Don Des Jarlais
Don Des Jarlais
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Professor of Epidemiology
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Professional overview
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Dr. Don Des Jarlais is a leader in the fields of AIDS and injecting drug use, and has published extensively on these topics including articles in The New England Journal of Medicine, JAMA, Science, and Nature.
He is active in international research, having collaborated on studies in many different countries. He serves as a consultant to various institutions, including the U.S. Centers for Disease Control and Prevention, the National Institute of Drug Abuse, the National Academy of Sciences, and the World Health Organization.
Dr. Des Jarlais’ research has received numerous awards, including a New York State Department of Health Commissioner’s award for promoting the health of persons who use drugs. He formerly served as avcommissioner for the National Commission on AIDS; as a core group member of the UNAIDS Reference Group on HIV and Injecting Drug Use; and as a member of the President’s Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board.
Dr. Des Jarlais is also an adjunct faculty of psychiatry and preventive medicine at Icahn School of Medicine at Mount Sinai, and guest investigator at Rockefeller University in New York.
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Education
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BA, Behavioral Science, Rice University, Houston, TXPhD, Social Psychology, University of Michigan, Ann Arbor, MI
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Areas of research and study
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EpidemiologyHIV/AIDSPsychology
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Publications
Publications
Mathilde Krim, amfAR, and the prevention of HIV infection among injecting drug users: A brief history
Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
AIDS patient care and STDsVolume
20Issue
7Page(s)
467-471Needle exchange use, sexual risk behaviour, and the prevalence of HIV, hepatitis B virus, and hepatitis C virus infections among Bulgarian injection drug users
AbstractVassilev, Z. P., Hagan, H., Lyubenova, A., Tomov, N., Vasilev, G., Krasteva, D., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
International Journal of STD and AIDSVolume
17Issue
9Page(s)
621-626AbstractAt a time when the rates of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) infections have risen among injection drug users (IDUs) in other countries in the region, little is known about the prevalence of these infections among Bulgarian injectors and about their sexual risk behaviours. IDUs (n = 773) in a community-based needle exchange programme (NEP) and two major drug treatment facilities in Sofia completed a structured interview and were tested for HIV, HBV, and HCV antibodies. While HCV prevalence in the sample was 73.9%, HBV and HIV prevalence was low -6% and 0.5%, respectively. Having more than 10 sexual partners, having sex with someone with hepatitis C or another IDU, and never using a condom with another IDU were common among those who were recruited through NEP. As 40% of the IDUs reported using NEP, it appears that needle exchange provides an opportunity to reach high-risk populations and prevent sexual transmission of blood-borne pathogens.Patients in long-term maintenance therapy for drug use in Italy: Analysis of some parameters of social integration and serological status for infectious diseases in a cohort of 1091 patients
AbstractQuaglio, G., Lugoboni, F., Pattaro, C., Montanari, L., Lechi, A., Mezzelani, P., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
BMC public healthVolume
6AbstractBackground: Heroin addiction often severely disrupts normal social functioning. The aims of this multi-centre study of heroin users in long-term replacement treatment were: i) to provide information on aspects of social condition such as employment, educational background, living status, partner status and any history of drug addiction for partners, comparing these data with that of the general population; ii) to assess the prevalence of hepatitis, syphilis and HIV, because serological status could be a reflection of the social conditions of patients undergoing replacement treatment for drug addiction; iii) to analyse possible relationships between social conditions and serological status. Methods: A cross-sectional study was carried out in sixteen National Health Service Drug Addiction Units in northern Italy. The data were collected from February 1, 2002 to August 31, 2002. Recruitment eligibility was: maintenance treatment with methadone or buprenorphine, treatment for the previous six months, and at least 18 years of age. In the centres involved in the study no specific criteria or regulations were established concerning the duration of replacement therapy. Participants underwent a face-to-face interview. Results: The conditions of 1091 drug treatment patients were evaluated. The mean duration of drug use was 14.5 years. Duration was shorter in females, in subjects with a higher educational background, and in stable relationships. Most (68%) had completed middle school (11-14 years of age). Seventy-nine percent were employed and 16% were unemployed. Fifty percent lived with their parents, 34% with a partner and 14% alone. Males lived more frequently with their parents (55%), and females more frequently with a partner (60%). Sixty-seven percent of male patients with a stable relationship had a partner who had never used heroin. HCV prevalence was 72%, HBV antibodies were detected in 42% of patients, while 30% had been vaccinated; 12.5% of subjects were HIV positive and 1.5% were positive for TPHA. Conclusion: A significant percentage of heroin users in treatment for opiate addiction in the cohort study have characteristics which indicate reasonable integration within broader society. We posit that the combination of effective treatment and a setting of economic prosperity may enhance the social integration of patients with a history of heroin use.Patterns of HIV prevalence and HIV risk behaviors among injection drug users prior to and 24 months following implementation of cross-border HIV prevention interventions in Northern Vietnam and Southern China
AbstractHammett, T. M., Kling, R., Johnston, P., Liu, W., Ngu, D., Friedmann, P., Kieu, T. B., Ha, V. D., Ly, K. V., Donghua, M., Chen, Y., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
AIDS Education and PreventionVolume
18Issue
2Page(s)
97-115AbstractIn 2002, we implemented a 4-year HIV prevention intervention for injection drug users (IDUs) in Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China, a cross-border region seriously affected by inter-twined epidemics of heroin injection and HIV infection. The interventions involve peer education on HIV risk reduction and provision of new needles/syringes through direct distribution and pharmacy vouchers. We consider this to be a structural intervention in which risk reduction information and sterile injection equipment are diffused through the IDU populations and not limited to those who actually interact with peer educators. The evaluation of structural interventions poses complex methodological challenges. The evaluation of our interventions relies primarily on cross-sectional surveys (interviews and HIV testing) of samples of IDUs selected using a combination of targeted cluster and snowball methods. We consider this to be an appropriate, albeit imperfect, design given the study context. This paper presents analyses of data from the IDU surveys conducted just prior to implementation of the interventions and 24 months thereafter. The cross-border interventions have reached large proportions of the IDUs in the project sites, drug-related HIV risk behaviors have declined in frequency, and HIV prevalence among IDUs has been stable in China and declined in Vietnam over the 24 months since the interventions were implemented. Attribution of these positive trends to the interventions must be qualified in light of possible sampling biases and the absence of control groups. However, we believe that the structural interventions implemented by the cross-border project have played a role in stabilizing HIV prevalence among IDUs two years after they were initiated. Evidence of further diffusion of the interventions among IDUs and continued stability or decline of HIV prevalence would strengthen this case.Patterns of sexual commerce among women at US Syringe Exchange Programs
AbstractBraine, N., Desjarlais, D. C., Goldblatt, C., Zadoretzky, C., & Turner, C. (n.d.).Publication year
2006Journal title
Culture, Health and SexualityVolume
8Issue
4Page(s)
289-302AbstractIn the USA, the majority of research on sex work has examined the experiences of women recruited from social locations commonly referred to as the 'sex industry', such as street strolls or escort services. This paper presents data from female syringe exchange participants who had sold sex in the last 30 days. The women interviewed for this study report a much broader array of commercial transactions than found in previous US studies, including selling sex to women, paying men for sex, and considerable role fluidity between buying and selling. In addition, approximately one-third of the women report only selling sex 1 day per week or less, and appear to be more socio-economically stable than women who sell sex more often. We argue that this data suggests the existence of an array of commercial sexual transactions outside of the socially recognized sex industry, and that social location may affect condom use.Providing support to drug users infected with hepatitis C: The role of methadone maintenance treatment staff
AbstractAstone, J. M., Strauss, S. M., Munoz-Plaza, C., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
Journal of Maintenance in the AddictionsVolume
3Issue
1Page(s)
33-46AbstractInjection drug users (IDUs) have the highest rate of HCV infection. Although IDUs need support to access and use HCV services, they often lack this support. Many IDUs, however, have contact with a methadone maintenance treatment program (MMTP) where they can gain access to HCV services and obtain support in using them. Unfortunately, however, IDUs often underutilize theMMTPservices that are available to them. Using qualitative data collected in 4 MMTPs, we identify some reasons for clients' lack of HCV service utilization and staff strategies that influence clients' perceptions of support in using these services.Rapid assessment and response studies of injection drug use: Knowledge gain, capacity building, and intervention development in a multisite study
AbstractStimson, G. V., Fitch, C., Des Jarlais, D., Poznyak, V., Perlis, T., Oppenheimer, E., & Rhodes, T. (n.d.).Publication year
2006Journal title
American journal of public healthVolume
96Issue
2Page(s)
288-295AbstractObjectives. We evaluated the World Health Organization's rapid assessment and response (RAR) method of assessing injection drug use and its associated health problems, focusing on knowledge gain, capacity building, and whether RAR leads to the development of interventions reducing the health effects of injection drug use, Methods. Data were derived from RAR studies conducted in Beijing, China; Bogota, Colombia; Greater Rosario, Argentina; Hanoi, Vietnam; Kharkiv, Ukraine; Minsk, Belarus; Nairobi, Kenya; Penang, Malaysia; St. Petersburg, Russia; and Tehran, Iran. Results. Substantial gains in knowledge and response capacity were reported at all of the study sites. Before RAR initiation, prevention and intervention programs had been absent or inadequate at most of the sites. The RARs resulted in many new or modified interventions; 7 sites reported 24 health-related interventions that were subsequently developed and influenced by the RARs. Conclusions. RARs, which require relatively little external funding, appear to be effective in linking assessment to development of appropriate interventions. The present results add to the evidence that rapid assessment is an important public health tool.Relationships of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas
AbstractFriedman, S. R., Cooper, H. L., Tempalski, B., Keem, M., Friedman, R., Flom, P. L., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
AIDSVolume
20Issue
1Page(s)
93-99AbstractObjective: To understand associations of punitive policies to the population prevalence of injection drug users and to HIV seroprevalence among injectors. Design and methods: A lagged-cross-sectional analysis of metropolitan statistical area data. Estimates of drug injectors per capita and of HIV seroprevalence among injectors in 89 large US metropolitan areas were regressed on three measures of legal repressiveness (hard drug arrests per capita; police employees per capita; and corrections expenditures per capita) controlling for other metropolitan area characteristics. Results: No legal repressiveness measures were associated with injectors per capita; all three measures of legal repressiveness were positively associated with HIV prevalence among injectors. Conclusions: These findings suggest that legal repressiveness may have little deterrent effect on drug injection and may have a high cost in terms of HIV and perhaps other diseases among injectors and their partners - and that alternative methods of maintaining social order should be investigated.Respondent-driven sampling in a study of drug users in New York City: Notes from the field
AbstractMcKnight, C., Des Jarlais, D., Bramson, H., Tower, L., Abdul-Quader, A. S., Nemeth, C., & Heckathorn, D. (n.d.).Publication year
2006Journal title
Journal of Urban HealthVolume
83Issue
7Page(s)
i54-i59AbstractBeth Israel Medical Center (BIMC), in collaboration with the Centers for Disease Control (CDC) and the New York State Department of Health (NYSDOH), used respondent-driven sampling (RDS) in a study of HIV seroprevalence among drug users in New York City in 2004. We report here on operational issues with RDS including recruitment, coupon distribution, storefront operations, police and community relations, and the overall lessons we learned. Project staff recruited eight seeds from a syringe exchange in Lower Manhattan to serve as the initial study participants. Upon completion of the interview that lasted approximately 1 h and a blood draw, each seed was given three coupons to recruit three drug users into the study. Each of the subsequent eligible participants was also given three coupons to recruit three of their drug-using acquaintances. Eligible participants had to have: injected, smoked or snorted an illicit drug in the last 6 months (other than marijuana), aged 18 or older, adequate English language knowledge to permit informed consent and complete questionnaire. From April to July 2004, 618 drug users were interviewed, including 263 (43%) current injectors, 119 (19%) former injectors, and 236 (38%) never injectors. Four hundred sixty nine (76%) participants were men, 147 (24%) were women, and two (<1%) were transgender. By race/ethnicity, 285 (46%) were black, 218 (35%) Hispanic, 88 (14%) white, 23 (4%) mixed/not specified, and four (<1%) native American. Interviews were initially done on a drop-in basis but this system changed to appointments 1 month into the study due to the large volume of subjects coming in for interviews. Data collection was originally proposed to last for 1 year with a target recruitment of 500 drug users. Utilizing RDS, we were able to recruit and interview 118 more drug users than originally proposed in one quarter of the time. RDS was efficient with respect to time and economics (we did not have to hire an outreach worker) and effective in recruiting a diverse sample of drug users.Sexual health in art and science
Semaan, S., Des Jarlais, D. C., & Bice, S. (n.d.).Publication year
2006Journal title
Emerging Infectious DiseasesVolume
12Issue
11Page(s)
1782-1788Staff perspectives on facilitating the implementation of hepatitis C services at drug treatment programs
AbstractMunoz-Plaza, C. E., Strauss, S. M., Astone-Twerwll, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2006Journal title
Journal of Psychoactive DrugsVolume
38Issue
3Page(s)
233-241AbstractDrug users are at risk of acquiring the hepatitis C virus (HCV). Although ancillary services available to clients at drug treatment programs are often limited, some of these programs are providing HCV services. Presenting qualitative data, the authors describe the HCV education and/or support services available at four drug treatment programs and examine staff and client perspectives on factors that facilitated the implementation of these services. Major findings include participants' perceptions that their programs had: (1) at least one change agent on staff who promoted the innovation and delivery ofHCV services; (2) at least one administrator or director who encouraged and supported the adoption of these services; and (3) a treatment team that tended to collectively “buy into” and value the HCV service. Ultimately, we found that some drug treatment programs are finding creative and nonresource-intensive ways of delivering HCV services despite the existence of significant barriers. While programs need more funding and resources to overcome these barriers, these findings may prove helpful to other drug treatment programs that would like to offer HCV services to at least some of their clients.Stigmatization of newly emerging infectious diseases: AIDS and SARS
AbstractDes Jarlais, D. C., Galea, S., Tracy, M., Tross, S., & Vlahov, D. (n.d.).Publication year
2006Journal title
American journal of public healthVolume
96Issue
3Page(s)
561-567AbstractObjectives. We assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases: AIDS and SARS. Methods. We conducted a random-digit-dialed survey of 928 residents of the New York City metropolitan area as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents' knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS. Results. In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS. Conclusions. Personal resources and mental health factors are likely to influence the public's ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS.Transitions to injecting drug use among noninjecting heroin users: Social network influence and individual susceptibility
AbstractNeaigus, A., Gyarmathy, V. A., Miller, M., Frajzyngier, V. M., Friedman, S. R., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
41Issue
4Page(s)
493-503AbstractObjectives: To determine the incidence/predictors of transitions to injecting among noninjecting heroin users (NIUs). Methods: Street-recruited NIUs in New York City, March/ 1996-March/2003, were interviewed for a prospective cohort study about social network influence (communication promoting injecting; exposure to injectors) and individual susceptibility. A transition to injecting was the first drug injection following baseline. Hazards ratios (HRs) (P < 0.05) were estimated by Cox proportional hazards regression, stratified by baseline injecting history. Results: Of 369 (64% of 579) followed, former-injectors were more likely to transition to injecting (33% or 53/160 vs. 12% or 25/209; 16.0/100 person-years-at-risk [pyar] vs. 4.6/100 pyar; HR = 3.25). Independent predictors among never-injectors included using ≥2 bags of heroin daily (HR = 7.0); social network influence (communication) and homelessness (HR = 6.3); shorter-term heroin use (HR = 5.3); social network influence (exposure) and physically abused (HR = 4.7); friends approve/condone drug injecting (HR = 3.5); lower perceived social distance from injectors (HR = 2.9); and younger age at first heroin use (HR = 1.2). Independent predictors among former-injectors were social network influence (communication) and lower perceived social distance from injectors (HR = 3.4); white race/ ethnicity (HR = 2.0); not very afraid of needles (HR = 1.8); and younger age (HR = 1.1). Conclusions: The risk of initiating injecting was lower than the risk of resuming injecting. Social network influence facilitates transitioning to injecting among those susceptible. Interventions to prevent injecting should address both social network influence and individual susceptibility.Using latent class analysis to identify patterns of hepatitis C service provision in drug-free treatment programs in the U.S.
AbstractStrauss, S. M., Rindskopf, D. M., Astone-Twerell, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2006Journal title
Drug and alcohol dependenceVolume
83Issue
1Page(s)
15-24AbstractHepatitis C virus (HCV) infection is a global health problem, and in many countries (including the U.S.), illicit drug users constitute the group at greatest risk for contracting and transmitting HCV. Drug treatment programs are therefore unique sites of opportunity for providing medical care and support for many HCV infected individuals. This paper determines subtypes of a large sample of U.S. drug-free treatment programs (N = 333) according to services they provide to patients with HCV infection, and examines the organizational and aggregate patient characteristics of programs in these subtypes. A latent class analysis identified four subtypes of HCV service provision: a "Most Comprehensive Services" class (13% of the sample), a "Comprehensive Off-Site Medical Services" class (54%), a "Medical Monitoring Services" class (8%) and a "Minimal Services" class (25%). "Comprehensive" services class programs were less likely to be outpatient and private for profit than those in the other two classes. It is of concern that so many programs belong to the "Minimal Services" class, especially because some of these programs serve many injection drug users. "Minimal Services" class programs in the U.S. need to innovate services so that their HCV infected patients can get the medical and support care they need. Similar analyses in other countries can inform their policy makers about the capacity of their drug treatment programs to provide support to their HCV infected patients.Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: Case study from the WHO Drug Injection Study Phase II
AbstractDes Jarlais, D. C., Perlis, T. E., Stimson, G. V., & Poznyak, V. (n.d.).Publication year
2006Journal title
BMC public healthVolume
6AbstractBackground: Successful cross-national research requires methods that are both standardized across sites and adaptable to local conditions. We report on the development and implementation of the methodology underlying the survey component of the WHO Drug Injection Study Phase II - a multi-site study of risk behavior and HIV seroprevalence among Injecting Drug Users (IDUs). Methods: Standardized operational guidelines were developed by the Survey Coordinating Center in collaboration with the WHO Project Officer and participating site Investigators. Throughout the duration of the study, survey implementation at the local level was monitored by the Coordinating Center. Surveys were conducted in 12 different cities. Prior rapid assessment conducted in 10 cities provided insight into local context and guided survey implementation. Where possible, subjects were recruited both from drug abuse treatment centers and via street outreach. While emphasis was on IDUs, non-injectors were also recruited in cities with substantial non-injecting use of injectable drugs. A structured interview and HIV counseling/testing were administered. Results: Over 5,000 subjects were recruited. Subjects were recruited from both drug treatment and street outreach in 10 cities. Non-injectors were recruited in nine cities. Prior rapid assessment identified suitable recruitment areas, reduced drug users' distrust of survey staff, and revealed site-specific risk behaviors. Centralized survey coordination facilitated local questionnaire modification within a core structure, standardized data collection protocols, uniform database structure, and cross-site analyses. Major site-specific problems included: questionnaire translation difficulties; locating affordable HIV-testing facilities; recruitment from drug treatment due to limited/selective treatment infrastructure; access to specific sub-groups of drug users in the community, particularly females or higher income groups; security problems for users and interviewers, hostility from local drug dealers; and interference by local service providers. Conclusion: Rapid assessment proved invaluable in paving the way for the survey. Central coordination of data collection is crucial. While fully standardized methods may be a research ideal, local circumstances may require substantial adaptation of the methods to achieve meaningful local representation. Allowance for understanding of local context may increase rather than decrease the generalizability of the data.A community-based study of hepatitis B infection and immunization among young adults in a high-drug-use neighborhood in New York City
AbstractKottiri, B. J., Friedman, S. R., Euler, G. L., Flom, P. L., Sandoval, M., Neaigus, A., Des Jarlais, D. C., & Zenilman, J. M. (n.d.).Publication year
2005Journal title
Journal of Urban HealthVolume
82Issue
3Page(s)
479-487AbstractWe conducted a community-based study of the prevalence and correlates of hepatitis B virus (HBV) infection and immunization among young adults in a "drug supermarket" neighborhood in New York City. Four hundred eighty-nine young adults ages 18-24 years were recruited from Bushwick, Brooklyn through multistage household probability sampling (n = 332) and targeted sampling (n = 157), interviewed, and tested for three hepatitis B markers (HBsAg, anti-HBc, and anti-HBs). Serological evidence of HBV infection was found in 8.0% (6.0% in the household sample and 12.1% in the targeted sample) and of hepatitis B immunization in 19.6% (22.6% in the household sample and 13.4% in the targeted sample). HBV infection was higher among young adults who either used crack or injected drugs and among those who traded sex for money or drugs. Having Medicaid was significantly associated with lower odds of infection in the household sample and higher odds of immunization in the targeted sample. Although adolescent hepatitis B immunization has been a public health priority in the United States since 1995, nearly three-quarters of young adults in this community did not have serological evidence of being either exposed or immunized. Whereas subsequent younger generations benefited from universal childhood hepatitis B immunization, this particular cohort of young adults who live in communities like Bushwick presents a unique group for prevention intervention.Community attitudes toward HIV prevention for injection drug users: Findings from a cross-border project in southern China and northern Vietnam
AbstractHammett, T. M., Norton, G. D., Kling, R., Liu, W., Chen, Y., Ngu, D., Binh, K. T., Dong, H. V., & Des Jarlais, D. C. (n.d.).Publication year
2005Journal title
Journal of Urban HealthVolume
82Page(s)
iv34-iv42AbstractSuccess of HIV prevention projects for injection drug users (IDUs) depends on the support of the communities in which they are implemented. This article presents data from cross-sectional community surveys of HIV knowledge and attitudes toward peer-based HIV prevention interventions for injection drug users in a border area of Lang Son Province, Vietnam and Ning Ming County, Guangxi Province, China. Analysis of these surveys at baseline and 18 months reveals generally high or improving levels of HIV knowledge and positive attitudes toward the interventions in both Vietnam and China. Levels of knowledge and positive attitudes tended to be higher in Vietnam than in China. Interviews with staff and peer educators suggest that the project's community education efforts have increased support for the interventions and contributed to their smooth implementation. However, the community surveys also reveal some continuing deficits in HIV knowledge and understanding of the interventions, including perceptions that provision of new needles/syringes will result in increased drug use. Additional education, including dissemination of countervailing project data, is necessary to address these deficits and further increase community support for the interventions.Correlates of HIV status among injection drug users in a border Region of Southern China and Northern Vietnam
AbstractHammett, T. M., Johnston, P., Kling, R., Liu, W., Ngu, D., Tung, N. D., Binh, K. T., Dong, H. V., Hoang, T. V., Van, L. K., Donghua, M., Chen, Y., & Des Jarlais, D. C. (n.d.).Publication year
2005Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
38Issue
2Page(s)
228-235AbstractThis article presents an analysis of the correlates of HIV status among samples of injection drug users (IDUs) in Lang Son Province, Vietnam (n = 348), and Ning Ming County, Guangxi Province, China (n = 294), who were interviewed and tested for HIV antibody just before the start of a peer-based HIV prevention intervention in this border region. Participants were largely male, in their 20s, and single. Logistic regression analysis suggests that among Chinese IDUs, border-related factors (eg, living closer to the border, buying drugs across the border more frequently) and younger age are the best predictors of HIV positivity. In Vietnam, HIV status seems to drive behavior (eg, some risk reduction practices are predictive of HIV positivity). These differing patterns may reflect the fact that the intertwined epidemics of heroin injection and HIV began earlier and HIV prevalence has reached significantly higher levels in Lang Son than across the border in Ning Ming. Although border-related factors emerge as predictors in Ning Ming, more IDUs in Lang Son are HIV-positive and may be reacting behaviorally to that status. Their greater likelihood of engaging in risk reduction measures may reflect some combination of a belief that risk reduction can slow disease progression and an altruistic desire to avoid infecting others.Drug abuse and the spread of infection
Des Jarlais, D. C., Hagan, H., & Friedman, S. R. (n.d.). In Epidemiology of Drug Abuse: HIV and AIDS as an example (1–).Publication year
2005Page(s)
193-208Evaluating national harm reduction programs
Des Jarlais, D. C. (n.d.).Publication year
2005Journal title
AddictionVolume
100Issue
11Page(s)
1575-1576Hepatitis C Among Intravenous Drug Users
Hagan, H., Des Jarlais, D. C., & Thiede, H. (n.d.). In Epidemiology (1–).Publication year
2005Volume
16Issue
3Page(s)
424Hepatitis C among intravenous drug users [6] (multiple letters)
Maher, L., Jalaludin, B., Chant, K., Kaldor, J., Hagan, H., Des Jarlais, D. C., & Thiede, H. (n.d.). In Epidemiology (1–).Publication year
2005Volume
16Issue
3Page(s)
423-424HIV incidence among injection drug users in New York City, 1990 to 2002: Use of serologic test algorithm to assess expansion of HIV prevention services
AbstractDes Jarlais, D. C., Perlis, T., Arasteh, K., Torian, L. V., Beatrice, S., Milliken, J., Mildvan, D., Yancovitz, S., & Friedman, S. R. (n.d.).Publication year
2005Journal title
American journal of public healthVolume
95Issue
8Page(s)
1439-1444AbstractObjectives. We sought to estimate HIV incidence among injection drug users (IDUs) in New York City from 1990 to 2002 to assess the impact of an expansion of syringe exchange services. Syringe exchange increased greatly during this period, from 250 000 to 300 0000 syringes exchanged annually. Methods. Serum samples were obtained from serial cross-sectional surveys of 3651 IDUs. HIV-positive samples were tested with the Serologic Test Algorithm for Recent HIV Seroconversion (STARHS) assay to identify recent HIV infections and to estimate HIV incidence. Consistency with other incidence studies was used to assess strengths and limitations of STARHS. Results. HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990-1992, to 2.63/100 PYAR from 1993-1995, to 1.05/100 PYAR from 1996-1998, and to 0.77/100 PYAR from 1999-2002 (P<.001). There was a very strong negative linear relationship (r=-.99, P<.005) between the annual numbers of syringes exchanged and estimated HIV incidence. These results were highly consistent with a large number of shorter incidence studies among IDUs conducted during the time period. Conclusions. STARHS testing of samples from large serial cross-sectional surveys can provide important data for the assessment of community-level HIV prevention.HIV risk behavior among amphetamine injectors at U.S. syringe exchange programs
AbstractBraine, N., Des Jarlais, D. C., Goldblatt, C., Zadoretzky, C., & Turner, C. (n.d.).Publication year
2005Journal title
AIDS Education and PreventionVolume
17Issue
6Page(s)
515-524AbstractThe goal of this study was to compare HIV risk behaviors of amphetamine and non-amphetamine injectors at syringe exchange programs (SEP) in the United States and to identify factors associated with injection risk. This analysis is based on data from a random cross-section of participants at 13 SEPs in different parts of the country. All interviews were done using Audio Computer-Assisted Personal Interviewing technology. Amphetamine injectors differ from other SEP participants in that they are younger and more likely to be White, to have had a recent same sex partner, and to be homeless. Rates of injection risk behavior are higher among amphetamine injectors than other SEP participants, but rates of condom use are similar. Factors associated with injection risk behavior are amphetamine injection, homelessness, depression, and having a recent same-gender sexual partner (for both men and women). SEPs have been repeatedly demonstrated to reduce injection risk behavior, but some groups of program participants continue to be at elevated risk. SEPs may need to develop new approaches to outreach and education to address the needs of amphetamine injectors and other populations at persistent risk.HIV/hepatitis C virus co-infection in drug users: Risk behavior and prevention
AbstractHagan, H., Thiede, H., & Des Jarlais, D. C. (n.d.).Publication year
2005Journal title
AIDSVolume
19Page(s)
S199-S207AbstractStudies of HIV-positive patients have consistently shown that drug users, in particular injection drug users (IDU), are far more likely to have hepatitis C virus (HCV) infection than other patient groups. HIV incidence and prevalence in IDU has declined in recent years, but HCV remains endemic in this population. HCV antibody prevalence among non-injection users of drugs such as heroin and cocaine is between 5 and 30%, although there are scant data on specific transmission risk behavior. The control of HIV/HCV co-infection must address HCV prevention. Epidemiological studies have suggested that HCV prevalence in IDU is subject to various influences, some of which may be modifiable by interventions. However, studies have not shown consistent effects of various prevention strategies on HCV transmission, including studies of HCV screening and education, drug treatment or needle exchange. Although some large cross-sectional studies in regions where needle exchange is available to a large number of drug injectors have reported declining HCV prevalence, the scale of services needed is a matter of considerable debate and has not been systematically quantified. Priorities for research related to the prevention of HIV/HCV co-infection should include estimating the effect on disease occurrence of eliminating specific risk factors, and specifying the level of resources needed to alter HCV incidence.