| Abstract: | High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue.Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence.These disparities should be addressed by the development of a federally supported Northeast–Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.Behavioral, biomedical, and structural interventions have led to significant reductions in HIV incidence in the United States. More than 30 years since HIV was first reported, the possibility of an AIDS-free generation in the United States has recently emerged. Current research and policy efforts focus on identifying those who may be unaware of their infection to engage and maintain them in antiretroviral treatment, and aim to reduce health disparities among racial/ethnic groups.Despite great advances in HIV prevention and care, insufficient progress has been made among Puerto Rican people who inject drugs (PRPWID). Research on the HIV/AIDS epidemic among people who inject drugs (PWID) has documented higher levels of risk behaviors and prevalence among individuals identified as Puerto Rican than among other groups since early in the epidemic, and these disparities persist. Although Puerto Ricans in the island and the continental United States represent about 9% of the US Hispanic population,1 nearly 23% of incident HIV cases among Hispanics in 2006 were among those born in Puerto Rico.2 Injection drug use accounted for the majority of AIDS cases in Puerto Rico early in the epidemic,3 and currently more than 20% of new infections in Puerto Rico are attributed to injection drug use, a higher percentage than for any other region of the United States 4 and for any other Hispanic subgroup.5To meet the challenge of eradicating HIV in the United States, health disparities within subgroups at high risk for HIV must be addressed. Furthermore, the HIV treatment–as–prevention paradigm6 in use to reduce HIV transmission will not suffice in reducing comorbidities associated with injection drug use (e.g., hepatitis C, overdoses), also found at disproportionately high rates among PRPWID. We focused on Puerto Rico and the northeastern United States, where the majority of Puerto Ricans live,1 to examine the history of the epidemic among PRPWID, the current state of the epidemic, and the availability of HIV prevention and treatment services. We also describe other challenges to health for PRPWID and interventions recently adopted in Puerto Rico and provide recommendations to further reduce HIV in this population. |
