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
WORLD HEALTH ORGANIZATION: Drug Injecting and HIV Infection: Global Dimensions and Local Responses
AbstractStimson, G. V., Des Jarlais, D. C., & Ball, A. L. (n.d.). (1–).Publication year
2003AbstractDrug Injecting and HIV Infection is a comparative international study of drug injecting behaviour and HIV infection based on the World Health Organization’s study of 13 cities as disparate as Athens, Bangkok, Glasgow and Rio de Janeiro. Using a standardized methodology for the collection of data, as well as central data management and analysis, this study represents the largest international project of its kind. It presents a comprehensive overview of what is currently known about drug injecting, HIV infection, epidemic dynamics and possibilities for prevention. Stressing the importance of linking research to intervention and policy, the contributors emphasize the need to place HIV and policy issues on the international agenda. Written by experts in the field, this global study offers an in-depth and definitive analysis of the subject.A meta-analysis of the effect of HIV prevention interventions on the sex behaviors of drug users in the United States
AbstractSemaan, S., Des Jarlais, D. C., Sogolow, E., Johnson, W. D., Hedges, L. V., Ramirez, G., Flores, S. A., Norman, L., Sweat, M. D., & Needle, R. (n.d.).Publication year
2002Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
30Page(s)
S73-S93AbstractWe examined the effectiveness of 33 U.S.-based HIV intervention studies in reducing the sexual risk behaviors of drug users by reducing unprotected sex or increasing the use of male condoms. The studies, identified as of June 1998, through the HIV/AIDS Prevention Research Synthesis project, were published in 1988 or later, measured behavioral or biologic outcomes, used experimental designs or certain quasiexperimental designs, and reported sufficient data for calculating an effect size for sexual risk reduction. Of the 33 studies, 94% recruited injection drug users; 21% recruited crack users. The mean age of participants was 36 years. Almost all studies were randomized (94%), provided another HIV intervention to the comparison groups (91%), and evaluated behavioral interventions (91%). On average, interventions were conducted in 5 sessions (total, 10 hours) during 4.5 months. Interventions compared with no interventions were strong and significant (k = 3; odds ratio [OR], 0.60; 95% confidence interval [CI], 0.43-0.85). Interventions compared with other HIV interventions showed a modest additional benefit (k = 30; OR, 0.91; 95% CI, 0.81-1.03). When we extrapolated our result (an OR of 0.60) to a population with a 72% prevalence of risk behavior, the proportion of drug users who reduced their risk behaviors was 12.6% greater in the intervention groups than in the comparison groups. Our meta-analysis shows that interventions can lead to sexual risk reduction among drug users and justifies providing interventions to drug users. Developing interventions with stronger effects to further reduce sexual risk behaviors among drug users must remain a high priority.A nationwide survey of hepatitis C services provided by drug treatment programs
AbstractStrauss, S. M., Falkin, G. P., Vassilev, Z., Des Jarlais, D. C., & Astone, J. (n.d.).Publication year
2002Journal title
Journal of Substance Abuse TreatmentVolume
22Issue
2Page(s)
55-62AbstractDrug treatment programs are a site of opportunity for the delivery of primary and secondary hepatitis C (HCV) prevention services to drug users, a population at great risk for contracting and transmitting the virus. Using data collected from a random nationwide sample (N = 439) of drug treatment programs in the United States, this study examines the extent to which various types of HCV services are provided to their patients. Findings indicate that the majority of drug treatment programs educate at least some of their patients about HCV, and provide some type of support for patients who are infected with the virus. Only 29 of the programs in the sample test all of their patients for HCV, however, and 99 programs test none of them. For the most part, residential treatment programs offer more HCV related services than outpatient drug-free programs.A profile of U.S.-based trials of behavioral and social interventions for HIV risk reduction
AbstractSemaan, S., Kay, L., Strouse, D., Sogolow, E., Mullen, P. D., Neumann, M. S., Flores, S. A., Peersman, G., Johnson, W. D., Lipman, P. D., Eke, A., & Des Jarlais, D. C. (n.d.).Publication year
2002Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
30Page(s)
S30-S50AbstractWe describe 99 (experimental and certain quasi-experimental) U.S.-based trials, reported or published since 1988, of behavioral and social interventions that measured prespecified behavioral and biologic outcomes and aimed to reduce risk for HIV infection. Studies identified through June 1998 by the HIV/AIDS Prevention Research Synthesis project were grouped into 4 risk behavior areas: drug-related (k [number of studies] = 48), heterosexual youth (k = 24), heterosexual adult (k = 17), and same-sex (k = 10). We compared the studies in the 4 areas by variables key to the development, evaluation, and transfer of interventions. Participants comprised injection drug users (43% of studies), drug users out of treatment (29%), African Americans (18%), clinic patients (18%), youth in schools (10%), and drug users in treatment (10%). Most studies were randomized (85%), provided another intervention to the control or comparison groups (71%), and evaluated behavioral interventions (92%). On average, interventions were conducted in 5 sessions (total, 8 hours) during 3 months. The theoretical basis of the intervention was not noted in 57% of the reports. At least one variable from each of the 3 outcome classifications was measured in 8% of the studies: behavioral, biologic, and psychosocial. Distinct profiles exist for the 4 risk areas. Addressing gaps in research and reporting would be helpful for analytical and program activities. This sizable portfolio of evaluated interventions contributes to effectiveness reviews and to considerations of transfer to program practice.Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990-1999
AbstractMaslow, C. B., Friedman, S. R., Perlis, T. E., Rockwell, R., & Des Jarlais, D. C. (n.d.).Publication year
2002Journal title
American journal of public healthVolume
92Issue
3Page(s)
382-384AbstractObjectives. This study examined HIV prevalence and risk behaviors among male injection drug users (IDUs) who have sex with men and among other male IDUs. Methods. Male IDUs were interviewed and tested for HIV at a detoxification clinic during 1990 to 1994 and 1995 to 1999. Analyses compared male IDUs who do and do not have sex with men within and between periods. Results. Initially, HIV seroprevalence and risk behaviors were higher among IDUs who have sex with men. Seroprevalence (initially 60.5% vs 48.3%) declined approximately 15% in both groups, remaining higher among those who have sex with men. Generally, injection prevalence, but not sexual risk behaviors, declined. Conclusions. Male IDUs who have sex with men are more likely to engage in higher-risk behaviors and to be HIV infected. Improved intervention approaches for male IDUs who have sex with men are needed.Compliance with hepatitis B vaccination in 1175 heroin users and risk factors associated with lack of vaccine response
AbstractQuaglio, G., Talamini, G., Lugoboni, F., Lechi, A., Venturini, L., Des Jarlais, D. C., & Mezzelani, P. (n.d.).Publication year
2002Journal title
AddictionVolume
97Issue
8Page(s)
985-992AbstractAims: To investigate the feasibility of hepatitis B vaccination among heroin users, assessing adherence to the vaccination schedules and identifying factors associated with antibody response. Design and participants: A large cohort study in nine public centres for drug users (PCDUs) in north-eastern Italy, with data collected between January 1989 and December 1998. A total of 1175 heroin users were selected and vaccinated with a recombinant vaccine using two schedules (0-1-6 months and 0-1-2 months). Findings: Eighty-eight per cent of patients completed the vaccination series and a protective antibody response occurred in 77% of subjects. Completion of the vaccination series was not related to the length of the vaccination schedule or whether the patient was still in drug abuse treatment at the end of the series, but was related strongly to the number of patients enrolled at each PCDU (Spearman correlation = - 0.93, P < 0.001). Four variables were significantly associated with lack of seroconversion in response to vaccination: older age (AOR = 0.91 per year, 95% CI 0.88-0.94, P < 0.001), 2-month vaccination schedule (AOR = 3.10, 95% CI 2.06-4.68, P < 0.001), HCV seropositivity (AOR = 0.69, 95% CI 0.47-0.99. P = 0.04), HIV seropositivity (AOR = 0.27, 95% CI 0.10-0.77, P = 0.01). Conclusions: A large-scale, multi-site hepatitis B vaccination programme for heroin users proved feasible and effective. The factors associated with a lack of antibody response may be useful in identifying patients who would benefit most from routine post-vaccination testing, with booster doses for non-responders. These results suggest that hepatitis B vaccination for drug users should become a routine public health practice.Consistent condom use among drug-using youth in a high HIV-risk neighbourhood
AbstractFriedman, S. R., Flom, P. L., Kottiri, B. J., Neaigus, A., Sandoval, M., Fuld, J., Curtis, R., Zenilman, J. M., & Des Jarlais, D. C. (n.d.).Publication year
2002Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
14Issue
4Page(s)
493-507AbstractThe objectives of this study were to determine predictors of consistent condom use in heterosexual relationships of young adults who use hard drugs in a neighbourhood with widespread drug-use-connected HIV. We interviewed 196 18-24 year olds who injected drugs or used heroin, cocaine or crack in the prior year and lived in the Bushwick neighbourhood of New York City. Interviews covered sociodemographics, substance use and sexual networks. The unit of analysis is the relationship; the dependent variable measures consistent condom use over the prior 30 days in a given relationship. Consistent condom use was reported in 26% of 377 non-commercial relationships and in all of 22 commercial relationships. Using multiple logistic regression, consistent condom use in non-commercial relationships was more likely in relationships that are not 'very close'; for men (but not women) with peers whose norms are more favourable to condom use; and for subjects who had concurrent sex partners in the last 12 months. In conclusion, we found that: (1) the lack of relationship between the peer norms of drug-using women and their condom use suggests they may have little control over condom use in their relationships - programmes should attempt to empower young women drug users and to develop ways for their peers to influence the men in their lives; (2) epidemiologically, the positive association of concurrency to consistent condom use suggests that condom use may be restricting HIV spread through the community - the presence of consistent condom use in all of the commercial sexual relationships also may restrict HIV spread; (3) prevention efforts should attempt to change peer cultures as a way to develop self-sustaining risk reduction. These changes should include changes in gender roles and power relations.Higher viral loads and other risk factors associated with HIV-1 seroconversion during a period of high incidence among injection drug users in Bangkok
AbstractHu, D. J., Subbarao, S., Vanichseni, S., Mock, P. A., Van Griensven, F., Nelson, R., Nguyen, L., Kitayaporn, D., Young, N. L., Des Jarlais, D., Byers, R., Choopanya, K., & Mastro, T. D. (n.d.).Publication year
2002Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
30Issue
2Page(s)
240-247AbstractWe analyzed data from a prospective cohort study of injection drug users (IDUs) attending methadone treatment clinics in Bangkok, Thailand, during 1995-1998 to characterize factors associated with a period of high incidence (PHI) from July 1996 through January 1997 compared with periods of lower incidence. Sociobehavioral characteristics were similar for all participants during and outside the PHI except for the following: there was more reported drug injection while IDUs were incarcerated during the PHI (odds ratio, 1.67; p = .02) and significantly higher proportions of persons reported heroin injection (91% vs. 75%, respectively; p = .02) and higher frequencies of daily injection and sharing of injection equipment (40% vs. 25%, respectively; p = .05) during the PHI than outside the PHI. Through most of the first year after seroconversion, plasma HIV-1 loads were significantly higher in persons who seroconverted during the PHI than in those who seroconverted outside the PHI. Higher viral loads may potentially contribute to faster disease progression and increased infectiousness or transmissibility to subsequent contacts. Our findings suggest that prevention efforts to reduce the effective size and turnover within IDU sharing networks may have a significant impact on the epidemic by disrupting the rapid transmission of HIV-1 from recently infected, highly infectious individuals.HIV among drug users in China [1] (multiple letters)
Feng, C., Des Jarlais, D., Kaufman, J., & Jun, J. (n.d.). In Science (1–).Publication year
2002Volume
298Issue
5596Page(s)
1171HIV among injecting drug users in Bangkok: The first decade
AbstractVanichseni, S., Choopanya, K., Des Jarlais, D. C., Sakuntanaga, P., Kityaporn, D., Sujarita, S., Raktham, S., Hiranrus, K., Wasi, C., Mock, P. A., & Mastro, T. D. (n.d.).Publication year
2002Journal title
International Journal of Drug PolicyVolume
13Issue
1Page(s)
39-44AbstractObjective: To examine the long-term structure of the high human immunodeficiency virus (HIV) prevalence epidemic among injecting drug users (IDUs) in Bangkok, Thailand. Methods: Annual HIV seroprevalence surveys were conducted at the drug abuse treatment clinics of the Bangkok Metropolitan Administration (BMA) from 1987 onward. Risk behavior surveys were conducted in 1989, 1993 and 1997. A large cohort study to measure HIV incidence was also conducted in the BMA drug treatment clinics from 1995 to 1998. Results: HIV prevalence rose rapidly in 1988 and then remained stable at 30-40%. A very high percentage (over 90%) of IDUs reported reducing risk behavior by the fall of 1989, with injection risk behavior declining from 1989 through 1997. Sexual risk behavior occurred mostly within primary relationships. Estimated HIV incidence was moderate to high at 5.8/100 person-years at risk from 1995 to 1998. Incarceration and injecting while incarcerated were strongly associated with incident HIV infections. Conclusions: The initial risk reduction served to reduce HIV transmission and stabilize the epidemic, preventing saturation of HIV within IDUs in Bangkok. Significant levels of risk behavior persisted, however, leading to a 'moderate to high' incidence rate. Successfully addressing a high seroprevalence HIV epidemic among IDUs will probably require multiple, large-scale prevention efforts maintained over long time periods.HIV prevention research: Cumulative knowledge or accumulating studies? An introduction to the HIV/AIDS prevention research synthesis project supplement
Des Jarlais, D. C., & Semaan, S. (n.d.).Publication year
2002Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
30Page(s)
S1-S7HIV risk behaviour among participants of syringe exchange programmes in central/eastern Europe and Russia
AbstractDes Jarlais, D. C., Grund, J. P., Zadoretzky, C., Milliken, J., Friedmann, P., Titus, S., Perlis, T., Bodrova, V., & Zemlianova, E. (n.d.).Publication year
2002Journal title
International Journal of Drug PolicyVolume
13Issue
3Page(s)
165-174AbstractObjective: To assess HIV risk behaviour among participants in syringe exchanges in five Central/Eastern European cities: Prague (Czech Republic), Budapest (Hungary), Skopje (Former Yugoslavian Republic of Macedonia), Krakow (Poland) and Poltava (Ukraine), and five Russian cities: Nizhniy Novgorod, Pskov, Rostov-Na-Donu, St. Petersburg, and Volgograd. Design: Cross-sectional survey with questions on injection risk behaviours for the 30 days prior to first use of the syringe exchange programme and for the 30 days prior to interview (while using the syringe exchange programme). Methods: Respondents were recruited from participants of the syringe exchanges. Structured questionnaires covering drug use and HIV risk behaviour were administered by trained interviewers. Results: 1671 respondents were interviewed across the ten programmes. Participants in the programmes tended to be young and relatively recent initiates into drug injection. Relatively low percentages of participants reported receptive syringe sharing ('injecting with needles and syringes used by others') in the past 30 days, from 1 to 29% across the ten programmes. These represented statistically significant reductions from the percentages of respondents reporting receptive syringe sharing in the 30 days prior to first use of the syringe exchange - from 7 to 47%. Conclusions: IDUs participating in the exchanges appear to be responding very positively in reducing sharing of needles and syringes. Syringe exchange and other HIV prevention programmes for injecting drug users (IDUs) in this geographic region should be expanded rapidly.Incarceration and risk for HIV infection among injection drug users in Bangkok
AbstractChoopanya, K., Des Jarlais, D. C., Vanichseni, S., Kitayaporn, D., Mock, P. A., Raktham, S., Hireanras, K., Heyward, W. L., Sujarita, S., & Mastro, T. D. (n.d.).Publication year
2002Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
29Issue
1Page(s)
86-94AbstractObjective: To assess potential multiple relationships between incarceration and HIV infection among injecting drug users (IDUs) in Bangkok. Previous cross-sectional studies have shown strong relationships between incarceration and HIV infection but have not been able to assess potential causal pathways. Methods: Injection drug users seen at methadone treatment programs in Bangkok were screened during 1995 to 1996 for enrollment into the study. With informed consent, 1,209 seronegative IDUs were enrolled in a cohort study to determine HIV incidence and identify factors associated with incident infections. Follow-up visits were conducted every 4 months, with HIV testing and assessment of risk behaviors. Results: Overall incidence rate was 5.8 per 100 person-years (95% confidence interval [CI], 4.8-6.8) of follow-up. A four-step "injection risk" scale was constructed that included less frequent than daily injection, daily injection, daily injection with reported sharing of injection equipment, and injection while incarcerated. This scale was strongly related to HIV incidence, with incidence approximately doubling for each step in the scale. Incidence rate for follow-up periods that contained drug injection while incarcerated was 35/100 person-years at risk. In multivariate analyses, incarceration was related to incident HIV infection in multiple ways: previous incarceration and recent incarceration without drug injection, and the injection risk scale were all independently predictors of incident HIV infection. Conclusions: Incarceration is related to incident HIV infection through multiple pathways. Previous incarcerations are likely to serve as markers for unmeasured highrisk behaviors, and it is also highly likely that HIV is transmitted during periods of incarceration. Programs to reduce HIV transmission in jails and prisons, including drug abuse treatment of inmates and programs to reduce the likelihood of incarceration of IDUs, are needed urgently. Given the current diffusion of injecting drug use, of HIV infection among drug injectors, and of the common policy of incarcerating drug users, it is very likely that the problem of HIV transmission in jails and prisons is increasing in many countries throughout the world.Legal syringe purchases by injection drug users, Brooklyn and Queens, New York City, 2000-2001.
AbstractDes Jarlais, D. C., McKnight, C., & Friedmann, P. (n.d.).Publication year
2002Journal title
Journal of the American Pharmaceutical Association (Washington,D.C. : 1996)Volume
42Issue
6Page(s)
S73-76AbstractOBJECTIVE: To assess preliminary results of the Expanded Syringe Access Demonstration Program (ESAP) in New York City. DESIGN: Temporal trends of pharmacy use among injection drug users (IDUs) in Brooklyn and Queens were analyzed from December 2000 through December 2001. SETTING: Brooklyn and Queens, New York City. PARTIPANTS: IDUs. MAIN OUTCOME MEASURES: Attempts to purchase syringes from pharmacies and success in doing so. RESULTS: Of the 1,072 IDUs interviewed from December 2000 through December 2001, the majority were daily heroin injectors, but there was also substantial speedball and cocaine injection. There was a clear increase over time in both the percentage of subjects who attempted to purchase syringes in pharmacies and in the percentage who successfully purchased syringes. Among IDUs interviewed 4 or more months after ESAP began, large majorities of those who attempted to purchase syringes were successful in doing so. No differences in use of ESAP by IDUs were identified in Brooklyn versus Queens: 27% of IDUs interviewed in Queens reported that they had attempted to purchase syringes in pharmacies versus 28% in Brooklyn. Persons who reported injecting on a daily or more frequent basis were more likely to have attempted pharmacy purchases than persons who reported injecting less frequently, 32% versus 21%. CONCLUSIONS: The ESAP program has led to an increase in the use of pharmacies as sources of sterile injection equipment among IDUs in New York City. The extent to which pharmacies become an important source of sterile injection equipment and the effect of legal pharmacy sales on risk behaviors for human immunodeficiency virus (HIV) infection remain to be determined.Risk correlates of prevalent HIV, hepatitis B virus, and hepatitis C virus infections among noninjecting heroin users
AbstractGyarmathy, V. A., Neaigus, A., Miller, M., Friedman, S. R., & Des Jarlais, D. C. (n.d.).Publication year
2002Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
30Issue
4Page(s)
448-456AbstractObjective: To examine lifetime correlates of HIV and hepatitis B and C (HBV and HCV) infections among noninjecting heroin users (NIUs). Methods: Between March 1996 and March 2001, 483 eligible NIUs were tested for HIV, HBV, and HCV antibodies and administered structured interviews. Multivariate logistic regression analyses were stratified by injecting history. Results: Among never-injectors (69.8%), significant (p < .05) correlates were unprotected sex with men who have sex with men (HIV and HBV), unprotected sex with NIUs (HIV), self-reported syphilis infection (HBV), longer duration of heroin use (HBV and HCV), shorter duration of cocaine use (HIV), blood transfusion before 1986 (HIV), and having been tattooed (HCV). Among former injectors (30.2%), significant correlates were receptive syringe sharing (HIV and HBV), frequent lifetime injection (HCV), longer duration of sexual activity (HBV), and having been tattooed (HCV). Conclusion: Never-injectors infected with HIV and HBV appear to have become infected mainly through sexual transmission, whereas former injectors appear to have become infected with HIV and HCV mainly though injecting risk and with HBV through both injecting and sexual risk. Interventions targeted at NIUs should prevent unsafe sex as well as the initiation or resumption of injecting. In addition, unhygienic tattooing, which may lead to HCV exposure, should be a focus of prevention efforts.Risk networks and racial/ethnic differences in the prevalence of HIV infection among injection drug users
AbstractKottiri, B. J., Friedman, S. R., Neaigus, A., Curtis, R., & Des Jarlais, D. C. (n.d.).Publication year
2002Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
30Issue
1Page(s)
95-104AbstractStudies among injection drug users (IDUs) find a higher prevalence of HIV infection among black and Puerto Rican IDUs than among white IDUs. Risk behaviors seldom explain these differences. We examine how risk networks contribute to racial/ethnic variations in HIV prevalence. Six hundred sixty-two IDUs were recruited on the street in Bushwick (New York City), interviewed, and tested for HIV. Risk behaviors and networks were analyzed to explain racial/ethnic variations in HIV. Forty percent of IDUs were infected with HIV. HIV prevalence was greater for Puerto Ricans (45%) and blacks (44%) than for whites (32%). Egocentric sexual and drug risk networks were predominantly racially/ethnically homogeneous. After multivariate adjustments for risk behaviors and risk networks, black-white differences in HIV prevalence were no longer significant. Although differences between Puerto Ricans and whites persisted, post hoc analyses suggested that network partner characteristics might explain these differences. In Bushwick, racially/ethnically discordant risk partnerships involving black IDUs may function as potential bridges of transmission between groups.The differential effects of face-to-face and computer interview modes
AbstractNewman, J. C., Des Jarlais, D. C., Turner, C. F., Gribble, J., Cooley, P., & Paone, D. (n.d.).Publication year
2002Journal title
American journal of public healthVolume
92Issue
2Page(s)
294-297AbstractObjectives. This study assessed the differential effects of face-to-face interviewing and audio-computer assisted self-interviewing (audio-CASI) on categories of questions. Methods. Syringe exchange program participants (n = 1417) completed face-to-face interviews or audio-CASI. The questionnaire was categorized into the groups "stigmatized behaviors," "neutral behaviors," and "psychological distress." Interview modes were compared for questions from each category. Results. Audio-CASI elicited more frequent reporting of "stigmatized behaviors" than face-to-face interviews. Face-to-face interviewing elicited more frequent reporting of "psychological distress" than audio-CASI. Conclusions. Responding to potentially sensitive questions should not be seen as merely "providing data," but rather as an activity with complex motivations. These motivations can include maintaining social respect, obtaining social support, and altruism. Ideally, procedures for collecting self-report data would maximize altruistic motivation while accommodating the other motives.Consistent condom use in the heterosexual relationships of young adults who live in a high-HIV-risk neighbourhood and do not use “hard drugs”
AbstractFriedman, S. R., Flom, P. L., Kottiri, B. J., Neaigus, A., Sandoval, M., Curtis, R., Des Jarlais, D. C., & Zenilman, J. M. (n.d.).Publication year
2001Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
13Issue
3Page(s)
285-296AbstractThis study was set up to determine the predictors of condom use in the heterosexual non-commercial sexual relationships of young adults who neither inject drugs nor use cocaine, heroin or crack, in a neighbourhood with widespread drug-use-connected HIV. The analytic sample is 279 young adults, aged 18-24, who have never injected drugs and who have not used heroin, cocaine or crack in the last year. They were recruited in the Bushwick neighbourhood of New York City, July 1997 to September 1999. A face-to-face interview included items about their sociodemographic background, substance use and sexual networks. Sexual relationship and self-reported consistent (100%) condom use over the prior year with the partner in a given relationship was examined. Subjects had 337 heterosexual non-commercial relationships. Consistent condom use was reported in 32% of these relationships. In multiple logistic regression, consistent condom use was more likely in relationships that are not 'very close' (odds ratio = 3.92; 95% confidence interval = 2.08, 7.52); in the relationships of subjects whose peer norms support condom use (OR = 1.94; 95% CI= 1.43, 2.69), who are not problem drinkers (OR = 8.70; 95% CI = 2.22, 58.8), and (perhaps as a result of measurement issues) who are men (OR = 1.95; 95% CI = 1.04, 3.68). In conclusion, consistent condom use remains uncommon among youth in this high-risk neighbourhood. It is thus important to keep HIV from entering the sexual networks of youth in communities like this through programmes aimed at drug injectors and their sexual partners. Programmes to increase condom use among young adults should focus on strengthening norms that promote safer sex to protect oneself and others. In addition, assistance should be provided to youth who are problem drinkers.Continued high HIV-1 incidence in a vaccine trial preparatory cohort of injection drug users in Bangkok, Thailand
AbstractVanichseni, S., Kitayaporn, D., Mastro, T. D., Mock, P. A., Raktham, S., Jarlais, D. C., Sujarita, S., Srisuwanvilai, L. O., Young, N. L., Wasi, C., Subbarao, S., Heyward, W. L., Esparza, J., & Choopanya, K. (n.d.).Publication year
2001Journal title
AIDSVolume
15Issue
3Page(s)
397-405AbstractBackground: A large epidemic of HIV-1 subtype B began among injection drug users (IDUs) in Bangkok in 1988. Despite ongoing prevention efforts, HIV-1 prevalence among IDUs remained at 30-50% through the 1990s. Objectives: To measure the incidence of HIV-1 infection and related risk factors to guide prevention efforts and to evaluate the feasibility of conducting an HIV vaccine efficacy trial. Design and methods: A prospective cohort study in which IDUs attending methadone treatment programs in Bangkok were screened during 1995-1996 for enrollment into the study. IDUs found to be HIV-seronegative on two occasions were offered enrollment with follow-up visits every 4 months. On each visit participants were evaluated with a questionnaire and serologic testing. Results: A total of 1209 HIV-negative IDUs were enrolled. Through the end of 1998, the overall HIV-1 incidence rate was 5.8 (95% confidence interval, 4.8-6.8) per 100 person-years of follow-up. HIV-1 subtypes E and B accounted for 79 and 21% of infections, respectively. On multivariate analysis, HIV-1 seroconversion was primarily associated with the frequency of heroin injection, the sharing of injection equipment, and incarceration, especially with drug injection. Sexual behavior was not associated with increased risk for HIV-1. Risk factors for infection with HIV-1 subtypes E and B were similar. Conclusion: HIV-1 transmission risk remains high among Bangkok IDUs despite methadone treatment and other current prevention strategies. There is an urgent need to address this ongoing epidemic, especially in jails and prisons. This study led to the initiation in 1999 of a phase III HIV-1 vaccine efficacy trial in this population.Factors associated with prevalent hepatitis C: Differences among young adult injection drug users in lower and upper Manhattan, New York City
AbstractDiaz, T., Des Jarlais, D. C., Vlahov, D., Perlis, T. E., Edwards, V., Friedman, S. R., Rockwell, R., Hoover, D., Williams, I. T., & Monterroso, E. R. (n.d.).Publication year
2001Journal title
American journal of public healthVolume
91Issue
1Page(s)
23-30AbstractObjectives. This study examined correlates of prevalent hepatitis C virus (HCV) infection among young adult injection drug users in 2 neighborhoods in New York City. Methods. Injection drug users aged 18 to 29 years were street recruited from the Lower East Side and Harlem. Participants were interviewed about drug use and sex practices; venipuncture was performed for hepatitis B virus (HBV), HCV, and HIV serologies. Results. In both sites, testing positive for HCV antibody (anti-HCV) was associated with having injected for more than 3 years. Additionally, HCV infection was positively associated with injecting with someone known to have had hepatitis (but the association was significant only in the Lower East Side) and with sharing cotton (but the association was statistically significant only in Harlem). Being in drug treatment and older than 24 years were associated with HCV in the Lower East Side but not in Harlem. Receiving money for sex was associated with anti-HCV positivity in Harlem but not in the Lower East Side. Conclusions. Several differences in factors associated with prevalent HCV infection existed among 2 populations of young injection drug users from the same city. Indirect transmission of HCV may occur.HIV risk networks and HIV transmission among injecting drug use1rs
AbstractNeaigus, A., Friedman, S. R., Kottiri, B. J., & Des Jarlais, D. C. (n.d.).Publication year
2001Journal title
Evaluation and Program PlanningVolume
24Issue
2Page(s)
221-226AbstractThe objective of this study was to demonstrate how injecting drug users' (IDUs) HIV risk networks affect their risk for infection with HIV and influence their HIV risk behaviors. Concepts utilized in a network approach were specified. These concepts included: (1) the distinction between risk networks (the people with or among whom IDUs - or others at risk of infection with HIV - engage in HIV risk behaviors) and social influence networks (the people who shape each others behavior), (2) the extent to which risk networks and social influence networks overlap, and (3) three levels of network analysis, i.e. the dyad, personal networks, and sociometric networks. The role of IDUs' risk networks in the transmission of HIV and their influence on promoting and preventing HIV risk behaviors were illustrated by reviewing studies of IDUs in New York City as well as other locations. Conclusions indicate that the network approach is a developing area in research on the relationship between injecting drug use and HIV risk. This approach provides a basis for deepening our understanding of this relationship, and could increase our ability to prevent the further spread of HIV among IDUs as well as their sex partners.HIV surveillance among injecting drug users
AbstractDes Jarlais, D. C., Dehne, K., & Casabona, J. (n.d.).Publication year
2001Journal title
AIDSVolume
15Page(s)
S13-S22AbstractInjecting drug users (IDUs) should be considered a 'partially hidden population' at high risk for HIV infection. In almost all locations it should be possible to locate and conduct research with IDUs, but it will probably never be possible to enumerate or draw random samples from an IDU population. Surveillance research studies with IDUs should include risk behaviors, as surveillance of HIV infection only will not be sufficiently time sensitive, and be used to develop and refine HIV prevention programming for the population. Contacts with IDUs can be developed at multiple settings, including voluntary treatment programs, law enforcement settings, and through 'street outreach.' Each type of setting has different advantages, disadvantages and ethical concerns. HIV testing as part of surveillance also raises additional important ethical concerns. The primary risk behaviors that should be included in surveillance studies are 'sharing' of drug injection equipment, the potential for rapid partner change among risk partners, and sexual risk behavior. Additional important objectives for surveillance research include: (1) the size of the local IDU population, (2) patterns of drug use, (3) availability injection equipment, (4) participation in prevention activities, and (5) access to and use of anti-retroviral treatments. HIV incidence is an ultimate objective for surveillance research, but there are no currently available cost-efficient methods for studying HIV incidence, so estimation from indirect measurements is usually required.Laws prohibiting over-the-counter syringe sales to injection drug users: Relations to population density, HIV prevalence, and HIV incidence
AbstractFriedman, S. R., Perils, T., & Des Jarlais, D. C. (n.d.).Publication year
2001Journal title
American journal of public healthVolume
91Issue
5Page(s)
791-793AbstractObjectives. This study sought to assess relations of laws prohibiting over-the-counter syringe sales (anti-OTC laws) to population prevalence of injection drug users and HIV prevalence or incidence among 96 US metropolitan areas. Methods. A cross-sectional analysis was used. Results. Metropolitan areas with anti-OTC laws had a higher mean HIV prevalence (13.8% vs 6.7%) than other metropolitan areas (pseudo-P>.001). In 83 metropolitan areas with HIV prevalence of less than 20%, anti-OTC laws were associated with HIV incidence rates of 1% or greater (pseudo-P>.001 ). Population proportions of injection drug users did not vary by presence of anti-OTC laws. Conclusions. Anti-OTC laws are not associated with lower population proportions of injection drug users. Laws restricting syringe access are associated with HIV transmission and should be re pealed.Needle exchange programs for the prevention of human immunodeficiency virus infection: Epidemiology and policy
AbstractVlahov, D., Des Jarlais, D. C., Goosby, E., Hollinger, P. C., Lurie, P. G., Shriver, M. D., & Strathdee, S. A. (n.d.).Publication year
2001Journal title
American Journal of EpidemiologyVolume
154Issue
12Page(s)
S70-S77AbstractThis epidemiology and policy case study is noteworthy for several reasons. First, the needs were urgent. Confronted with an epidemic of a previously unknown but highly fatal infectious disease for which there was no effective treatment at the time, epidemiologists scrambled to assemble data rapidly. Second, as strategies for prevention became evident from field studies, epidemiologists were drawn in by the policy relevance of the research. In this case, there were few organized constituencies to support needle exchange as a component within a comprehensive strategy to confront the HIV epidemic in injection drug users. After activists worked to place needle exchange on the agenda for HIV prevention, epidemiologists helped to frame the policy debate. The data provided by epidemiologists were used to shift political and popular opinion towards supporting programs that were initially unthinkable. The scientific case for needle exchange was built on a foundation of several factors: 1) careful epidemiologic investigation of the problem; 2) evaluation of feasible alternatives; 3) generation of hypotheses and studies based on the concerns of policy-makers; and 4) determination to proceed in spite of administrative bans on research and competing political orientations on the drug abuse problem. The process of needle exchange program development and expansion is due in part to epidemiologists who helped to frame a controversial topic in the scientifically grounded area of infection prevention. In this arena, epidemiologists were often drawn beyond detached observations to become advocates of a despised and disenfranchised population in order to improve the public's health. The controversial nature of needle exchange also illustrates the paradox whereby federal policy called for research but for a time imposed an administrative ban on the research. No groundswell or clamor among researchers occurred, but this was wrong in retrospect. Researchers cannot tolerate such prohibitions. As a profession, epidemiologists need to advocate for openness, even when unpopular, for scientific investigation and evaluation when the root of the issue is protection of the public's health.Potential risk factors for the transition to injecting among non-injecting heroin users: A comparison of former injectors and never injectors
AbstractNeaigus, A., Miller, M., Friedman, S. R., Hagen, D. L., Sifaneck, S. J., Ildefonso, G., & Des Jarlais, D. C. (n.d.).Publication year
2001Journal title
AddictionVolume
96Issue
6Page(s)
847-860AbstractAims. To compare potential risk factors for the transition to injecting among non-injecting heroin users (NIUs) with different injecting histories. Design. Cross-sectional data from baseline structured interviews with NIUs in a study on transitions to injecting. Sample recruited by outreach or chain-referral in New York City (NYC), 1996-1998. Setting. Recruitment of sample and interviews conducted in a NYC neighborhood where many drug users reside and/or use drugs. Participants. Of 575 NIUs, 67% had never injected; 16% had injected one to nine times (infrequent former injectors (IFI)); and 18% 10 or more times (frequent former injectors (FFI)). Measurements. Controlling for age and race/ethnicity, adjusted odds ratios were estimated in multivariate logistic regression, and differences in means tested by ANCOVA. Findings. FFI (compared to never injectors and IFI) were more likely: to be homeless; to be unemployed; to be long-time users; to be younger at first heroin use; to not have initiated heroin use through non-injected routes; to not be afraid of injecting themselves with needles; to sniff heroin with former IDUs; and, for both men and women separately, to have sex partners who were former IDUs. Both FFI and IFI were twice as likely as never injectors to perceive that their friends thought that it was "OK" to inject drugs. Conclusions. FFI have multiple individual and network characteristics that may increase their risk of injecting drugs. Interventions among NIUs to prevent transitions to injecting need to ascertain NIUs' injecting history and address the many potential risks that FFI have for resuming injecting drug use.