To Help Puerto Ricans Who Inject Drugs, We Must Speak Their Language
September 26, 2014
The HIV epidemic lodges itself in society's most marginalized populations, and communities that deal with multiple forms of oppression are often at the highest risk for HIV infection. Globally, around 16 million people inject drugs and 3 million of them are living with HIV, according to the World Health Organization. One group that struggles in particular with high HIV infection rates is Puerto Ricans who inject drugs (PRID) living in the Northeastern U.S. and Puerto Rico.
A new study describes the epidemic among PRID in Puerto Rico and the Northeast U.S. and the unique challenges this population faces when it comes to accessing HIV prevention and treatment services. In Puerto Rico, injection drug users make up 20.4% of new HIV diagnoses. Also, while Puerto Ricans make up only 9% of U.S. Latinos, they account for 23% of HIV infections among Latinos, according the study researchers.
"We reviewed HIV-related data for PRID living in Puerto Rico, and Northeastern U.S., which contains the highest concentration of Puerto Ricans out of any U.S. region," Dr. Sherry Deren, primary author of the study and director of New York University's Center for Drug Use and HIV Research (CDUHR), said in a press release. "Injection drug use as a risk for HIV continues to be over-represented among Puerto Ricans. Lower availability of HIV prevention tools (syringe exchange and drug treatment) and ART treatment challenges, for PRID in Puerto Rico, contribute to higher HIV risk and incidence for PRID in both locations."
In Puerto Rico, the challenges facing PRID may be even larger.
"I don't think [there are] enough programs here in Puerto Rico. [Injection drug users] are looking for housing and health services from the government," said Dr. Juan Panelli, the executive director of Amor Que Sana, translated as "Love That Heals," an organization that provides housing services, food services and HIV testing to injection drug users in Ponce, Puerto Rico's second-largest city. "We're trying to get them all the services they need, but we are just one organization. Probably, we are giving Ponce 20% of the housing it needs, so there's still 80% who need housing."
As for the other 80%, they "just keep living in the streets because of the lack of programs," Panelli said.
"In light of the lack of available resources in Puerto Rico, many individuals migrate to the Northeast seeking drug treatment," Deren said. "Many of those coming to the Northeast, however, do not become engaged in evidence-based drug treatment."
Sadat Iqbal, director of syringe exchange and outreach services at the Lower East Side Harm Reduction Center (LESHRC), says that about 40 percent of LESHRC's clients are Latino, and that a "great proportion" of those are Puerto Rican. "Economic opportunity, that's a big driving factor for migrations to New York City," he said. "A lot of those individuals are Spanish-speaking Puerto Rican folks." Organizations like LESHRC struggle to meet their needs, he noted. "Linguistic barriers are a big thing. We have a few staff members at LESHRC who speak Spanish and their case loads are packed because there's such a need. If we had more resources, we'd hire more Spanish-speaking staff."
LESHRC strives to provide marginalized groups such as PRID with services that are specifically aimed at them, Iqbal said. "In terms of culturally competent programs and services, we have peer educators who do a lot of the syringe exchange and outreach work," he said. "They're leaders within our participant base, so they work within their social networks to provide culturally competent services. For example, they have transgender peers, Spanish-speaking peers, so based on the communities they are a part of, they'll cater their work to them."
Panelli pointed to the lack of government assistance as a hindrance in reaching this vulnerable population. "I know that the government is not going to help people deal with this, so they're counting on our program, Amor Que Sana," he said. "We have two housing programs and a third program, a methadone clinic for the people in Ponce."
However, organizations such as LESHRC and Amor Que Sana are unable to receive federal funding for syringe exchange due to a long-standing ban. The federal ban was lifted briefly in 2009, but then reinstated in 2011 as a concession made on the floor of Congress in order to achieve a balanced budget, according to the Harvard Health Policy Review. Because of the federal ban, LESHRC is forced to rely more heavily on the New York City Department of Health and the New York State Department of Health. Panelli noted that Amor Que Sana does receive money for HIV prevention and treatment services through the Ryan White CARE Act, but did not comment on funding for syringe exchange.
While researchers call for a federally supported collaborative initiative that serves PRID both in Puerto Rico and the Northeast U.S., Panelli and Iqbal continue to see great need for frontline services to address not only drug use, but other structural issues as well.
"Drug use is often a symptom of other things -- struggling with poverty, with racism, oppression. Drug use is often a way of coping with those structural factors of oppression," Iqbal said.
Panelli has hopes that he can transform a school in Ponce that had to close due to Puerto Rico's poor economy into an emergency shelter for the homeless. "We are in discussions for that," he said. "It's probable that they will give us this school, then maybe we can help most of the people from the streets in Ponce."
Panelli and Iqbal both stressed that their work benefits more than Puerto Rican injection drug users, as well. For instance, Iqbal pointed out that LESHRC also serves transgender Puerto Ricans who inject hormones, as well as people who use steroids and insulin injects. "These are folks to whom cost is a barrier to access syringes for insulin and so they access them from us for free," he said.
Amor Que Sana also sees its work as aiding those with the fewest resources. "Our model is to serve everyone," Panelli said. "We specialize in the people that don't have any help."
Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com.
Follow Mathew on Twitter: @mathewrodriguez.
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