Voices Boricuas: Health perspectives of injecting drug users in Puerto Rico and Massachusetts

This study examines associations between health status and mental health (MH) services among Puerto Rican injecting drug users (IDUs) in Massachusetts and Puerto Rico. A cross-sectional study design was used and in-person interviews were conducted with 437 Puerto Rican IDUs; 139 on the Island and 298 in Massachusetts. Bivariate analyses indicated significant differences in types of health services received. Only 7.8% of the USA sample had received MH treatment compared to 21% of the PR sample in the past 30 days. Additional analysis revealed that of those IDUs who received MH treatment in the PR sample, 23% were incarcerated in the past 6 months compared to 8.3% in Massachusetts. Logistic regression analyses demonstrated that, controlling for perceived health status, age, gender, incarceration in the past 6 months, injection drug use in the past 30 days, homelessness, education, and employment, those IDUs living in Puerto Rico were 5.5 times more likely to have received outpatient mental health services in the past year. Women were three times more likely to have received outpatient mental health counseling in the past year than men (p<.05). The correctional system in Puerto Rico requires routine health screening and treatment of inmates. Puerto Rican IDUs on the island may have less access to community based health services than those in the US. However, they may receive higher levels of health care while in prison. Further research is suggested to explore the length, quality of treatment and follow ups after IDUs are released from prison in Puerto Rico.