NYU research: Tourism as a driver of illicit drug use, HIV risk in the DR

The Caribbean has the second highest global human immunodeficiency virus (HIV) prevalence in the world outside of Sub-Saharan Africa, with HIV/AIDS as leading cause of death among people aged 20–59 years within the region. Particularly hard-hit are the Dominican Republic (DR) and Haiti, on the island of Hispaniola, accounting for approximately 70% of all people living with HIV in the Caribbean region.

Insufficient attention has been paid to the intersection of drugs and tourism as contributing factors for the region's elevated HIV/AIDS risk. Caribbean studies have almost exclusively focused on drug transportation. Seldom acknowledged are the roles which drugs play in tourism areas which may be fueling the Caribbean HIV/AIDS epidemic.

Now a new study, "Illicit drug use and HIV risk in the Dominican Republic: Tourism areas create drug use opportunities," published in Global Public Health. (2014 Oct 20:1-13. [Epub ahead of print]), addresses this gap by conducting in-depth interviews with 30 drug users in Sosúa, a major sex tourism destination of the DR. The study's results suggest three themes: (1) local demand shifts drug routes to tourism areas, (2) drugs shape local economies and (3) drug use facilitates HIV risk behaviors in tourism areas.

"We know that the DR is located on a primary drug transportation route and is also the Caribbean country with the most tourist arrivals, receiving over 4.5 million visitors in 2012," said Vincent Guilamo-Ramosa, PhD, MPH, MS, LCSW, RN, professor of Social Work and Global Public Health and a co-director at NYU's Center for Drug Use and HIV Research (CDUHR) and NYU's Center for Latino Adolescent and Family Health. "Tourism areas represent distinct ecologies of risk often characterized by sex work, alcohol consumption and population mixing between lower and higher risk groups."

The researchers sought to document drug use in tourism areas of the DR and its impact on HIV risk behaviors, potentially informing public health policies and programmatic efforts to address local drug use and improve HIV prevention efforts within tourism areas.

The researchers employed a two-step qualitative data analysis process and interview transcripts were systematically coded using a well-defined thematic codebook. Key findings from the in-depth interviews with drug users in Sosúa, DR include:

• Drug users commonly work in jobs related to tourism, and the vast majority of drug users in tourism areas indicated having sexual intercourse with someone in exchange for money, drugs, or another good (90%).

• Cocaine (86%) and marijuana (83%) were the most commonly used illegal drugs, with amphetamine use much less common (3%).

• Drugs have become linked to the touristic economy and are perceived to facilitate greater profitability for locals working in the area. As such, tourism environments provide opportunities for locals and tourists to engage in high risk behaviors involving sex and drug use.

• The majority of participants in the study (79%) agreed that drug use is a serious public health problem in the area. Similarly, there is an increased awareness of drugs in Sosúa, which drug users attributed to the tourism economy.

According to Dr. Guilamo-Ramosa and his team, the study supports the need for targeted research and intervention efforts for HIV prevention that address local drug use within the context of tourism areas and their role on risk behaviors.

"Our analysis suggests that local demands shift drug routes to tourism areas, drugs influence the local economies, and drug use facilitates HIV risk behaviors in tourist towns," said Dr. Guilamo-Ramosa. "This study is important because it indicates the need for drug policies to address the structural factors of the tourism economy involving local drug transport with specific impact on HIV transmission. The current failure to provide a local level response in tourist areas of high sexual risk behaviors potentially exacerbates HIV transmission."

The researchers stress that given the estimated 20 million tourists travelling to the Caribbean region annually and the documented elevated rates of HIV within prime tourism destinations, research related to such contexts is of importance to locals and visitors and has widespread importance to both the Caribbean region and the countries in which the tourists originate.

Funding: This work was supported by the Global Public Health Research Challenge Fund (GPHRCF) at New York University.

Vincent Guilamo-Ramos*, Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, NY, USA; Jane J. Lee, Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, NY, USA; Yumary Ruiz, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA; Holly Hagan, College of Nursing, New York University, New York, NY, USA; Marlyn Delva, Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA; Zahira Quiñones, Pontificia Universidad Católica Madre y Maestra, Santiago de los 10 Caballeros, Dominican Republic; Alexandra Kamler and Gabriel Robles, Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, NY, USA; *Corresponding author. Email: Vincent.Ramos@nyu.edu

The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit http://www.cduhr.org.

The Center for Latino Adolescent and Family Health at the NYU Silver School of Social Work investigates the role of the Latino family in shaping the development and well being of Latino adolescents. Strategically based in New York City, CLAFH addresses the needs of New York's diverse Latino communities in both national and global contexts. The Center serves as a link between the scientific community, Latino health and social service providers, and the broader Latino community. CLAFH works in collaboration with The Center for Drug Use and HIV Research (CDUHR), whose mission is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national, and global levels.

The mission of the Silver School of Social Work at New York University is to educate professionals in a global perspective for social work practice with individuals, families, groups, and communities and to provide leadership in the development of knowledge relevant to social work practice in complex urban environments.

NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit https://nursing.nyu.edu/