Drug-Scene Roles and HIV Risk Among Puerto Rican Injection Drug Users in East Harlem, New York and Bayamón, Puerto Rico

Abstract

This article describes and compares distributions of drug-scene roles, frequency of engaging in role behaviors, and relationships of role-holding to high-risk behaviors and sexual partnerships among Puerto Rican injection drug users in New York and Puerto Rico. For this study 561 street-recruited injection drug users in East Harlem, New York, and 312 in Bayamón, Puerto Rico were asked the number of days (in the last 30) in which they earned money or drugs in each of seven drug-scene roles; and about behaviors and egocentric risk partner characteristics in the last 30 days. East Harlem subjects were more likely to get resources by selling drugs and syringes, and buying drugs for someone else; Bayamón subjects were more likely to be "hit doctors," buy needles for others, operate a shooting gallery, or escort others to shooting galleries. All roles were part-time except shooting gallery management in East Harlem. About 27% of respondents at each site engaged in two or more roles. Many roles were associated with increased odds of injecting more than twice a day, receptive syringe sharing, distributive syringe sharing, receptive paraphernalia sharing, and having a drug-injecting sex partner. Drug-scene role structures vary between cities. Most roles are part-time pursuits. Role-holders have higher-risk behaviors and sexual partnerships than other drug injectors. Although further research is needed, drug-scene role-holders should be targeted for interventions to affect their own risk and their communications with others.

Drug-related risks among street youth in two neighborhoods in a Canadian setting

“…While caution is warranted in the interpretation of univariate results, these data may suggest that the initiation of crystal methamphetamine by youth residing in the DTS signals an immersion into a street-based illicit drug scene, and may therefore represent a potential interventional point for the prevention of street entrenchment among youth. Taken alongside the findings of our multivariate analysis and previous qualitative work from our study setting, these results suggest that the DTS may be an introductory area for those youth drawn towards street-involvement and may uniquely facilitate transitions to the development of more intense risk behaviors as observed among youth in the DTES (21). This phenomenon may also be a product of the socio-historical context of drug use, illicit drug culture, and policy responses in the city of Vancouver.…”

“…That we observed non-significant risks for a variety of types of drug use as well as for involvement in drug dealing and the sex trade between street youth residing in the DTS and the DTES may suggest that interventions to reduce youth entrenchment in an open-air illicit drug market should take into consideration the role of adjacent neighborhood street scenes in influencing drug use patterns (21). Specifically, while we found that participants residing in the DTES were more likely than those in the DTS to report having a primary illicit income source, we found no significant differences in risk of drug dealing, as well as comparably high levels of this illicit activity, among individuals residing in both neighborhoods.…”

“…Preventing illicit drug scene entrenchment is critical to the reduction of a variety of severe health risks, and experts have therefore urged a greater focus on research into the prevention of injection drug use initiation (19). Street youth are at particularly high risk of drug scene entrenchment and related risk behaviors such as the initiation of injection drug use (20), and exposure to an adult illicit drug injection scene has previously been shown to be associated with a variety of health harms among this population (4, 21). …”

“…Locally, concern exists that the proximity of the DTS to the DTES, coupled with the mobility of the city’s street youth population across these distinct neighborhoods, may contribute to a process of normalization of more intense drug-related harms (21). This process of normalization could in turn lead to increased uptake of injection drug use and higher levels of street entrenchment among youth residing in both areas (in spite of the fact that open injection drug use is far less prevalent in the DTS than in the DTES) (29).…”

Injecting drug use is associated with HIV risk perception among Mexican Americans in the Rio Grande Valley of South Texas, USA

“…3, 5-10 Other studies have also focused specifically on Puerto Ricans. 7,[11][12] In general, these studies have demonstrated that an individual's perception of risk rather than actual risk such as IDU and non-IDU determine HIV infectionrelated behavior including unsafe sex. Therefore, a comprehensive and reliable methodology to assess risk perception among minority populations is necessary in reducing HIV incidence and prevalence.…”