Abstract
This report examines associations between homelessness and HIV risk behaviors among injection drug users (IDUs) in Puerto Rico. The study sample consisted of 557 IDUs who were not in treatment, recruited in inner-city neighborhoods of the North Metro Health Care Region. Subjects were categorized into three groups by residential status (last 30 days): housed, transitionally housed (living with friends, family, or others but considering themselves homeless), and on-the-street homeless (living on the street or in a shelter). Multiple logistic regression models were fitted to assess effects of residential status on each HIV risk behavior after adjusting for sociodemographic and drug-use related covariates. Transitionally housed and on-the-street homeless subjects made up 16% of the total sample. On-the-street homeless IDUs were more likely to test positive for HIV than were transitionally housed and housed IDUs. In the adjusted analysis, on-the-street homeless subjects were significantly more likely to share needles, share rinse water, and practice back loading than the other two groups. Sexual risk behaviors (last 30 days) were not significantly associated with residential status after adjustment. Findings from this study present an added challenge to drug treatment and HIV prevention and treatment programs, to provide services that can address the additional needs of drug users suffering the stressors of homelessness.
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References
Unidos de Puerto Rico. Estudio sobre las necesidades sociales en Puerto Rico. Vol. 2. San Juan: Fondos Unidos de Puerto Rico; 1997.
O’Toole TP, Gibbon JL, Hanusa BH, Freyder PJ, Conde AM, Fine MJ. Self-reported changes in drug and alcohol use after becoming homeless. Am J Public Health. 2004;94:830–835.
Link B, Phelan J, Bresnahan M, Stueve A, Moore R, Susser E. Lifetime and five-year prevalence of homelesness in the United States: new evidence on an old debate. Am J Orthopsychiatry. 1995;65:347–354.
Sosin MR, Bruni M. Honelessness and vulnerability among adults with and without alcohol problems. Subst Use Misuse. 1997;32:939–968.
Goldman HH. Denstitutionalization and community care: social welfare policy as mental health policy. Harv Rev Psychiatry. 1998;6:219–222.
Gamache G, Rosenheck R, Tessler R. Overrepresentation of women veterans among homeless women. Am J Public Health. 2003;93:1132–1136.
Rosenheck R, Lam JA. Individual and community-level variation in intensity and diversity of service utilization by homeless persons with serious mental illness. J Nerv Ment Dis. 1997;185:633–638.
Barrow SM, Herman DB, Cordova P, Struening EL. Mortality among homeless shelter residents in New York City. Am J Public Health. 1999;89:529–534.
Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, NY: Guilford Press; 1991.
Robles RR, Colón HM, Sahai H, Matos TD, Marrero CA, Reyes JC. Behavioral risk factors and human immunodeficiency virus (HIV) prevalence among intravenous drug users in Puerto Rico. Am J Epidemiol. 1992;135:531–540.
Weatherby NL, Needle R, Cesari H, et al. Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Eval Program Plann. 1994;17:347–355.
Needle R, Fisher DG, Weatherby N, et al. The reliability of self-reported HIV risk behaviors of drug users. Psychol Addict Behav. 1995;9:242–250.
Beck AT. Measuring depression: the depression inventory. In: Williams TA, Katz M, Shield JA, eds. Recent Advances in the Psychobiology of the Depressive Illness. Washington, DC: Government Printing Office; 1972:299–302.
Susser E, Miller M, Valencia E, Colson P, Roche B, Conover S. Injection drug use and risk of HIV transmission among homeless men with mental illness. Am J Psychiatry. 1996;153:794–798.
Metsch LR, McCoy CB, McCoy HV, et al. HIV-related risk behaviors and seropositivity among homeless drug-abusing women in Miami, Florida. J Psychoactive Drugs. 1995;27:435–446.
Robles RR, Matos TD, Colón HM, et al. Determinants of health care use among Puerto Rican drug users in Puerto Rico and New York City. Clin Infect Dis. 2003;37:S392-S403.
Connors MM. Risk perception, risk taking and risk management among intravenous drug users implications for AIDS prevention. Soc Sci Med. 1992;34:591–601.
Galea S, Vlahov D. Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Rep. 2002;117:S135-S145.
Lam JA, Rosenheck R. Street outreach for homeless persons with serious mental illness: is it effective. Med Care. 1999;37:894–907.
Wenzel SL, Audrey-Burnam M, Koegel P, et al. Access to inpatient or residential substance abuse treatment among homeless adults with alcohol or other drug use disorders. Med Care. 2001;39:1158–1169.
Robles RR, Reyes JC, Colon HM, et al. Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: a randomized controlled study. J Subst Abuse Treat. 2004;27:145–152.
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Reyes, J.C., Robles, R.R., Colón, H.M. et al. Homelessness and HIV risk behaviors among drug injectors in Puerto Rico. J Urban Health 82, 446–455 (2005). https://doi.org/10.1093/jurban/jti073
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DOI: https://doi.org/10.1093/jurban/jti073