: Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites. Objective: Understand the persistence of these HIV behaviors. Methods: In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression. Results: A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants. Conclusions: The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.

KEYWORDS:

• Puerto Rican
• immigrants
• HIV
• syringe sharing
• acculturation
• enculturation

Additional information

Notes on contributors

Camila Gelpí-Acosta

Camila Gelpí-Acosta received her PhD in Sociology from the New School University in 2013. Her dissertation explores the experiences of street heroin users with different narratives that define addiction as a “disease.” These data led to her “Junkie habitus” theory, which has appeared in a number of manuscript publications and academic conference presentations. She also consults in an RO1 (R01DA037117) studying infectious diseases among rural injectors in Puerto Rico. In 2014, she was appointed as Assistant Professor at LaGuardia/CUNY, Criminal Justice Program. She also collaborates with El Punto en la Montaña, a syringe exchange program in Puerto Rico.

Enrique R. Pouget

Enrique R. Pouget is an epidemiologist whose work is focused on social determinants of health and health disparities, mental disorders, substance use, HIV, other sexually transmitted infections and hepatitis C. He is an experienced methodologist and quantitative analyst, with expertise in scale development, clinical trials, process and systems modeling, and mixed effects modeling. He is Contact Principal Investigator of “Developing measures to study how structural interventions may affect HIV risk” (R01 DA031597), which is developing measures of pathways by which structural interventions can change the size of the population of susceptibles, and affect HIV outbreaks and epidemics.

Kathleen H. Reilly

Kathleen H. Reilly is the Project Director of the NYC National HIV Behavioral Surveillance System at the NYC Department of Health and Mental Hygiene. Dr. Reilly's research has focused on behavioral epidemiology of HIV both in the United States and internationally.

Holly Hagan

Holly Hagan, PhD, is a Professor at NYU College of Nursing and Co-Director of the NIH Center for Drug Use and HIV Research. She holds a PHD in Epidemiology from the University of Washington School of Public Health and Community Medicine. Her research has focused on the infectious disease consequences of substance use, and reducing hepatitis C in people who inject drugs. Her NIH RO1 uses methods of implementation to optimize HCV control strategies in the United States. She is a member of the WHO Global Burden of Disease Study Diseases and Injuries Group, and served on the Institute of Medicine Committee on the Prevention and Control of Viral Hepatitis.

Alan Neaigus

Alan Neaigus, PhD (Sociology), was, until recently, the Director of Research in the HIV Epidemiology Program at the New York City Department of Health and Mental Hygiene. He is an Adjunct Associate Professor in the Department of Epidemiology at the Mailman School of Public Health, Columbia University, and is also an independent research consultant. For over 25 years he has conducted research on HIV/AIDS among injecting and noninjecting drug users and in other at-risk populations in New York City, Newark (NJ), and elsewhere in the USA and internationally. He has also conducted research on the factors associated with the initiation and resumption of injecting among noninjecting drug users. He has authored or co-authored numerous publications in peer-reviewed journals.

Travis Wendel

Travis Wendel, JD, PhD, is an ethnographer working with marginalized populations in NYC since 1996, is Research Director of St. Ann's Corner of Harm Reduction in the Bronx, and Principal Investigator of a CDC-funded ethnographic study of prescription opioid and heroin markets in Vermont. From 2004 to 2013, he was Project Director, Co-Investigator, and Principal Investigator on the CDC's NYC National HIV Behavioral Surveillance study. He has also been funded by NIJ, NIDA, and NSF. Dr. Wendel's research interests center on the roles of social networks in illicit drug markets, and the harms caused by drug criminalization. His favorite color is green.

David M. Marshall

David M. Marshall IV graduated Summa Cum Laude and as class Salutatorian from John Jay College of Criminal Justice, with a major in Deviance and Culture Studies and minors in Gender Studies and Forensic Psychology. David authored a paper titled “Methamphetamine Use and Mental Health,” which led to his work with the National Institute of Justice, the Social Justice Sexuality Initiative, the NYC National HIV Behavioral Surveillance (Centers for Disease Control and Prevention), and the Center for HIV Educational Studies and Training. David's publications focus on HIV prevention and transmission in relation to sexual orientation, drug misuse, and other factors.