Understanding the unique role of shooting galleries as risk and protective environments for injection drug users in San Juan, Puerto Rico

Aims: Injection drug use in Puerto Rico is prominent and remains a pertinent route to HIV/HCV infection on the island. This presentation will highlight the nuanced role of shooting galleries (SGs) in the provision of social network connections and care services for active drug users.  Results are based on ethnographic observations conducted in the preliminary phases of Proyecto PACTo (PPo), a clinical trial that aims to implement and evaluate in a community-level, structured approach to enhance HIV care access and retention for substance users in San Juan, Puerto Rico.

Methods: A rapid ethnographic approach was used to inform the recruitment of HIV-infected drug users into PPo and to describe the HIV cascade of care in a culturally and contextually situated manner. The fieldwork entailed participant observations of syringe exchange outreach primarily to SGs, over 35 informal conversations and 150+ encounters with members of the target population that were captured in detailed field notes and photographs and later analyzed for recurrent themes.

Results: As central hubs of information and resources, SGs play a two-pronged role as an environment of risk and protection. On the one hand, SGs are places where drug users share drugs and paraphernalia heightening risk for HIV and HCV transmission. On the other hand, SGs represent spaces that are accommodating to drug users social and health needs (i.e. clean syringes, support for drug rehabilitation and seeking medical services).

Conclusions: Understanding how drug users function within the structure of shooting galleries can help illuminate intervention opportunities in this site.