TY - JOUR
T1 - When “the Cure” Is the Risk
T2 - Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico
AU - Hernández, Diana
AU - Castellón, Pedro C.
AU - Fernández, Yohansa
AU - Torres-Cardona, Francisco A.
AU - Parish, Carrigan
AU - Gorshein, Danielle
AU - Vargas Vidot, Jose
AU - Miranda de Leon, Sandra
AU - Rodriguez, Allan
AU - Santana Bagur, Jorge
AU - Feaster, Daniel J.
AU - Schackman, Bruce R.
AU - Metsch, Lisa R.
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (R01DA035280) and the National Institute of Allergy and Infectious Diseases (P30AI073961). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies or the U.S. government.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - 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.
AB - 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.
KW - HIV
KW - Puerto Rico
KW - community-based interventions
KW - ethnography
KW - people who use drugs
KW - risk environments
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U2 - 10.1177/1090198117728547
DO - 10.1177/1090198117728547
M3 - Article
C2 - 28891344
AN - SCOPUS:85029849885
VL - 44
SP - 748
EP - 757
JO - Health Education and Behavior
JF - Health Education and Behavior
SN - 1090-1981
IS - 5
ER -