Despite the epidemiological reality of ongoing HIV infection in Puerto Rico, the public health infrastructure related to HIV/AIDS and substance abuse in the territory is severely lacking, as reflected in alarmingly high rates of morbidity/mortality among people who inject drugs (PWID). Because of this, HIV continues to have substantial impact on individual health and the healthcare system in Puerto Rico. While Puerto Rico ranks in the top 5% of US states and territories with respect to HIV prevalence, San Juan ranks only in the top 20% of metropolitan areas. This discrepancy points to a different type of epidemic, where rural communities contribute disproportionately to HIV prevalence rates relative to urban areas. The dynamics of HIV among PWID in rural Puerto Rico remains largely unknown, though HIV risk is known to increase precipitously upon migration to the mainland-a journey that has become the norm for PWID in need of services. Understanding the dynamics of rural HIV infection is critical to developing effective cost-efficient prevention strategies using he most recent developments in epidemiology, prevention, and treatment. This project applies both quantitative and qualitative methods to characterize and address HIV propagation dynamics in rural PWID networks of Central Puerto Rico. This is achieved by: (i) characterizing demographics, disease prevalence, and behaviors of at-risk populations in four rural communities via analysis of respondent- driven sampling surveys;(ii) modeling the dynamic structure of risk partnerships within the rural communities via ethnographically validated network micro-assays, (iii) developing stochastic computer simulations of artificial (but statistically plausible) dynamic risk networks, via models of the real-world data collected;(iv) identifying which behavioral and structural variables most strongly impact HIV/HCV epidemiology in these rural settings, via sensitivity analysis of simulation outcomes;(v) evaluating the relative efficay and cost efficiency of a range of evidence-based HIV control strategies within the target population via augmented simulations. The project addresses lack of link-to-care for the PWID population by (1) developing a working relationship with local private infectious disease doctors in all four municipalities to enhance access to care by immediately linking study participants who test positive for HIV or HCV to services;(2) developing an PWID escort system to ensure access and treatment throughout the life of the project, (3) developing new ways to support testing and treatment enrollment for this population using a social network approach that builds upon peer-driven community education and advocacy programs to slow the spread of the HIV/HCV in rural Puerto Rico;and finally, in concert with a Dissemination Advisory Board comprised of local stakeholders, (4) disseminating the simulation-based findings concerning optimal evidence-based HIV control strategies that are most likely to be effective and cost-efficient in addressing disease propagation in rural Puerto Rico. 1

Public Health Relevance

This research will document behavior and network-based risk for HIV among rural drug injectors in Puerto Rico. This population plays a disproportionate role in the spread of HIV when compared to other rural populations. The regional and long term dynamics of HIV will be established via simulation based data collected in the project, and the success and cost-effectiveness of potential interventions will be tested.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
Project #
Application #
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Hartsock, Peter
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Nebraska Lincoln
Social Sciences
Schools of Arts and Sciences
United States
Zip Code
Abadie, R; Gelpi-Acosta, C; Davila, C et al. (2018) ""It Ruined My Life"": The effects of the War on Drugs on people who inject drugs (PWID) in rural Puerto Rico. Int J Drug Policy 51:121-127
Khan, Bilal; Duncan, Ian; Saad, Mohamad et al. (2018) Combination interventions for Hepatitis C and Cirrhosis reduction among people who inject drugs: An agent-based, networked population simulation experiment. PLoS One 13:e0206356
Habecker, Patrick; Abadie, Roberto; Welch-Lazoritz, Melissa et al. (2018) Injection Partners, HCV, and HIV Status among Rural Persons Who Inject Drugs in Puerto Rico. Subst Use Misuse 53:1128-1138
Hautala, Dane; Abadie, Roberto; Thrash, Courtney et al. (2018) Latent Risk Subtypes Based on Injection and Sexual Behavior Among People Who Inject Drugs in Rural Puerto Rico. J Rural Health 34:236-245
Thrash, Courtney; Welch-Lazoritz, Melissa; Gauthier, Gertrude et al. (2018) Rural and urban injection drug use in Puerto Rico: Network implications for human immunodeficiency virus and hepatitis C virus infection. J Ethn Subst Abuse 17:199-222
Abadie, Roberto; Goldenberg, Shira; Welch-Lazoritz, Melissa et al. (2018) Establishing trust in HIV/HCV research among people who inject drugs (PWID): Insights from empirical research. PLoS One 13:e0208410
Duncan, Ian; Curtis, Ric; Reyes, Juan Carlos et al. (2017) Hepatitis C serosorting among people who inject drugs in rural Puerto Rico. Prev Med Rep 6:38-43
Dombrowski, Kirk; Khan, Bilal; Habecker, Patrick et al. (2017) The Interaction of Risk Network Structures and Virus Natural History in the Non-spreading of HIV Among People Who Inject Drugs in the Early Stages of the Epidemic. AIDS Behav 21:1004-1015
Abadie, Roberto; Welch-Lazoritz, Melissa; Bilal, Khan et al. (2017) Social Determinants of HIV/HCV Co-Infection: A case Study from People Who Inject Drugs in Rural Puerto Rico. Addict Behav Rep 5:29-32
Welch-Lazoritz, Melissa; Hautala, Dane; Habecker, Patrick et al. (2017) Association between alcohol consumption and injection and sexual risk behaviors among people who inject drugs in rural Puerto Rico. J Subst Abuse Treat 82:34-40

Showing the most recent 10 out of 19 publications