Migration and HIV Risk Behaviors: Puerto Rican Drug Injectors in New York City and Puerto Rico

The relationship between migration and HIV-related risk behaviors has been reported among diverse populations, including Hispanic populations in Mexico and the Caribbean who travel to New York and migrant workers in southern Africa. Studies have found that travel to an AIDS epicenter is related to HIV infection among drug users from low-prevalence communities.

High rates of HIV/AIDS and HIV-related risk behaviors have been found among Puerto Rican IDUs. The extensive migration/travel between the two communities provides the opportunity to compare differences in levels of risk behaviors between IDUs at each location who have experienced injecting in the other location and thus to examine risk behaviors of those who have been socialized in injection behaviors in a community with higher- or lower-risk behaviors than their current community. The authors compared injection-related risk behaviors for IDUs in New York between those who had previously injected in Puerto Rico and those who had not, and for IDUs in Puerto Rico between those who had previously injected in New York and those who had not.

Between January 1998 and July 1999, a total of 873 IDUs (561 in New York City and 312 in Puerto Rico) were recruited from the communities of East Harlem, New York City, and Bayamón, Puerto Rico. Of the former, 39 percent were "newcomers," having previously injected in Puerto Rico; of the latter, 14 percent were "returnees," having previously injected in New York. Eligible subjects were age 18 or older, identified themselves as Puerto Rican, and had injected drugs or smoked crack within the last 30 days.

Of the recruited IDUs, the majority were male and had been born in Puerto Rico (56 percent of those recruited in New York and 87 percent of those recruited in Puerto Rico). The authors applied the term "returnees" to the IDUs recruited in Puerto Rico who met the criterion of having previously injected in New York, because the majority of them (approximately 70 percent) reported spending most of their youth in Puerto Rico. Only 19 percent of the New York newcomers reported spending their childhood in New York. The New York IDUs were older (28 percent were older than age 42, compared with 10 percent of the Puerto Rico sample). The New York sample had been injecting for a longer time (18 years vs. 13 years in Puerto Rico), and they were less likely to report sharing injection equipment (10 percent shared syringes vs. 37 percent in Puerto Rico.

The newcomers to New York reported more years of injecting and more frequent injecting than other New York IDUs. They also reported riskier injection practices than other New York IDUs. After control for the influence of sociodemographic factors on injection frequency, newcomer/returnee status was not a significant predictor of injection frequency in either site. In New York, being a newcomer was significantly related to shooting-gallery use. In Puerto Rico, returnee status was not significantly related to these two variables.

The newcomer IDUs who had injected in Puerto Rico and moved to New York City -- a location with lower levels of injection-related risk behaviors and more tools available for risk reduction -- saw higher levels of risk behaviors than other Puerto Rican IDUs in New York. However, these newcomers' levels of risk behaviors were still lower than those found in the Puerto Rico sample. The authors concluded "incorporating information about the new risks or potential risk-increasing factors that may affect immigrants (e.g., for IDUs who may be immigrating to areas where shooting galleries are widely available) can be helpful in reducing HIV-related risks and HIV transmission."

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