Content area
Full Text
Puerto Rico is undergoing serious political and socioeconomic crises. Before the recent political turmoil forcing the resignation of (now former) Governor Ricardo Rossello, massive government debt had already led to unrest because of unpopular austerity measures (e.g., pension cuts, shrinking public education, and hospital closures). Additionally, a decades-long financial crisis had already triggered large-scale emigration from Puerto Rico (a colony of the United States) to the continental United States, a phenomenon that was significantly augmented by Hurricane Maria in 2017. Puerto Rico's vulnerability to natural disasters is compounded with its adverse political and socioeconomic conditions to create an exceptionally unstable public health environment.
Although 28 000 people who inject drugs (PWID) call Puerto Rico home,1 the island hosts only five syringe services programs (SSPs), which are poorly funded, and only six methadone clinics, which are at capacity, to serve 5500 PWID. Because of limited services, needle sharing and cooker sharing are normative behaviors among PWID in Puerto Rico.2 In fact, 48% of the 49 476 cumulative HIV/AIDS cases in Puerto Rico are PWID linked (42% injection drug use and 6% male-to-male sexual contact and injection drug use),3 and HIV prevalence among PWID in San Juan, the capital of Puerto Rico, is 13%.4
Puerto Rico also hosts one of the most hepatitis C virus (HCV)-vulnerable PWID populations of the United States and its territories. Hepatitis C prevalence among PWID in rural Puerto Rico is 79%, and it is as high as 90% in San Juan.5 Puerto Rico's Department of Corrections and Rehabilitation reports that there were 12 381 people incarcerated in 2015. Data gathered by the Department of Corrections and Rehabilitation from 12 074 of these individuals show that 11.17% suffered from substance use disorders while incarcerated.6 Injection drug use is rampant throughout Puerto Rico's prison system, and access to sterile injection supplies is nonexistent. Among PWID living with HIV in Puerto Rican prisons, many are coinfected with HCV. And...