The Alliance for Research in El Barrio and Bayamon (ARIBBA) study compared HIV-related injection and sex risk behaviors, HIV infection rates and mortality rates of 800 Puerto Rican injection drug users and crack smokers in East Harlem, New York with 399 of their counterparts in Bayamon, Puerto Rico. It is among the most comprehensive studies ever conducted on HIV risk behaviors among drug users in Puerto Rico.
The study’s methods included initial and follow-up structured interviews with participants, qualitative methods and HIV testing, and was conducted from 1996 to 2004.
To be eligible for the study, participants had to be a) 18 years of age or older, b) self-report as Puerto Rican and c) report injecting drugs or smoking crack within the past 30 days; drug use was confirmed through urinalysis.
1. High-risk drug injection.Drug users in Puerto Rico were more likely than participants in New York to practice high-risk drug injection.
2. Low rates of drug treatment. Participants in Puerto Rico were less likely to be in a methadone program or to receive drug treatment in prison.
3. Island-wide decline in the number of drug users in treatment. The number of drug users treated throughout Puerto Rico declined by 39% between 1998 to 2002.
4. Less access to clean syringes. Participants in Puerto Rico received significantly few syringes from needle exchange programs (NEPs than in NY.
5. High rates of unprotected sex. Participants in Puerto Rico were more likely to have unprotected sex with their main and casual sex partners.
6. Higher HIV infection and mortality rates. Participants in Puerto Rico who were HIV negative at the start of the study became infected at a higher rate. Mortality was also higher among participants in Puerto Rico.
The research participants in Puerto Rico engaged in riskier drug-using and sexual behaviors than their counterparts in New York. The combination of high risk behaviors and lack of access to services increased the likelihood that they would become infected with HIV. Participants in Puerto Rico who were HIV negative at their baseline interview became infected at a rate that was almost four times higher than their New York counterparts, and they died at a rate that was more than three times higher.
HIV prevention programs for drug users reduce risk behaviors, thereby reducing transmission rates and the number of new infections. The study found that drug users in Puerto Rico who had migrated to New York, where there are substantially more HIV prevention programs, were less
risky than drug users who remained in Puerto Rico.
The number of persons who become infected with HIV in Puerto Rico can be reduced by a combination of prevention strategies, including:
- Increasing the number and funding of methadone programs and other drug treatment modalities.
- Increasing resources for street outreach projects, so that drug users can get current information about risk reduction and receive referrals to drug treatment and healthcare services.
- Increasing access to clean needles, for example through pharmacy distribution and needle exchange programs.
- In addition, there is a need to develop an island-wide HIV/AIDS surveillance system, and create a task force with broad representation to coordinate and monitor services.
This research was supported by the National Institute on Drug Abuse (NIDA), R01DA010425.