Rural Puerto Ricans have Different Serosorting Habits than their Mainland Counterparts

While injection drug use poses a large risk for the spread of infectious diseases like HIV and HCV, people who use injection drugs (PWID) have developed a variety of methods to prevent such infection in their networks. For instance, one method is “serosorting”—a type of strategy where injection drug users utilize knowledge of one’s own HIV or HCV infection status and question others’ status to determine whether to engage in risky practices or not.

In an injection drug use context, serosorting strategies advise the user of the selection and number of people with whom an individual may participate safely in injection. And while public health officials warn against sharing equipment and injecting with partners due to the expense of treating HCV and other infectious diseases, such practices are often necessities of the lifestyles of PWID due to economic and legal restraints. Serosorting, then, is often utilized by users to more safely engage in such behaviors many people who inject drugs would have to participate in to decrease the cost and risk of drug use.

REACH researchers have contributed to the understanding of serosorting behaviors with their ongoing studies of PWID in Puerto Rico. Most recently, REACH researchers Duncan, Khan, Dombrowski, and Abadie worked with affiliates in Puerto Rico on a study published in the Preventative Medicine Reports which analyzes information gathered on serosorting behaviors in the rural areas of the U.S. territory.

Studies based in the general United States population have found that knowledge of HCV status facilitates serosorting behaviors, leading more people to question potential partners’ status. This study was done to test whether the same would be true in more rural areas that are disconnected from the mainland US. On the contrary, the team found that in rural Puerto Rico, knowledge of HCV status had no significant effect on the selection of recent injection partners. They concluded then that injectors in rural Puerto Rico differ from the broader US population in their serosorting habits. The team urges that this difference should be taken into account in future outreach and intervention strategies.

Limitations to the findings presented here mostly concern differences in sample size. The Smith et al. study—to which the team compared their rural Puerto Rican data—had a much larger sample, representative of a much larger, generalizable population. Despite this limitation, the findings presented here are very significant and the differences found in this rural community are likely to extend to other regions.

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