The converging issues of heroin drug dependance and HIV have emerged as a public health emergency in Puerto Rico. With the government overwhelmed, non-profits groups try to fill the void.

For the last three decades, Puerto Rico's public health officials have unsuccessfully fought a full-scale public health crisis. Today, the island has one of the highest HIV/Aids infection rates in the US, and more than 50% of all newly reported cases come from intravenous drug use.

Overwhelmed and chronically underfunded, the existing framework of health programs struggles to serve the island's estimated 60,000 intravenous drug users, so a patchwork of groups tries to fill the void. In 2007, Joseph Carroll Miranda helped start El Punto en la Montaña, a group that offers medical supplies and services to addicts who live in rural areas, out of the reach of government services.

Operating on a shoestring budget of about $50,000 a year – most of it from non-profit donors in the US – Miranda and a small team of volunteers deliver clean needles, juice and snacks to addicts each week. They bring along educational pamphlets, too, with explanations on how to use syringes and warnings about reusing needles. Sometimes he puts them in detoxification programs.

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