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
Initiation of regular marijuana use among a cohort of women infected with or at risk for HIV in the Women's Interagency HIV Study (WIHS)
AbstractKuo, W. H., Wilson, T. E., Weber, K. M., Madhava, V., Richardson, J., Delapenha, R., & Des Jarlais, D. (n.d.).Publication year
2004Journal title
AIDS patient care and STDsVolume
18Issue
12Page(s)
702-713AbstractOur study sought to determine the incidence of weekly marijuana use among HIV-infected and uninfected women, to identify correlates of weekly marijuana use, and to test its association with stage of HIV disease and type of HIV treatment received. A total of 2059 HIV-positive and 569 HIV-negative women from 6 sites were recruited between 1994 and 1995 and followed through 2000. After excluding women who reported weekly marijuana use at baseline, 2050 women were included in the analysis. The incidence rate for initiating marijuana was calculated and survival analysis was performed to determine the correlates of initiating weekly marijuana use. Three hundred and three women initiated weekly marijuana use within 5.5 years of the baseline visit, yielding a cumulative incidence (CI) of 14.8%. There was no significant difference in weekly marijuana use initiation between HIV-infected (CI = 14.5%) and HIV-uninfected women (CI = 16.0%). Younger age and having more sex partners was associated with incident weekly marijuana use among both infected and uninfected women. While undetectable viral load was associated with lower incidence rate (p < 0.001, RH = 0.44) and wasting syndrome with higher incidence (p < 0.01, relative hazard [RH] = 3.1), CD4 count was not. Compared to receiving no AIDS treatment at all, women who received basic combination antiretroviral therapy had significantly higher incidence of weekly marijuana use (p < 0.001, RH = 1.93), while highly active antiretroviral therapy (HAART) receivers had significantly lower incidence (p < 0.001, RH = 0.24). In summary, among HIV-infected women, the incidence of weekly marijuana use was associated with only one marker of HIV disease stage and HAART was associated with lower initiation rate of weekly marijuana use.Injection Drug Users and the Provision of Hepatitis C-Related Services in a Nationwide Sample of Drug Treatment Programs
AbstractVassilev, Z. P., Strauss, S. M., Astone, J., & Des Jarlais, D. C. (n.d.).Publication year
2004Journal title
Journal of Behavioral Health Services and ResearchVolume
31Issue
2Page(s)
208-216AbstractDrug treatment facilities are important sites for providing targeted prevention and health services to injection drug users (IDUs) who are infected with the hepatitis C virus (HCV). A nationwide survey was conducted to examine whether differences exist in the HCV-related services provided by drug treatment programs that have varying proportions of IDUs among their patients. The results indicate that, overall, drug treatment programs with a greater proportion of IDUs offer significantly more HCV services as compared to programs with a smaller proportion of IDUs. However, important components of hepatitis C-related care, such as universal basic education and counseling about HCV and extensive HCV-antibody testing, are not yet being provided by all programs with a large proportion of IDUs among their patient populations.Long-term effects of syringe exchange on risk behavior and HIV prevention
AbstractBraine, N., Des Jarlais, D. C., Ahmad, S., Purchase, D., & Turner, C. (n.d.).Publication year
2004Journal title
AIDS Education and PreventionVolume
16Issue
3Page(s)
264-275AbstractThe purpose of this study was to assess stability of population-level injection risk behavior over time among participants in a syringe exchange program and compare factors affecting syringe sharing at two points in time. Participants of the Tacoma Syringe Exchange Program were interviewed in 1997 and 2001 using audio computer assisted self-interviewing technology. In each wave of data collection, a random cross section of participants was recruited and interviewed, with no attempt made to follow respondents over time. Rates of injection risk behavior remained stable across the 4-year period, despite increases in factors associated with syringe sharing. Homelessness, rates of depression symptoms, and injection of amphetamines all increased from 1997 to 2001. The central factors associated with syringe sharing in both 1997 and 2001 were depression symptoms and the interaction of younger age with amphetamine injection. The data indicate that the exchange has been able to stabilize risk among a high-risk population for a substantial period of time. This study confirms previous findings that SEPs can play a significant role in the prevention of HIV in marginal and impoverished communities in the United States.Opiate agonist maintenance treatment for injecting drug user peer educators [4]
Des Jarlais, D. C., Hammett, T. M., Wei, L., Van, L. K., Donghua, M., & Ngu, D. (n.d.). In Addiction (1–).Publication year
2004Volume
99Issue
10Page(s)
1355-1356Outpatient drug treatment program directors' hepatitis C-related beliefs and their relationship to the provision of HCV services
AbstractAstone, J. M., Strauss, S. M., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2004Journal title
American Journal of Drug and Alcohol AbuseVolume
30Issue
4Page(s)
783-797AbstractThe hepatitis C virus (HCV) continues to penetrate populations within the United States, especially within the drug-abusing population. Therefore, drug users need access to HCV testing and medical care, and drug treatment programs are well situated to provide these services. Because directors of these programs are gatekeepers who can influence decisions about service provision, their beliefs about the value of providing particular services for drug treatment program patients are of considerable importance. Directors of 121 outpatient drug treatment programs throughout the United States responded to an in-depth telephone survey that included questions on their beliefs about providing HCV services in drug treatment programs. We constructed an eight-item scale to examine these beliefs and investigated the relationship between them and the actual HCV services offered. Overall, directors were moderately supportive of the provision of HCV medical services (on-site or through referral) during drug treatment. Our findings indicate that there is a positive significant relationship between director's beliefs and the provision of HCV antibody testing, follow-up testing, and the provision of HCV medication.Public Funding of US Syringe Exchange Programs
AbstractDes Jarlais, D. C., McKnight, C., & Milliken, J. (n.d.).Publication year
2004Journal title
Journal of Urban HealthVolume
81Issue
1Page(s)
118-121AbstractAlthough there has been no federal government funding of syringe exchange, there is substantial state and local government funding. We report here on program characteristics associated with receiving state and local government funding. Annual telephone surveys were made of program directors of syringe exchange programs known to the North American Syringe Exchange Network. The number of syringe exchange programs known to this network has increased from 63 in 1994-1995 to 127 in 2000. Approximately 80% of programs participated in each of the surveys. Approximately 50% of programs receive state and local government funding, and this has remained constant from 1994 to 2000. Receiving state and local government funding was associated with larger numbers of syringes exchanged per year and providing more on-site services. Among programs that received state or local government funding, this funding accounted for a mean of 87% of the budget for syringe exchange services. In the absence of federal funding, state and local government support is associated with better syringe exchange performance.Sexual risk reduction in a cohort of injecting drug users in Bangkok, Thailand
AbstractVanichseni, S., Des Jarlais, D. C., Choopanya, K., Mock, P. A., Kitayaporn, D., Sangkhum, U., Prasithiphol, B., Hu, D. J., Van Griensven, F., Mastro, T. D., & Tappero, J. W. (n.d.).Publication year
2004Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
37Page(s)
1170-1179AbstractObjective: Interventions to reduce sexual risk behavior among injecting drug users (IDUs) have generally had very modest effects, but almost all such interventions have been conducted within short time frames. This study assessed whether long-term participation in interventions to reduce sexual risk behavior was associated with reduced sexual risk behavior. Methods: A total of 806 IDUs participated in the Bangkok HIV Vaccine Trial Preparatory Cohort Study from 1995-1998 and remained in the study for at least 4 follow-up visits (approximately 16 months). Participants received HIV counseling and testing every 4 months and free condoms were provided. Structured interviews including questions on sexual behavior were administered every 4 months. Results: Approximately 40% of participants reported engaging in unprotected sex (vaginal intercourse without always using a condom) with a regular partner at each study visit, without any decline over time in this behavior. There were declines in the proportions of participants reporting unprotected sex with casual partners and with paid partners (men only) over time, but the declines were confined to the early period of the study. Unprotected sex with casual partners was associated with amphetamine use. Condom use increased substantially among participants who seroconverted for HIV during the study. Conclusions: Interventions to reduce sexual risk behavior among HIV-seronegative IDUs over extended periods were no more likely to be effective than shorter interventions. New programs are needed to reduce sexual risk behavior among amphetamine users and among IDUs who are currently seronegative but are engaging in injection risk behaviors and in unprotected sex with regular partners.The Content and Comprehensiveness of Hepatitis C Education in Methadone Maintenance and Drug-Free Treatment Units
AbstractStrauss, S. M., Astone, J. M., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2004Journal title
Journal of Urban HealthVolume
81Issue
1Page(s)
38-47AbstractAlthough drug users are at elevated risk for hepatitis C virus (HCV) infection, many are uniformed or misinformed about the virus. Drug treatment programs are uniquely situated to provide comprehensive risk-modifying educational programs for decreasing HCV transmission, a strategy advocated in the most recent National Institutes of Health Consensus Development Conference Statement on the Management of Hepatitis C. Given the large proportion of patients that inject drugs in methadone maintenance treatment programs and the high prevalence of HCV among drug injectors, we compared a nationwide sample (N=246) of methadone maintenance treatment programs and drug-free programs regarding the content and comprehensiveness of HCV education. All of these programs provide HCV education to at least some of their patients. Results indicated that, compared to drug-free programs, methadone maintenance treatment programs cover a significantly greater number of HCV-related topics, and that a significantly greater proportion of the methadone programs cover specific topics (e.g., bow to avoid transmitting HCV, the importance of testing for HCV, treatment options if HCV positive). Of special concern is that fewer than three quarters of the drug-free programs address what to do if co-infected with human immunodeficiency virus (HIV) and HCV and bow to maintain health if HCV positive, and only about half of the drug-free and methadone maintenance treatment programs educate HCV-positive patients about the importance of obtaining vaccinations for hepatitis A and B. Drug treatment programs need to educate patients about the proactive steps these individuals can take to deal with HCV, provide critically needed HCV services, and encourage patients to make full use of these services.TREND: An important step, but not enough [1] (multiple letters)
Dzewaltowski, D. A., Estabrooks, P. A., Klesges, L. M., Glasgow, R. E., Des Jarlais, D. C., Lyles, C., & Crepaz, N. (n.d.). In American journal of public health (1–).Publication year
2004Volume
94Issue
9Page(s)
1474-1475Development and implementation of a cross-border HIV prevention intervention for injection drug users in Ning Ming County (Guangxi Province), China and Lang Son Province, Vietnam
AbstractHammett, T. M., Des Jarlais, D. C., Liu, W., Ngu, D., Tung, N. D., Hoang, T. V., Van, L. K., & Donghua, M. (n.d.).Publication year
2003Journal title
International Journal of Drug PolicyVolume
14Issue
5Page(s)
389-398AbstractThis paper describes the background and early implementation of a peer-based HIV prevention intervention involving social marketing of sterile needles and syringes for injection drug users (IDUs) in a border region of northern Vietnam and southern China. Peer educators collect and safely dispose of used needles and syringes and provide IDUs with a choice of new needles/syringes or vouchers redeemable in pharmacies and clinics for new needles/syringes. The project arose from a pattern of changing drug use and increasing HIV infection in the region but its development took 4 years and faced many challenges. Implementation of the intervention posed a new set of challenges for the participating health departments, police, peer educators, pharmacists, injection drug users, and the communities at large. Early implementation of the project has revealed successful multi-sectoral collaboration, and broad acceptance by IDUs of pharmacy vouchers and distribution of new needles/syringes. However, IDUs' persistent fear of the police, particularly in Vietnam, has required reliance on separate collection by peer educators of used needles/syringes and distribution of pharmacy vouchers and new needles. In China, new needles/syringes and vouchers are largely being provided through exchange. Understanding the development and implementation challenges and the strategies that were successful in overcoming them (including the importance of being flexible and adaptable to contextual factors) may be useful to those interested in launching similar, much-needed interventions in other parts of the world.Drug dealing and attitudes and norms about drug dealing among young adults and their peers in a high-risk community
AbstractFriedman, S. R., Flom, P. L., Kottiri, B. J., Neaigus, A., Sandoval, M., Curtis, R., Johnson, B. D., & Des Jarlais, D. C. (n.d.).Publication year
2003Journal title
International Journal of Drug PolicyVolume
14Issue
3Page(s)
261-268AbstractObjective: To assess the extent of drug dealing and of non-hostile views towards drug dealing among young adults and their peers in an impoverished minority community with considerable drug dealing and use. Methods: A population-representative sample of three hundred and sixty-three 18-24 year olds was interviewed in the Bushwick section of Brooklyn, NY. Questions asked about drug dealing, attitudes to dealing, and friends' norms toward drug dealing. Results: 16% of men and 4.5% of women dealt drugs in the year prior to the interview. Among the other subjects, 30% of men and 13% of women view dealers in a non-hostile way; 22% of men and 8% of women report close friends have encouraged them to deal drugs; and 30% of men and 50% of women report that all of their close friends would object if they were to deal drugs. Among young women, potentially-traumatic events while growing up, such as sexual or physical abuse and undergoing racial discrimination are associated with less hostile attitudes and friends' norms towards dealing; as is, for men, undergoing racial discrimination while growing up. Conclusions: In spite of policies based on imprisoning and stigmatising drug dealers and drug users, both drug dealing and non-hostile views towards it remain fairly prevalent among young adults in this community.Drug use patterns and infection with sexually transmissible agents among young adults in a high-risk neighbourhood in New York City
AbstractFriedman, S. R., Flom, P. L., Kottiri, B. J., Zenilman, J., Curtis, R., Neaigus, A., Sandoval, M., Quinn, T., & Des Jarlais, D. C. (n.d.).Publication year
2003Journal title
AddictionVolume
98Issue
2Page(s)
159-169AbstractAims: To determine relationships between drug use 'hardness' (defined in increasing order of hardness as no drug use, marijuana use, non-injected heroin or cocaine use, crack smoking and injection drug use) and prevalences of several sexually transmissible infections among young adults in a high-risk neighbourhood. Drug users, particularly injection drug users and crack smokers, may be a core group for some sexually transmitted infections. Design: Cross-sectional survey and assays of young adults from (a) a household probability sample and (b) a targeted sample of youth who have used injected drugs, crack, other cocaine or heroin. Setting: Bushwick, an impoverished New York City minority neighbourhood, with major drug markets. Participants: A total of 363 18-24-year-olds from a household probability sample: 165 Bushwick 18-24-year-olds who have used injected drugs, crack, other cocaine or heroin. Measurements: Drug use by self-report; serum- and urine-based assays for HIV, hepatitis B and C, syphilis, gonorrhoea, chlamydia and herpes simplex (type 2). Findings: Household-sample prevalences: HIV, hepatitis C and syphilis. 1%; gonorrhoea 3%; chlamydia 5%; past or present hepatitis B infection 8%; herpes simplex (type 2) 18%. In combined household and targeted samples, hepatitis C and HIV were concentrated among drug injectors. Herpes simplex (type 2). syphilis and hepatitis B increased among women with 'hardest drug ever used'. Conclusions: Using 'harder' drugs is associated with some but not all of these infections, Prevention efforts should help youth avoid unsafe sex and higher-risk drugs.Factors associated with hepatitis C virus infection in injection and noninjection drug users in Italy
AbstractQuaglio, G., Lugoboni, F., Pajusco, B., Sarti, M., Talamini, G., Lechi, A., Mezzelani, P., & Des Jarlais, D. C. (n.d.).Publication year
2003Journal title
Clinical Infectious DiseasesVolume
37Issue
1Page(s)
33-40AbstractWe describe the prevalence of hepatitis C virus (HCV) infection among noninjection users of heroin in Italy and compare the prevalence of HCV infection among noninjection drug users (NIDUs) and injection drug users (IDUs). Multiple logistic regression analysis of data from NIDUs showed that hepatitis B virus (HBV) infection status was the only independent predictor of HCV seroprevalence. Among IDUs, the number of years of drug use and HBV and human immunodeficiency virus infection status were independent predictors of HCV seropositivity. We found an HCV infection prevalence of 20% among NIDUs. This rate was much lower than that for IDUs, who are 11 times more likely to have antibodies against HCV. The prevalence of HCV infection was much higher than that of HBV infection among the IDUs. In contrast, the prevalence of HBV infection was slightly higher than that of HCV infection among unvaccinated NIDUs. The prevalence of HCV infection among long-term IDUs approached true population saturation; among long-term NIDUs, however, it appeared to plateau at ∼40%. Additional research on HCV infection among NIDUs is needed to develop a strategic prevention program for this patient subgroup.Gaps in the drug-free and methadone treatment program response to Hepatitis C
AbstractStrauss, S. M., Astone, J., Vassilev, Z. P., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2003Journal title
Journal of Substance Abuse TreatmentVolume
24Issue
4Page(s)
291-297AbstractDrug treatment programs are sites of opportunity for the delivery of hepatitis C (HCV) prevention and care services to drug users. Using data collected from a random nationwide sample (N = 595) of drug treatment programs in the United States, this study compares the provision of HCV services by drug-free and methadone maintenance treatment programs (MMTPs). It then examines and compares perceived inadequacies in this service provision from the perspective of the managers in these two types of programs. Findings indicate that MMTPs are providing more HCV services to their patients, and that a greater proportion of MMTPs are dissatisfied with their current level of HCV service provision. Managers of drug-free programs would like to be offering patients more HCV education, while MMTP managers would like to be providing more HCV testing to their patients, and more support and care for patients who are HCV+.Hepatitis C virus infection: Prevalence, predictor variables and prevention opportunities among drug users in Italy
AbstractQuaglio, G. L., Lugoboni, F., Pajusco, B., Sarti, M., Talamini, G., Mezzelani, P., Des Jarlais, D. C., Ariano, C., Baggio, E., Banon, D., Bellio, G., Bossi, C., Cantiero, D., Casari, R., Civitelli, P., Danieli, D., Faccini, M., Fornasiero, A., Giacomin, M. A., … Vendramin, A. (n.d.).Publication year
2003Journal title
Journal of Viral HepatitisVolume
10Issue
5Page(s)
394-400AbstractThe study assessed rates and predictor variables of hepatitis C virus (HCV) infection among drug users receiving pharmacological treatment for opiates addiction. There was a large cohort study in 16 public centres for drug users in north-eastern Italy, with data collected by standardized face-to-face interviews between February 2001 and August 2001. Of 1095 participants, 74.2% were HCV seropositive. Anti-HCV status was independently associated with duration of drug use of over 10 years, injecting as a route of drug administration, and hepatitis B virus (HBV) and human immunodeficiency virus (HIV) seropositivity. Further statistical analysis was conducted by dividing the subjects on the basis of the duration of heroin use: more or <10 years. In the multivariate analyses, route of drug administration and HBV status were associated with HCV seropositivity among both groups. Less education was associated with HCV among the shorter term drug users. HIV status and having a sexual partner with a history of drug use were associated with HCV seropositivity among the longer term drug users. Half of the short-term heroin users were still HCV seronegative when starting treatment, suggesting opportunities for reducing new HCV infections. Remarkable was the relationship between vaccination for hepatitis B and HCV serostatus. Being HBV seropositive was strongly associated with being HCV seropositive. But heroin users who had been vaccinated for HBV were not significantly more likely to be HCV seropositive than heroin users who were HBV seronegative. HBV vaccination does not provide biological protection against HCV; however, vaccinating heroin users against HBV may help to create a stronger pro-health attitude among heroin users, leading to a reduction in HCV risk behaviour.HIV risk reduction in a cohort of injecting drug users in Bangkok, Thailand
AbstractChoopanya, K., Des Jarlais, D. C., Vanichseni, S., Mock, P. A., Kitayaporn, D., Sangkhum, U., Prasithiphol, B., Hiranrus, K., Van Griensven, F., Tappero, J. W., & Mastro, T. D. (n.d.).Publication year
2003Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
33Issue
1Page(s)
88-95AbstractObjective: To determine changes in risk behavior in relation to study participation among injecting drug users (IDUs) in Bangkok, Thailand. Methods: During 1995-1996, 1,209 HIV-seronegative IDUs were recruited from Bangkok Metropolitan Administration drug abuse treatment programs to participate in a prospective cohort study. Study visits occurred every 4 months, at which the participants underwent an interview to assess risk behavior and HIV counseling and testing. Eight hundred nine of the IDUs were considered "long-term" participants, who remained in the study through at least the first four scheduled follow-up visits (16 months). Injection risk behavior at each study visit was measured on a four-point scale strongly associated with incident HIV infections in the cohort. Individual regression slopes were used to assess changes in injection risk behavior (risk increase, no change, or risk reduction). Results: Of the 806 long-term study participants, 79% showed declines, 4% showed no change, and 17% showed increases in injection risk behavior. The percentage of participants in the highest-risk category (injecting daily or more frequently and sharing needles and syringes) declined from 42% at baseline to 3% at the final follow-up visit. Being in methadone maintenance treatment was associated with stable low rates of injection risk behavior, while recruitment from the 45-day detoxification treatment was associated with reductions in injection risk behavior. The risk reduction was independent of decline in risk behavior among IDUs in the community at large. Conclusions: Participation in this cohort study was associated with substantial declines in injection risk behavior. This information is important in the evaluation of possible adverse behavioral effects of participation in future preventive HIV vaccine trials including IDUs, particularly in developing country settings.Impact of Monetary Incentives on Adherence to Referral for Screening Chest X-rays after Syringe Exchange-Based Tuberculin Skin Testing
AbstractPerlman, D. C., Friedmann, P., Horn, L., Nugent, A., Schoeb, V., Carey, J., Salomon, N., & Des Jarlais, D. C. (n.d.).Publication year
2003Journal title
Journal of Urban HealthVolume
80Issue
3Page(s)
428-437AbstractIntroduction. Syringe-exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active injection drug users. Chest x-rays (CXRs) are needed to exclude active tuberculosis prior to initiating treatment for latent tuberculosis infection. Adherence of drug users to referral for off-site chest x-rays has been incomplete. Previous cost modeling demonstrated that a monetary incentive to promote adherence could be justified on the cost basis if it had even a modest effect on adherence. Methods. We compared adherence to referral for chest x-rays among injection drug users undergoing syringe exchange-based tuberculosis screening in New York City before and after the implementation of monetary incentives. Results. From 1995 to 1998, there were 119 IDUs referred for CXRs based on tuberculin skin testing at the SEP. From 1999 to 2001, there were 58 IDUs referred for CXRs with a $25 incentive based on adherence. Adherence to CXR referral within 7 days was 46/58 (79%) among individuals who received the monetary incentive versus 17/119 (14%) prior to the implementation of the monetary incentive (P < .0001; odds ratio [OR] = 23; 95% confidence interval [CI] = 9.5-57). The median time to obtaining a CXR was significantly shorter among those given the incentive than among those referred without the incentive (2 vs. 11 days, P < .0001). In multivariate logistic regression analysis, use of the incentive was highly independently associated with increased adherence (OR = 22.9; 95% CI = 10-52). Conclusions. Monetary incentives are highly effective in increasing adherence to referral for screening CXRs to exclude active tuberculosis after syringe exchange-based tuberculin skin testing. Prior cost modeling demonstrated that monetary incentives could be justified on the cost basis if they had even a modest effect on adherence. The current data demonstrated that monetary incentives are highly effective at increasing adherence in this setting and therefore are justifiable on a cost basis. When health care interventions for drug users require referral off site, monetary incentives may be particularly valuable in promoting adherence.New Injectors and HIV-1 Risk
AbstractFriedman, S. R., Friedmann, P., Telles, P., Bastos, F., Bueno, R., Mesquita, F., & Des Jarlais, D. C. (n.d.). In World Health Organization (1–).Publication year
2003Page(s)
76-90AbstractMost persons who inject drugs for the first time are likely to be uninfected with HIV-1 unless they are men who have sex with men or residents of a country characterized by very high rates of heterosexual transmission. Indeed, there is a considerable literature showing that new drug injectors are less likely to be infected with HIV-1 than longer-term injectors (De Rossi et al., 1988; Friedman et al, 1989; Lima et al., 1994; van den Hoek et al., 1988; Vlahov et al., 1990; Zunzunegui-Pastor et al., 1993). It has been suggested that the seroconversion rates of new injectors may vary in a complicated relationship with the overall seroprevalence and seroconversion rates of an area (Friedman et al., 1994a), with new injectors having higher seroconversion rates than longer-term injectors in cities with high but stable seroprevalence (Ciaffi et al., 1992), lower serocon-version rates in cities of medium-to-high but increasing seroprevalence, and equally low seroconversion rates in cities with low seroprevalence. New male injectors seem to become infected later in their injection careers than do women in New York, as well as in some (but not all) other American cities (Des Jarlais et al., 1994; Friedman et al., 1993, 1994a; Neaigus et al, 1995).On-site HIV testing in residential drug treatment units: Results of a nationwide survey
AbstractStrauss, S. M., Des Jarlais, D. C., Astone, J., & Vassilev, Z. P. (n.d.).Publication year
2003Journal title
Public Health ReportsVolume
118Issue
1Page(s)
37-43AbstractObjective. Residential drug treatment units are uniquely situated to provide HIV testing and counseling to their patients. This article examines the extent to which residential drug treatment units in the United States provide HIV testing on-site, and identifies organizational and institutional characteristics that differentiate units in which on-site HIV testing is available from those in which it is not. Methods. The analyses use data collected in telephone interviews with unit managers from a random nationwide sample (N=138) of residential drug treatment units in 2001. Results. About half (48.6%) of the residential drug treatment units made HIV testing available to their patients on-site. Residential units were significantly more likely to make on-site testing available if they were larger (i.e., had a greater number of patients treated each month or had a greater number of staff that provided direct patient services) and if they were publicly rather than privately owned. Provision of on-site HIV testing was significantly correlated with having a medical orientation, i.e., with being operated by a hospital, with the unit viewing itself as patients' primary medical provider, or with providing medical care to the patients either on-site or at another part of the same treatment agency. Conclusion. In view of the critical importance of HIV testing for individuals who use illicit drugs and the existence of a simplified testing protocol involving saliva samples (eliminating the need for phlebotomy), units that do not have a medical orientation should be encouraged to make HIV testing available on-site.Potential impact of HIV among IDUs on heterosexual transmission in Asian settings: Scenarios from the Asian Epidemic Model
AbstractSaidel, T. J., Des Jarlais, D., Peerapatanapokin, W., Dorabjee, J., Singh, S., & Brown, T. (n.d.).Publication year
2003Journal title
International Journal of Drug PolicyVolume
14Issue
1Page(s)
63-74AbstractIntroduction: An important public health question is the degree to which HIV epidemics among injecting drug users (IDUs) can contribute to more generalised spread of the virus heterosexually among non-IDUs. Mathematical models can be of use in understanding the complexities of such epidemiological problems. Methods: In this paper, the Asian Epidemic Model (AEM) is used to explore different scenarios for potential HIV transmission by IDUs to non-injecting sexual partners and beyond. The model is applied to a 'general Asian' setting, in which (1) there is the potential for sex work to drive a self-sustaining heterosexual epidemic, and (2) the vast majority of IDUs are male and do not engage in sex work themselves, but a substantial minority of the IDUs do purchase sexual services from sex workers. Within such a setting, three different scenarios are modeled, and within each scenario, the level of HIV prevalence among IDUs is varied, to see the impact of preventing HIV among IDUs at different stages. Results: The number of HIV infections attributable to IDUs over a 15-year period was greatest when the epidemic among IDUs started in advance of a generalised heterosexual epidemic, with a 171% increase in infections if the IDU prevalence was not kept under control. Once a heterosexual epidemic was underway, controlling HIV prevalence among IDUs still resulted in a meaningful reduction in infections (23%), including among non-IDUs. Once the heterosexual epidemic started to decline, the relative proportion of infections attributable to IDUs increased, creating a situation for IDUs to feed into new epidemics. Discussion: In the early stages of a heterosexual epidemic, maintaining HIV prevalence at low levels among IDUs can buy critical time to address the potential for rapid heterosexual transmission. In more advanced heterosexual epidemics, preventing HIV among IDUs can still avert a substantial number of infections.Preventing Epidemics of HIV-1 among Injecting Drug Users
AbstractDes Jarlais, D. C., Hagan, H., Friedman, S. R., Friedmann, P., Goldberg, D., Frischer, M., Green, S., Tunving, K., Ljungberg, B., Wodak, A., Ross, M., Purchase, D., Millson, P., & Myers, T. (n.d.). In World Health Organization (1–).Publication year
2003Page(s)
183-200AbstractIn many areas, the spread of HIV-1 among injecting drug users (IDUs) due to the multi-person use of drug injection equipment has occurred with extreme rapidity. In New York City, for example, HIV-1 seroprevalence among IDUs increased from under 10 per cent to over 50 per cent in a period of five years (Des Jarlais et al., 1989); in Edinburgh, HIV-1 seroprevalence among IDUs increased from zero to over 40 per cent in one year (Robertson et al., 1986); in Bangkok, HIV-1 seroprevalence increased from 2 per cent to over 40 per cent in two years (Vanichseni and Sakuntanaga, 1990); and in the state of Manipur, India, levels increased from zero to approximately 50 per cent in one year (Naik et al., 1991). HIV-1 has spread rapidly among populations where there has been a lack of awareness of AIDS as a local threat and mechanisms such as ‘shooting galleries’, ‘dealer’s works’ and professional injectors that provide rapid and efficient mixing among large numbers of IDUs (Friedman and Des Jarlais, 1991).Provision of hepatitis C education in a nationwide sample of drug treatment programs
AbstractAstone, J., Strauss, S. M., Vassilev, Z. P., & Des Jarlais, D. C. (n.d.).Publication year
2003Journal title
Journal of drug educationVolume
33Issue
1Page(s)
107-117AbstractHepatitis C virus (HCV) has reached epidemic proportions among drug users, and drug programs are in a unique position to provide each of their patients with HCV education. Using a nationwide sample (N= 434) of drug treatment programs, we report the results of a logistic regression analysis that differentiates programs providing HCV education to all of their patients versus programs that do not. Fifty-four percent of the programs provide HCV education to all of their patients. Programs are about four and a half times as likely to provide HCV education to all patients if they dispense methadone; almost four times as likely to provide this service if they educate most of their staff about HCV; twice as likely if they are residential; and almost twice as likely if they conduct HIV testing on-site. Our findings indicate that there is a need to increase HCV educational services in drug treatment programs.The Structure of Stable Seroprevalence HIV-1 Epidemics among Injecting Drug Users
AbstractDes Jarlais, D. C., Choopanya, K., Millson, P., Friedmann, P., & Friedman, S. R. (n.d.). In World Health Organization (1–).Publication year
2003Page(s)
91-100AbstractIn many areas, the introduction of HIV-1 into the local population of injecting drug users (IDUs) was followed by extremely rapid dissemination within this group. Rapid HIV-1 spread has occurred both in industrialized and developing countries, and in very large cities such as New York (Des Jarlais et al., 1989), moderate-sized cities such as Edinburgh (Robertson et al., 1986) and in semirural areas such as the state of Manipur, India (Naik et al., 1991) (also see: Des Jarlais et al., 1992; Friedman and Des Jarlais, 1991).Variability in the incidence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among young injecting drug users in New York City
AbstractDes Jarlais, D. C., Diaz, T., Perlis, T., Vlahov, D., Maslow, C., Latka, M., Rockwell, R., Edwards, V., Friedman, S. R., Monterroso, E., Williams, I., & Garfein, R. S. (n.d.).Publication year
2003Journal title
American Journal of EpidemiologyVolume
157Issue
5Page(s)
467-471AbstractCohort studies of young (aged 18-30 years) injecting drug users recruited in 1997-1999 in the Harlem and Lower East Side areas of New York City, New York, were used to assess the incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The authors found that HIV incidence was low at both sites: 0.8/100 person-years at the Harlem site and 0/100 person-years at the Lower East Side site. In contrast, HBV incidence was moderate (12.2/100 person-years) at the Harlem site and high (30.7/100 person-years) at the Lower East Side site. Similarly, HCV incidence was moderate (9.3/100 person-years) at the Harlem site and high (34.0/100 person-years) at the Lower East Side site. Results show that high rates of HBV and HCV transmission do not imply high rates of HIV transmission, even within an area of high HIV seroprevalence.What predicts which metropolitan areas in the USA have syringe exchanges?
AbstractTempalski, B., Friedman, S. R., Des Jarlais, D. C., McKnight, C., Keem, M., & Friedman, R. (n.d.).Publication year
2003Journal title
International Journal of Drug PolicyVolume
14Issue
5Page(s)
417-424AbstractHIV epidemics among IDUs vary widely across different cities in the USA [American Journal of Public Health 86 (5) (1996) 642]. Few studies have focused on how localities differ in regard to response to the HIV epidemic. While syringe exchange programmes (SEPs) are a response to HIV among IDUs, they are often unwelcome and difficult to set up even in communities hit hardest by the epidemic. It is important to understand what metropolitan area characteristics are related to when and if an SEP opens in a particular locality. Logistic regression models are used to explore how need, political factors, SEP diffusion from Tacoma (the first SEP), and metropolitan socioeconomic characteristics are related to SEP presence. Results indicate that need is not a significant predictor of having an SEP. Predictors were the percentage of the population who are men who have sex with men (AOR = 6.95; 95% CI = 1.29-37.49), and metropolitan area population (AOR = 1.08 per 100,000; 95% CI = 1.02-1.14). Predictors of having an SEP in a metropolitan area seem to be political factors and metropolitan area population size, not need among IDUs. Gay political influence and/or support may well facilitate SEP formation, and geographic diffusion may influence where SEPs are established.