Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct;44(5):748-757.
doi: 10.1177/1090198117728547. Epub 2017 Sep 9.

When "the Cure" Is the Risk: Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico

Diana Hernández  1 , Pedro C Castellón  1 , Yohansa Fernández  1 , Francisco A Torres-Cardona  2 , Carrigan Parish  1 , Danielle Gorshein  1 , Jose Vargas Vidot  2 , Sandra Miranda de Leon  3 , Allan Rodriguez  4 , Jorge Santana Bagur  5 , Daniel J Feaster  4 , Bruce R Schackman  6 , Lisa R Metsch  1
Affiliations

When "the Cure" Is the Risk: Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico

Diana Hernández et al. Health Educ Behav. 2017 Oct.

Abstract

Background: Substance use, particularly injection drug use, continues to fuel the HIV/HCV (hepatitis C virus) epidemics in San Juan, Puerto Rico (PR).

Aim: This article examines individual and sociostructural factors that affect HIV/HCV risk among people who use drugs (PWUD) living with or at risk for HIV/HCV in San Juan, PR. Findings were used to inform a community-level intervention to enhance HIV care access and retention for this population.

Method: A rapid ethnographic assessment in collaboration with a community-based organization was conducted. Data collection took place between June and December 2013 and included field observations, 49 unstructured interviews with PWUD, and 19 key informant interviews with community stakeholders. Fieldnotes, photographs, and interview transcripts were analyzed for recurrent themes and to address the intervention-planning needs. Study results are presented as fieldnote excerpts, direct quotes from interviews, and photographs.

Results: Findings suggest that PWUD in PR face myriad challenges that affect HIV/HCV risk and hinder linkage to and retention in care. Results describe a layered risk environment where PWUD encounter many barriers to prevention, care, and treatment such as transience, social isolation, stigma, limited housing options, and inadequate medical and substance use disorder treatment services.

Discussion: These observed circumstances provide an empirical basis for the development and evaluation of comprehensive interventions that may serve to reduce barriers to care and link individuals to other supportive services.

Conclusion: New approaches and comprehensive interventions are needed to break the structures that perpetuate risk and lack of engagement and retention in HIV care and substance use disorder treatment in San Juan.

Keywords: HIV; Puerto Rico; community-based interventions; ethnography; people who use drugs; risk environments.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests

The Authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Map of Designated Study Areas in the San Juan MSA
Images 1-2
Images 1-2
Lesions on the skin, the physical evidence of injection drug use with Xylazine
Image 3
Image 3
“A cry for help” through many “signs” – the message and the physical manifestations of his addiction in the form of track marks and abscesses.
Image 4
Image 4
Rules posted in a shooting gallery
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Rourke SB. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. American Journal of Public Health. 2016;106(1):e1–e23. - PMC - PubMed
    1. Asencio Toro G, Burns P, Pimentel D, Sánchez Peraza LR, Rivera Lugo C. Using a Multisectoral Approach to Assess HIV/AIDS Services in the Western Region of Puerto Rico. American Journal of Public Health. 2006;96(6):995–1000. - PMC - PubMed
    1. Bourgois P. Just Another Night in a Shooting Gallery. Theory, Culture & Society. 1998;15(2):37–66.
    1. Carlson R, Wang J, Siegal H, Falck R, Guo J. An Ethnographic Approach to Targeted Sampling: Problems and Solutions in AIDS Prevention Research Among Injection Drug and Crack-Cocaine Users. Human Organization. 1994:279–286.
    1. Centers for Disease Control and Prevention (CDC) Incidence and diagnoses of HIV infection – Puerto Rico, 2006. MMWR. Morbidity and Mortality Weekly Report. 2009;58(21):589–591. - PubMed

Publication types