Injection risk norms and practices among migrant Puerto Rican people who inject drugs in New York City: The limits of acculturation theory

Int J Drug Policy. 2019 Jul;69:60-69. doi: 10.1016/j.drugpo.2019.03.016. Epub 2019 Jun 10.


Background: Among people who inject drugs (PWID) in New York City (NYC), racial minorities are disproportionately infected with HIV and hepatitis C (HCV). Prior research has shown that PWID who started injecting drugs in Puerto Rico (P.R.) tend to maintain the risky injection behaviors learned there. This study identifies the P.R.-native norms supporting the continued injection risk behavior of migrant Puerto Rican PWID in NYC to inform a culturally appropriate risk-reduction intervention.

Methods: 40 migrant Puerto Rican PWID were recruited in NYC for a longitudinal qualitative study. The sample was stratified to include 20 migrants with <3 years in NYC and 20 migrants with >3-6 years in NYC. Time-location sampling was used to curb possible network bias in recruitment. Over 12 months, migrants completed semi-structured interviews at baseline, monthly follow-ups, and study exit. Analyses were guided by grounded theory.

Results: Most participants (90%) reported having had chronic HCV, and 22.5% reported being HIV-positive. Syringe- and cooker-/cotton-sharing were widespread in both P.R. and NYC. The ubiquitous practice of cleaning used syringes by "water-rinsing and air-blowing" was guided by a normative belief, learned in P.R., that "water and air kill HIV." Sterile syringe use was not a priority. HCV was not a concern. P.R.-native abstinence-only narratives discouraged opioid agonist treatment (OAT) enrollment among recent migrants (≤3 years). Experiences with drug dealers, prison-power groups, and injection doctors ("Gancheros") in P.R. influenced migrants' injection risk behavior in NYC. Those who were Gancheros in P.R. continued working as Gancheros in NYC.

Conclusions: Injection risks make migrant Puerto Rican PWID in NYC vulnerable to HIV/HCV. Harm reduction programs should pay closer attention to the rationales behind these injection risks. A risk-reduction intervention that incorporates the Ganchero figure may be a credible way to help migrants reduce injection risk and accept OAT and syringe exchange programs (SEP).

Keywords: HCV; HIV; Injection risks; Migrant; New York City; Overdose; PWID; Puerto Rican.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Drug Users / psychology
  • Female
  • HIV Infections / epidemiology
  • Harm Reduction
  • Hepatitis C / epidemiology
  • Humans
  • Injections
  • Interview, Psychological
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Needle Sharing
  • Needle-Exchange Programs / supply & distribution*
  • New York City / epidemiology
  • Puerto Rico / epidemiology
  • Risk-Taking
  • Socioeconomic Factors
  • Substance Abuse, Intravenous / complications*
  • Substance Abuse, Intravenous / epidemiology*
  • Substance Abuse, Intravenous / prevention & control
  • Transients and Migrants / psychology*