Honors Program


Date of this Version


Document Type



Santos, C. 2023. Unsterile Needle Acquisition among PWIDs in Rural Puerto Rico. Undergraduate Honors Thesis. University of Nebraska-Lincoln.


Copyright Clarice Santos 2023


The purpose of this study is to identify risk factors that are predictive of engaging in unsterile needle use among persons who inject drugs (PWIDs) within rural areas of Puerto Rico. Although unsterile needle use is usually associated with urban areas, there is an increasing problem of injection drug use and the transmission of blood-borne illnesses in rural areas, especially rural Puerto Rico. However, despite the shifting epicenter of the issue, most of the current studies are focused on urban areas. Thus, there is a critical need to identify risk factors so that improved strategies can be developed for rural areas. Respondent driven sampling was used to recruit two groups of PWIDs. The first group included those who were not in any form of opioid agonist treatment and the second group included those currently enrolled in treatment. This data collection was supported by an NIH R21 grant (R21DA047304). Analysis was conducted in Stata and included a series of logistic regressions. Based on prior research, it was expected that participating in treatment will reduce injecting risk behavior, while PWIDs with higher education levels and older injection age will participate in less injecting risk behavior. By increasing our understanding of the drivers of unsterile needle use, we can inform the creation and implementation of harm reduction intervention, to decrease infection rates.