Drug Use in the Dominican Republic and its connection to HIV/AIDS: an exploratory study

1. El consumo de drogas en la República Dominicana y su vínculo con el VIH/SIDA: un estudio exploratorio Drug Use in the Dominican Republic and its connection to HIV/AIDS: an exploratory study Michele Shedlin,Ph.D.*, Francisco I. Cáceres Ureña,Ph.D.**, and Sherry Deren,Ph.D.* *National Development and Research Institutes, Inc. (NDRI) ** Asociación Dominicana Pro-Bienestar de la Familia (PROFAMILIA)

2. Acknowledgements • National Institute on Drug Use (NIDA), National Institutes of Health (NIH) • Asociación Dominicana Pro-Bienestar de la Familia (PROFAMILIA) (DR) • National Development and Research Institutes, Institute for AIDS Research (NDRI) (NY) • Programa de Prevención del Uso Indebido de Drogas (PROPUID) (DR) • Universidad Central del Caribe, Centro de Estudios de Adicción (PR)

4. Crack Cocaine Marijuana Morphine Heroin Ecstasy Special K Speed Mushrooms PCP Hashish Range of Drugs Used Drugs mentioned by users included:

5. Pharmaceuticals  ("fármacos") reported:

6. Study Sample: Injectors • 45% have injected sometime • 69% (of injectors) have shared needles

7. Study Sample: Use of Protection • 65% do not protect against STIs and AIDS 85% students 60% upper middle class 42% gay men 70% sex workers 39% prisoners 44% persons in treatment 40% heroin users

8. Study Sample: Non-sex workers who have sex for money and/or drugs 23% students 77% prisoners 50% persons in treatment 20% heroin users 92% gay men 100% sex workers

11. Awareness ofDrug Use • “There is a grave problem of drug use in our country that over time, through the years, has grown so that today we have a palpable problem …” “Dentro de nuestro país, hay un grave problema de consumo de drogas que con el tiempo, a medida de los años, se ha ido acrecentando hasta llegar a ser hoy, una problemática palpable...”

12. Awareness ofDrug Use – Cont. • “…here in the Dominican Republic there are a lot of drugs everywhere...I don’t know why they try to cover the sun with a finger and say ‘there isn’t’…” “...aquí en la República Dominicana hay mucha droga por donde quiera...yo no sé por qué tratan de tapar el sol con un dedo y dicen que ‘no’…”

13. Awareness ofDrug Use – Cont. •  “there does not seem to be reliable data on drug use. ...there is an information crisis” “no parece haber muchos datos confiables sobre el consumo de drogas. ...hay una crisis de información”

14. The Drug “Bridge” • “It [the country] is not only a bridge, but is becoming a large consumer…” “No solamente [el país] es puente sino se está convirtiendo en un gran consumidor...”

15. The Drug “Bridge”- Cont. • “trafficking means that a large part stays here to sell and consume” • “it’s a business like any other business, the only difference is that it’s prohibited”

16. Relationship Between Selling and Use • “In most of the cases, everyone that sells uses because, as a man near my house says, ‘if I am selling oranges, I need to know if the orange is good’…”   “En la mayoría de los casos, todo el que vende consume porque es como dice un señor por mi casa, ‘si yo vendo china, yo tengo que saber si la china es buena’...”

17. Crisis of Values Perceived • “The crisis of our own values in this society is a product of the pressures of poverty and modernization...a series of factors intervene: media, the influence of North American society, the migration of Dominicans to the U.S....to the point where a family here in the country doesn’t care if their relative is selling drugs...what is important are better economic conditions...”

18. “la crisis de los valores propios de nuestra sociedad [es] producto de la presión de la pobreza y producto de ese proceso de modernización... intervienen una serie de factores: los medios de comunicación; la influencia de la sociedad norteamericana; la migración de los Dominicanos hacia EEUU....a tal punto que a una familia aquí en el país no le importa que su familiar esté vendiendo droga....lo importante es que mejore las condiciones económicas”

19. Barrio Youth • “Here there are many youth that we are losing; they are slipping through our hands and we are not paying attention…” “Aquí hay mucha juventud que se nos está perdiendo, se nos está yendo de la mano y no nos estamos dando cuenta...” • “The drugs in the schools...the situation now is alarming…” “Las drogas en las escuelas...es alarmante la situación ahora mismo...”

20. Barrio Youth – Cont. • Students report perceived high risk for marijuana (63%), crack (61%) and cocaine (56%); regular use of inhalants (50%)  • 1% perceived no risk for marijuana or crack and 0.7% saw no risk for cocaine use. [Encuesta Nacional de Escolares (PACARDO 2000)]

21. Women • “…women [users] are viewed as much worse because of their children...their role as mother educating those children...I mean, they question more the fact that she uses drugs, much more than the father”. “...la gente ve mucho peor la mujer por los hijos...con su rol de madre debe educar esos muchachos...es decir, cuestionan mucho el hecho de que ella consuma drogas, mucho más que el padre”. • “…women are always blamed more for all sorts of things” “...siempre es más condenada la mujer en todos tipos de cosas”

22. Gay Men • “...there are guys that when they are going to have sex with you, the first thing they say is, ‘if there is no coke I won’t go to bed with you’...” “...hay muchachos que cuando van a tener sexo con uno lo primero que dicen es ‘si no hay perico, no me acuesto contigo’…”

23. Effects of Tourism, Out-Migration & Returning Deportees • “…we suffer from a serious problem which is that we are recipients of many cultures...the fact that the Dominican creates a style of life that is not real but rather is based on lifestyles adopted from other cultures” “...sufrimos un grave problema que es que nosotros somos receptores de múltiples culturas...el hecho que el Dominicano cree una forma de vida que no es real sino son formas de vida adoptadas de otras culturas...”

24. Effects of Tourism, Out-Migration & Returning Deportees – Cont. • “…the major influence in our country is New York, this is undeniable, New York is where there is the most drug use” “...la mayor influencia en nuestro país viene de Nueva York, eso es innegable...es de Nueva York que es donde más, donde más se consume...”

25. Effects of Tourism, Out Migration & Returning Deportees – Cont. • “...looking for a new way of life, the Dominican who emigrates to New York returns frequently 3-4 times a year for special dates such as Mother’s Day, Christmas, Easter, Carnaval, the Merengue Festival. In each of these trips for these holidays, with them comes a new system...the vice that is crack...” “..ese Dominicano que emigra a Nueva York viene frequentemente...en cada una de esas venidas...con ellos traen un nuevo sistema de vicio que es el crack...”

26. Relationship of Drug Use & HIV • “We don’t yet understand that the drug addict has an illness and that the person with AIDS is also another sick person; for us Dominicans, it is an affront, something shameful...”  “Todavía no tenemos conciencia de que el drogadicto es un enfermo y de que él que tiene SIDA también es otro enfermo...para nosotros los Dominicanos, es una afrenta, es una vergüenza...”

27. RecommendationsPolicy 1. Acknowledge and identify the problem of drug use and addiction in the population 2. Separate trafficking and consumption as policy issues 3. Clearly establish the link between HIV/AIDS and drug use

28. RecommendationsPolicy 4. Re-enforce traditional values which work to support prevention and treatment 5. Respond quickly to the growing drug crisis in youth 6. Develop and implement education and prevention activities in all sectors of the population, not only the most vulnerable and involved

29. RecommendationsPrograms 1.Prevention education and treatment alternatives are clearly indicated 2. A resource assessment is needed which will permit the support of already existing efforts by community- based agencies and others; mobilize the community to create “protected micro-environments” [‘micro-ambientes protectores’]

30. Thank you for your attention.Muchas gracias por su atención.