Spread of Disease in Drug Use Networks: Differences Found in Rural and Urban Communities in Puerto Rico

Substance use of all varieties has seen great demographic shifts throughout the United States in the past century. While attention to drug use, trafficking, and addiction was once centered on urban populations and networks, epidemics like those concerning methamphetamines, heroin, and opioids have increasingly complicated the understanding of urban versus rural drug use. REACH researchers have been working to better understand these significant disparities between urban and rural drug use in ongoing studies throughout Puerto Rico’s population of injection drug users.

A REACH study concerning these differences in risk networks and the spread of infectious diseases was published in a recent volume of the Journal of Ethnicity in Substance Abuse. Alongside employees from the Puerto Rico Department of Health to examine, REACH researchers Thrash, Welch-Lazoritz, Gauthier, Khan, Abadie, and Dombrowski set out to investigate the rural and urban differences in risk networks and the spread of HIV and Hepatitis C.

The data was gathered by Respondent-Driven Sampling (RDS) in order to obtain information on injection drug use in San Juan and four rural towns in the mountainous area of central Puerto Rico. RDS data was then used to find differences in gender, income, age, perceived HCV status, participation in drug treatment efforts, frequency of various substance use, and the frequency of sharing injection equipment between rural and urban populations.

With further analysis of this information on people who use injection drugs (PWID) in Puerto Rico, researchers found very little difference in age, unemployment status, perceived HCV status, use of speedball (heroin and cocaine mixtures), and frequency of sharing injection equipment between these rural and urban networks. Demographically, however, the urban population had higher percentages of women in its sample (17.5% vs. 9.2%), lower average income (91% vs. 80% earning less than $5,000 annually), fewer people participating in drug treatment (67% vs. 81% in their lifetimes), fewer people drinking (51% vs. 71% in the last year), fewer people binge drinking (37% vs. 57% in the last year), and higher average injection frequency (92.7% vs. 84.8% injecting at least once a day). The study also found that only the frequency of injection drug use is associated with a clustering behavior of networks in both rural and urban areas, emphasizing the sociocultural differences between the lives of PWID in rural and urban areas.

Furthermore, the team compared characteristics of these populations with the hopes of better understanding the transmission of disease an injection drug use networks. These findings importantly suggest different levels and characteristics of network affiliation in rural and urban communities, meaning that PWID cluster with characteristically similar individuals based on different traits in rural and urban settings. Finding differences in clustering based on gender and income between rural and urban populations will then lead to distinctive and more effective intervention strategies and ways that we work with these different communities.

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