universidad central del caribe comorbidity and hiv risk behaviors among hispanic drug users...

Universidad Central del CaribeUniversidad Central del Caribe

http://cbattc.uccaribe.eduhttp://cbattc.uccaribe.edu

Comorbidity and HIV Risk Behaviors among

Hispanic Drug Users Residing in Puerto Rico

Comorbidity and HIV Risk Behaviors among

Hispanic Drug Users Residing in Puerto Rico

Oral Presentation

Session XV

6/19/2003

Oral Presentation

Session XV

6/19/2003


IntroductionIntroduction

• Puerto Rico has been one of the HIV epicenters of the United States since the middle 1980s, soon after the Island’s first AIDS case was detected in 1981

• Puerto Rico ranks fourth in AIDS incidence after Washington, D.C., New York, and Maryland

• Early in the initial period of the HIV epidemic in Puerto Rico, drug users were identified as the group at highest risk of HIV transmission

• Puerto Rico has been one of the HIV epicenters of the United States since the middle 1980s, soon after the Island’s first AIDS case was detected in 1981

• Puerto Rico ranks fourth in AIDS incidence after Washington, D.C., New York, and Maryland

• Early in the initial period of the HIV epidemic in Puerto Rico, drug users were identified as the group at highest risk of HIV transmission



• In contrast to the U.S. population, injection drug use has been found to be the most common risk factor for AIDS in Puerto Rico and among Puerto Ricans in the US mainland

• HIV seroprevalence rates for IDUs in Puerto Rico appear to have followed a downward trend similar to those observed among IDUs in several northeastern U.S. cities

• In contrast to the U.S. population, injection drug use has been found to be the most common risk factor for AIDS in Puerto Rico and among Puerto Ricans in the US mainland

• HIV seroprevalence rates for IDUs in Puerto Rico appear to have followed a downward trend similar to those observed among IDUs in several northeastern U.S. cities



• Although AIDS incidence has decreased in the Island, our recent studies continue to show a significantly high prevalence of HIV risk behaviors, especially among young drug injectors

• In Puerto Rico, as in the U.S., many preventive programs have been conducted since the late 1980s to reduce HIV risk behaviors among drug injectors

• Although AIDS incidence has decreased in the Island, our recent studies continue to show a significantly high prevalence of HIV risk behaviors, especially among young drug injectors

• In Puerto Rico, as in the U.S., many preventive programs have been conducted since the late 1980s to reduce HIV risk behaviors among drug injectors



• Previous reports have shown significant associations between mental health conditions and HIV risk behaviors among drug users

• This study will add to previous studies by providing data specifically related to depression and anxiety and their association with HIV risk behaviors, among Hispanic drug injectors recruited in the Island’s neighborhoods

• Previous reports have shown significant associations between mental health conditions and HIV risk behaviors among drug users

• This study will add to previous studies by providing data specifically related to depression and anxiety and their association with HIV risk behaviors, among Hispanic drug injectors recruited in the Island’s neighborhoods


Methods Methods

• Recruitment Area– North region of Puerto Rico

• Eligibility Criteria– Had injected in the last 30

days prior to the interview– At least 18 yrs. Old– Were not enrolled in drug

abuse treatment during the last 30 days prior to the interview

• Recruitment Area– North region of Puerto Rico

• Eligibility Criteria– Had injected in the last 30

days prior to the interview– At least 18 yrs. Old– Were not enrolled in drug

abuse treatment during the last 30 days prior to the interview


Methods Methods

• Sample– 557 injection drug users

• Instrument– Socio demographics– Drug use patterns– HIV risk behaviors– Beck inventory scale for anxiety and

depression symptoms

• Analysis– Frequency distributions– Chi-square test of independence– Logistic regression

• Sample– 557 injection drug users

• Instrument– Socio demographics– Drug use patterns– HIV risk behaviors– Beck inventory scale for anxiety and

depression symptoms

• Analysis– Frequency distributions– Chi-square test of independence– Logistic regression

Description of the study sampleDescription of the study sample

VariablesVariables N = 557N = 557nn %%

GenderGenderMales 239 87.9

Females 33 12.1

AgeAgeLess than 25 yrs. 90 34.6

25 – 34 yrs. old 101 38.8

35 yrs. old 69 26.5

EducationEducation< High school 156 57.4

High school 90 33.1

> High School 26 9.6

TABLE 1TABLE 1

Drug Use and Mental Health Co-morbidity by Socio-demographics drug use Patterns and other Health Related Variables


TABLE 2TABLE 2

ComorbidityComorbidity

Drug use only

Severe anxiety

symptoms

Severe depressio

n symptoms

Both

n (%) n (%) n (%) conditions P value

GenderGender

Females 15 (6.8) 5 (10.0) 11 (8.3) 28 (17.9)

Males 204 (93.2) 45 (90.0) 121 (91.7) 128 (82.1) 0.005

AgeAge

Less than 25 yrs.

73 (34.1) 21 (43.8) 39 (31.0) 53 (34.6)

25 – 34 yrs. old

78 (36.4) 17 (35.4) 38 (30.2) 65 (42.5)

35 yrs. old 63 (29.4) 10 (20.8) 49 (38.9) 35 (22.9) 0.064

EducationEducation

< High school 118 (53.9) 20 (40.0) 89 (67.4) 90 (57.7)

High school 77 (35.2) 20 (40.0) 31 (23.5) 48 (30.8)

> High School 24 (11.0) 10 (20.0) 12 (9.1) 18 (11.5) 0.029



TABLE 2-2TABLE 2-2

ComorbidityComorbidity

Drug use only

Severe anxiety

symptoms

Severe depressio

n symptom

s

Both conditio

ns

n (%) n (%) n (%) P value

HomelessnessHomelessness

no 196 (89.5) 44 (88.0) 113 (85.6) 117 (75.0)

yes 23 (10.5) 6 (12.0) 19 (14.4) 39 (25.0) 0.001

Daily Frequency Daily Frequency of Drug Injectionof Drug Injection

< 3 times 91 (41.9) 20 (40.0) 42 (31.8) 50 (32.1)

3 times 126 (58.1) 30 (60.0) 90 (68.2) 106 (67.9) 0.133

Years of Drug Years of Drug InjectionInjection

< 6 121 (55.3) 34 (68.0) 71 (53.8) 88 (56.4)

6 – 10 yrs 34 (15.5) 5 (10.0) 20 (15.2) 26 (16.7)

11 – 15 yrs 25 (11.4) 3 (6.0) 12 (9.1) 20 (12.8)

16 yrs 39 (17.8) 8 (16.0) 29 (22.0) 22 (14.1) 0.615

Logistic Regression Analyses Logistic Regression Analyses TABLE 3TABLE 3

Share needlesShare needles Shared cottonShared cotton Shared waterShared water BackloadingBackloading

OR CI OR CI OR CI OR CI

None 1.00 --- 1.00 --- 1.00 --- 1.00 ---

Anxiety only 2.27 0.93-5.51 3.58 1.70-7.56 3.93 1.51-10.27 1.63 0.48-5.52

Depression only

2.23 1.13-4.38 1.86 1.02-3.40 1.28 0.53-3.11 1.24 0.48-3.17

Both conditions

2.21 1.15-4.25 3.47 1.99-6.06 2.43 1.12-5.27 3.92 1.80-8.54

Adjusted by gender, age, education, drug treatment experience, Adjusted by gender, age, education, drug treatment experience, homeless, frequency of drug use, years of drug injection.homeless, frequency of drug use, years of drug injection.


DiscussionDiscussion

• Data from this study concur with previous studies showing that comorbidity involving various psychiatric conditions has been related to HIV risk behaviors

• This study shows that among Islander Puerto Rican drug injectors not-in-treatment, those affected by either high depression symptomatology or anxiety are significantly more likely to share needles, cotton, or rinse water, and engage in back loading

• Data from this study concur with previous studies showing that comorbidity involving various psychiatric conditions has been related to HIV risk behaviors

• This study shows that among Islander Puerto Rican drug injectors not-in-treatment, those affected by either high depression symptomatology or anxiety are significantly more likely to share needles, cotton, or rinse water, and engage in back loading


DiscussionDiscussion

• The results from this study of heroin injectors with depression or anxiety suggest that these individuals are clearly in need of special attention

• The development of interventions tailored to address heroin injection, depression, and anxiety seems necessary in order to reduce HIV risks and to decrease drug injection

• The results from this study of heroin injectors with depression or anxiety suggest that these individuals are clearly in need of special attention

• The development of interventions tailored to address heroin injection, depression, and anxiety seems necessary in order to reduce HIV risks and to decrease drug injection

universidad central del caribe comorbidity and hiv risk behaviors among hispanic drug users...

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