Advocacy and Media Literacy to Address Drug Addiction Treatment Needs In Puerto Rico

Background:  Drug treatment, particularly pharmacotherapy with opiate analogues, reduces HIV contagion in drug user.  In Puerto Rico more that 50% of HIV cases are those of drug users that share drug injection equipment.  Even though Puerto Rico ranks fourth in HIV/AIDS cases in the US, there is available space to treat only 8% of the needy population. Advocacy has become a necessary tool to prevent HIV among people with drug use disorders. It is known as a process to sensitize public opinion, media people, key stake holders, and policymakers for the benefit of specific health agenda. As competition for scarce resources increases, advocacy skills become important tools in influencing the decision-making process regarding resource allocation. This presentation examines the experience of the Puerto Rico Closing the Addiction Treatment Gap Alliance in designing, developing, and setting indicators for monitoring and evaluating an advocacy campaign and strategy aimed at influencing policy change.

Program background:  The Alliance adapted and applied the Community Dialogue and Collective Action model to address the need for effective drug treatment in the island where: a) community members take actions as a group; b) reduce the magnitude of the treatment gap; c) through strategies that result in social change; d) and that increase capacity to solve new problems. We utilized a combination of the Inter-sectorial model, community empowerment, and Leadership and Practice Theory to inform our activities.

Evaluation Methods and Results:  Media campaign that presented results of an island wide opinion survey exploring support for treatment expansion influenced changes adopted by the state public insurance administration and significant legislative actions that provide opportunities for treatment expansion.  Recognition of our work by government officials provided the opportunity for direct work with legislators in legislative pieces aimed to expand addiction treatment.  We created an advocacy group that support addiction treatment and that help us engage key stakeholders in treatment expansion.  Trainings on efficient service delivery have resulted in addiction treatment system changes across provider networks. 

Conclusions:  Despite the changes of leaders in agencies that are part of the alliance, we were able to maintain the support to this project and the compromise with the expansion of treatment.  This resulted from the development and nurture of networks within the community not only from top-down leaders but we strategically engage bottom-up ones.

Implications for research and/or practice: The approach employed has facilitated initiation of efforts to reduce treatment disparities and consequently reduce HIV contagion among drug users.