Injection-related hepatitis C serosorting behaviors among people who inject drugs: An urban/rural comparison.

Although previous research has focused on injection drug use behaviors in both urban and rural settings, few have drawn direct comparisons between adjacent rural and urban areas. Using data from the National HIV Behavioral Surveillance study as well as original data collected in a similar fashion, we compare the risk behaviors of people who inject drugs (PWID) in San Juan, Puerto Rico, with those of PWID in nearby rural areas. Specifically, we examine whether one's own hepatitis C (HCV) infection status can be used to predict whether one asked their most recent co-injection partner about their HCV status. Acquiring such information allows injectors to seek out co-injection partners of concordant status as a way to minimize the risk of viral transmission. Results indicate that urban PWID with a known HCV+ status were more likely to know their last co-injector partner's HCV status than were their peers with a negative or unknown HCV status. However, this relationship was not present in the rural data. These findings suggest that there are different risk norms in rural and urban PWID communities and that interventions successful in one type of community may not be so in others.

Latent Risk Subtypes Based on Injection and Sexual Behavior Among People Who Inject Drugs in Rural Puerto Rico.

BACKGROUND: People who inject drugs (PWID) in Puerto Rico engage in high levels of injection and sexual risk behavior, and they are at high risk for HIV and hepatitis C (HCV) infection, relative to their US counterparts. Less is known, however, about the clustering of risk behavior conducive to HIV and HCV infection among rural Puerto Rican communities. OBJECTIVES: The purpose of this study was to examine concurrent injection and sexual risk subtypes among a rural sample of PWID in Puerto Rico. METHODS: Data were drawn from a respondent-driven sample collected in 2015 of 315 PWID in 4 rural communities approximately 30-40 miles from San Juan. Latent class analysis (LCA) was used to examine risk subtypes using 3 injection and 3 sexual risk indicators. In addition, demographic and other PWID characteristics were examined as possible predictors of latent class membership. RESULTS: Four LCA subtypes were identified: low risk (36%), high injection/low sexual risk (22%), low injection/high sexual risk (20%), and high risk (22%). Younger age and past year homelessness predicted high risk latent class membership, relative to the other classes. In addition, daily speedball use predicted membership in the high injection/low sexual risk class, relative to the low risk and low injection/high sexual risk classes. CONCLUSION/IMPORTANCE: The findings suggest ways in which PWID risk clusters can be identified for targeted interventions.

Rural and urban comparisons of polysubstance use profiles and associated injection behaviors among people who inject drugs in Puerto Rico.

INTRODUCTION: In contrast to urban populations, little is known about polysubstance use among rural people who inject drugs (PWID), particularly in Puerto Rico where injection drug use and related health consequences are prevalent. The aim of the study is to compare injection and non-injection substance use profiles among separate urban and rural samples of Puerto Rican PWID. MATERIAL AND METHODS: Data for the urban sample come from 455 PWID who participated in the CDC's National HIV Behavioral Surveillance survey of injection drug use in San Juan. The data for the rural sample come from 315 PWID residing in four rural cities approximately 40-miles from San Juan. Latent class analysis was used to derive separate urban and rural profiles of weekly injection and non-injection substance use. Injection behaviors were examined as possible correlates of latent class membership. RESULTS: Five latent classes were identified in the urban sample, and three latent classes were identified in the rural sample. Classes were similar across samples; however, key differences emerged. Both samples had classes of primary heroin injectors, primary speedball injectors, and cocaine-heroin injectors. The urban sample had one high polysubstance class. Polysubstance use profiles that shared similar characteristics between samples also shared similar injection patterns, with some variation. DISCUSSION: Variations in substance use patterns and associated health risks are likely shaped by social and geographic boundaries. CONCLUSIONS: Understanding variations in substance use patterns across rural and urban locales may improve surveillance efforts and tailor desistance and harm reduction efforts at the state and local levels.

Association between alcohol consumption and injection and sexual risk behaviors among people who inject drugs in rural Puerto Rico.

Although alcohol use has been associated with risky behavior generally, the relationship between alcohol use and multiple types of risk behaviors that could lead to the acquisition and transmission of HIV and hepatitis C (HCV) among people who inject drugs (PWID) has not been fully examined. The current study seeks to contribute to the understanding of how alcohol use is related to both injection risk and sexual risk, among a non-treatment, cross-sectional sample of mostly male PWID in rural Puerto Rico (n=315). "At-risk" alcohol use was defined as consuming ≥14 drinks per week for males and ≥7 drinks per week for females. Binge drinking frequency was defined as consuming ≥5 drinks on one occasion for males and ≥4 drinks on a single occasion for females. Multivariate regression models were used to examine the association between the alcohol use variables and injection and sexual risk outcomes, adjusting for demographic characteristics. Overall, 14% (n=45) of the participants in this sample were considered at-risk drinkers (44% low risk drinkers and 42% alcohol abstainers), and participants reported binge drinking, on average, at least once per month. At-risk drinking, compared to low risk or no drinking, increased both injection and sexual risk behaviors. Frequency of past year binge drinking was also associated with both injection and sexual risk behaviors. Interventions aimed at reducing HIV and HCV transmission among injection drug users non-PWID networks should both target individuals who drink alcohol frequently and in high volumes, and include strategies for reducing risky behaviors while heavy drinking is occurring.