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

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Title: When 'The Cure' Is the Risk: Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico
Language: English
Authors: Hernández, Diana, Castellón, Pedro C., Fernández, Yohansa, Torres-Cardona, Francisco A., Parish, Carrigan, Gorshein, Danielle, Vargas Vidot, Jose, Miranda de Leon, Sandra, Rodriguez, Allan, Santana Bagur, Jorge, Feaster, Daniel J., Schackman, Bruce R., Metsch, Lisa R.
Source: Health Education & Behavior. Oct 2017 44(5):748-757.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: http://sagepub.com
Peer Reviewed: Y
Page Count: 10
Publication Date: 2017
Sponsoring Agency: National Institute on Drug Abuse (DHHS/PHS)
National Institute of Allergy and Infectious Diseases (NIAID/NIH)
Contract Number: R01DA035280
P30AI073961
Document Type: Journal Articles
Reports - Research
Descriptors: Substance Abuse, Acquired Immunodeficiency Syndrome (AIDS), Drug Abuse, Individual Characteristics, Social Influences, At Risk Persons, Ethnography, Observation, Interviews, Photography, Planning, Barriers, Access to Health Care, Prevention, Social Bias, Housing, Homeless People, Rehabilitation
Geographic Terms: Puerto Rico
DOI: 10.1177/1090198117728547
ISSN: 1090-1981
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.
Abstractor: As Provided
Number of References: 38
Entry Date: 2017
Accession Number: EJ1155163
Database: ERIC
FullText Text:
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  Data: When 'The Cure' Is the Risk: Understanding How Substance Use Affects HIV and HCV in a Layered Risk Environment in San Juan, Puerto Rico
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  Data: <searchLink fieldCode="AR" term="%22Hernández%2C+Diana%22">Hernández, Diana</searchLink><br /><searchLink fieldCode="AR" term="%22Castellón%2C+Pedro+C%2E%22">Castellón, Pedro C.</searchLink><br /><searchLink fieldCode="AR" term="%22Fernández%2C+Yohansa%22">Fernández, Yohansa</searchLink><br /><searchLink fieldCode="AR" term="%22Torres-Cardona%2C+Francisco+A%2E%22">Torres-Cardona, Francisco A.</searchLink><br /><searchLink fieldCode="AR" term="%22Parish%2C+Carrigan%22">Parish, Carrigan</searchLink><br /><searchLink fieldCode="AR" term="%22Gorshein%2C+Danielle%22">Gorshein, Danielle</searchLink><br /><searchLink fieldCode="AR" term="%22Vargas+Vidot%2C+Jose%22">Vargas Vidot, Jose</searchLink><br /><searchLink fieldCode="AR" term="%22Miranda+de+Leon%2C+Sandra%22">Miranda de Leon, Sandra</searchLink><br /><searchLink fieldCode="AR" term="%22Rodriguez%2C+Allan%22">Rodriguez, Allan</searchLink><br /><searchLink fieldCode="AR" term="%22Santana+Bagur%2C+Jorge%22">Santana Bagur, Jorge</searchLink><br /><searchLink fieldCode="AR" term="%22Feaster%2C+Daniel+J%2E%22">Feaster, Daniel J.</searchLink><br /><searchLink fieldCode="AR" term="%22Schackman%2C+Bruce+R%2E%22">Schackman, Bruce R.</searchLink><br /><searchLink fieldCode="AR" term="%22Metsch%2C+Lisa+R%2E%22">Metsch, Lisa R.</searchLink>
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: http://sagepub.com
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  Data: <searchLink fieldCode="DE" term="%22Substance+Abuse%22">Substance Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Acquired+Immunodeficiency+Syndrome+%28AIDS%29%22">Acquired Immunodeficiency Syndrome (AIDS)</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Abuse%22">Drug Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Influences%22">Social Influences</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Ethnography%22">Ethnography</searchLink><br /><searchLink fieldCode="DE" term="%22Observation%22">Observation</searchLink><br /><searchLink fieldCode="DE" term="%22Interviews%22">Interviews</searchLink><br /><searchLink fieldCode="DE" term="%22Photography%22">Photography</searchLink><br /><searchLink fieldCode="DE" term="%22Planning%22">Planning</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22Housing%22">Housing</searchLink><br /><searchLink fieldCode="DE" term="%22Homeless+People%22">Homeless People</searchLink><br /><searchLink fieldCode="DE" term="%22Rehabilitation%22">Rehabilitation</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Puerto+Rico%22">Puerto Rico</searchLink>
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  Data: 10.1177/1090198117728547
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  Data: 1090-1981
– Name: Abstract
  Label: Abstract
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  Data: 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.
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