Prevalence and risk factors associated with homelessness among drug users in Puerto Rico

Objective: This study aimed to determine the association between years of drug injection and homelessness among drug users in rural Puerto Rico. Methods: Respondent-driven sampling methods allowed us to obtain a sample of 315 intravenous drug users (IDUs) in rural Puerto Rico. Information about sociodemographic characteristics, drug use patterns, homelessness and risk behaviors was obtained through structured interviews. HIV and HCV statuses were assessed via rapid antibody tests. Frequency distributions were used to describe the study sample. Bivariate analysis and multivariate logistic regressions were used to assess covariates of homelessness. The study received IRB approval through the University of Nebraska-Lincoln and the University of Puerto Rico. Results: Almost 91% of the study participants were males. The mean age was 41.7 years and the majority of the participants had not completed high school (47.6%). The prevalence of current homelessness was 21.9%. After controlling for sociodemographic characteristics, homelessness was strongly associated with the number of years of injection drug use. The odds of being homeless for IDUs with 21 years or more of drug injection was almost 3 times higher than were the odds of being homeless for IDUs with fewer than 10 years of injection (OR = 2.58 95%; CI=1.21,5.48). Conclusion: In rural Puerto Rico, the prevalence of current homelessness in IDUs was 21.7%. In the sample, 6.0% were HIV positive and 78.4% were HCV positive. Our results highlight the necessity of increasing accessibility to substance abuse treatment and establishing additional needle-exchange programs (currently, there is only 1) in rural Puerto Rico.