Injection risk norms and practices among migrant Puerto Rican people who inject drugs in New York City

The limits of acculturation theory

C. Gelpí-Acosta, H. Guarino, E. Benoit, Sherry Deren, E. R. Pouget, A. Rodríguez

Research output: Contribution to journalArticle

Abstract

Background: Among people who inject drugs (PWID) in New York City (NYC), racial minorities are disproportionately infected with HIV and hepatitis C (HCV). Prior research has shown that PWID who started injecting drugs in Puerto Rico (P.R.) tend to maintain the risky injection behaviors learned there. This study identifies the P.R.-native norms supporting the continued injection risk behavior of migrant Puerto Rican PWID in NYC to inform a culturally appropriate risk-reduction intervention. Methods: 40 migrant Puerto Rican PWID were recruited in NYC for a longitudinal qualitative study. The sample was stratified to include 20 migrants with <3 years in NYC and 20 migrants with >3-6 years in NYC. Time-location sampling was used to curb possible network bias in recruitment. Over 12 months, migrants completed semi-structured interviews at baseline, monthly follow-ups, and study exit. Analyses were guided by grounded theory. Results: Most participants (90%) reported having had chronic HCV, and 22.5% reported being HIV-positive. Syringe- and cooker-/cotton-sharing were widespread in both P.R. and NYC. The ubiquitous practice of cleaning used syringes by “water-rinsing and air-blowing” was guided by a normative belief, learned in P.R., that “water and air kill HIV.” Sterile syringe use was not a priority. HCV was not a concern. P.R.-native abstinence-only narratives discouraged opioid agonist treatment (OAT) enrollment among recent migrants (≤3 years). Experiences with drug dealers, prison-power groups, and injection doctors (“Gancheros”) in P.R. influenced migrants’ injection risk behavior in NYC. Those who were Gancheros in P.R. continued working as Gancheros in NYC. Conclusions: Injection risks make migrant Puerto Rican PWID in NYC vulnerable to HIV/HCV. Harm reduction programs should pay closer attention to the rationales behind these injection risks. A risk-reduction intervention that incorporates the Ganchero figure may be a credible way to help migrants reduce injection risk and accept OAT and syringe exchange programs (SEP).

Original languageEnglish (US)
Pages (from-to)60-69
Number of pages10
JournalInternational Journal of Drug Policy
Volume69
DOIs
StatePublished - Jul 1 2019

Fingerprint

Acculturation
Puerto Rico
Hispanic Americans
Injections
Pharmaceutical Preparations
Syringes
HIV
Risk Reduction Behavior
Risk-Taking
Opioid Analgesics
Needle-Exchange Programs
Air
Harm Reduction
Water
Prisons
Hepatitis C
Longitudinal Studies
Interviews
Therapeutics

Keywords

  • HCV
  • HIV
  • Injection risks
  • Migrant
  • New York City
  • Overdose
  • Puerto Rican
  • PWID

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

Injection risk norms and practices among migrant Puerto Rican people who inject drugs in New York City : The limits of acculturation theory. / Gelpí-Acosta, C.; Guarino, H.; Benoit, E.; Deren, Sherry; Pouget, E. R.; Rodríguez, A.

In: International Journal of Drug Policy, Vol. 69, 01.07.2019, p. 60-69.

Research output: Contribution to journalArticle

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abstract = "Background: Among people who inject drugs (PWID) in New York City (NYC), racial minorities are disproportionately infected with HIV and hepatitis C (HCV). Prior research has shown that PWID who started injecting drugs in Puerto Rico (P.R.) tend to maintain the risky injection behaviors learned there. This study identifies the P.R.-native norms supporting the continued injection risk behavior of migrant Puerto Rican PWID in NYC to inform a culturally appropriate risk-reduction intervention. Methods: 40 migrant Puerto Rican PWID were recruited in NYC for a longitudinal qualitative study. The sample was stratified to include 20 migrants with <3 years in NYC and 20 migrants with >3-6 years in NYC. Time-location sampling was used to curb possible network bias in recruitment. Over 12 months, migrants completed semi-structured interviews at baseline, monthly follow-ups, and study exit. Analyses were guided by grounded theory. Results: Most participants (90{\%}) reported having had chronic HCV, and 22.5{\%} reported being HIV-positive. Syringe- and cooker-/cotton-sharing were widespread in both P.R. and NYC. The ubiquitous practice of cleaning used syringes by “water-rinsing and air-blowing” was guided by a normative belief, learned in P.R., that “water and air kill HIV.” Sterile syringe use was not a priority. HCV was not a concern. P.R.-native abstinence-only narratives discouraged opioid agonist treatment (OAT) enrollment among recent migrants (≤3 years). Experiences with drug dealers, prison-power groups, and injection doctors (“Gancheros”) in P.R. influenced migrants’ injection risk behavior in NYC. Those who were Gancheros in P.R. continued working as Gancheros in NYC. Conclusions: Injection risks make migrant Puerto Rican PWID in NYC vulnerable to HIV/HCV. Harm reduction programs should pay closer attention to the rationales behind these injection risks. A risk-reduction intervention that incorporates the Ganchero figure may be a credible way to help migrants reduce injection risk and accept OAT and syringe exchange programs (SEP).",
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