Don Des Jarlais
Don Des Jarlais
Scroll
Professor of Epidemiology
-
Professional overview
-
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.
-
Education
-
BA, Behavioral Science, Rice University, Houston, TXPhD, Social Psychology, University of Michigan, Ann Arbor, MI
-
Areas of research and study
-
EpidemiologyHIV/AIDSPsychology
-
Publications
Publications
Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation
AbstractFriedman, S. R., Kottiri, B. J., Neaigus, A., Curtis, R., Vermund, S. H., & Des Jarlais, D. C. (n.d.).Publication year
2000Journal title
American Journal of EpidemiologyVolume
152Issue
10Page(s)
913-922AbstractIn many cities, human immunodeficiency virus (HIV)-1 seroprevalence among drug injectors stabilizes at 30-70% for many years without secondary outbreaks that increase seroprevalence by 15% or more. The authors considered how HIV-1 incidence can remain moderate at seroprevalence levels that would give maximum incidence. Previously suggested answers include behavioral risk reduction and network saturation within high-risk subgroups. Among 767 drug injectors studied in 1991-1993, during a period of stable high seroprevalence in New York City, risk behaviors remained common, and networks were far from saturated. The authors suggest a different network-based mechanism: in stable high-prevalence situations, the relatively small sizes of subnetworks of linked seronegatives (within larger networks containing both infected and uninfected persons) may limit infectious outbreaks. Any primary infection outbreak would probably be limited to members of connected subcomponents of seronegatives, and the largest such subcomponent in the study contained only 18 members (of 415 seronegatives). Research and mathematical modeling should study conditions that may affect the size and stability of subcomponents of seronegatives. Finally, if the existence of small, connected components of seronegatives prevents secondary outbreaks, this protection may weaken, and vulnerability to new outbreaks increase, if HIV-1 seroprevalence falls. Thus, in situations of declining prevalence, prevention programs should be maintained or strengthened.Prevalence and risk factors for positive tuberculin skin tests among active drug users at a syringe exchange program
AbstractSalomon, N., Perlman, D. C., Friedmann, P., Ziluck, V., & Des Jarlais, D. C. (n.d.).Publication year
2000Journal title
International Journal of Tuberculosis and Lung DiseaseVolume
4Issue
1Page(s)
47-54AbstractOBJECTIVES: To evaluate the prevalence and predictors of tuberculin skin test (TST) reactions ≥10 mm among active injection drug users (IDUs) at a syringe exchange program in New York City. METHODS: From August 1995 to January 1996, participants were offered TB screening, an interview, and received $15.00 upon returning for skin test interpretation. RESULTS: 610/650 (94%) consented to screening. Of the 566 (93%) who returned for skin test readings, skin test data were available for 564 (99.8%); 14% (95%CI 11.6- 17.4) had TSTs ≥10 mm. When the ≥5 mm threshold for interpretation of TST among HIV-infected persons was used, the prevalence of TST positivity increased by only 1%. In univariate analysis, the prevalence of TST ≥10 mm increased with age and with increasing years of IDU (both P = 0.001). Because of a strong correlation between age and duration of IDU, two logistic regression models were examined. In the model with age alone, a history of self-reported TST positivity (OR 8.88; 95%CI 4.9-16.09; P = 0.0001) and increasing age (OR per 10 years increase in age, 1.69; 95%CI 1.24-2.29; P = 0.0008) were independent predictors of TSTs ≥10 mm. In the model with duration of IDU, a history of TST positivity (OR 8.82; 95%CI 4.74-16.41; P = 0.0001) and duration of IDU (OR per 10 years of IDU, 1.46; 95%CI 1.10-1.94; P = 0.0081) were independent predictors of TST ≥10 mm. CONCLUSIONS: Use of the reduced cutoff point for TST positivity from 10 mm to 5 mm did not significantly affect the prevalence of positive TSTs in this cohort of active drug users. Increased prevalence of TB infection with age suggests a high annual incidence of TB infection in this population, and the increased risk of TB infection with increasing duration of IDU suggests that the duration spent in IDU environments may increase infection risk.Prevention of HIV infection in street-recruited injection drug users
AbstractMonterroso, E. R., Hamburger, M. E., Vlahov, D., Des Jarlais, D. C., Ouellet, L. J., Altice, F. L., Byers, R. H., Kerndt, P. R., Watters, J. K., Bowser, B. P., Fernando, M. D., & Holmberg, S. D. (n.d.).Publication year
2000Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
25Issue
1Page(s)
63-70AbstractBackground: Injection drug users (IDUs) and their sex partners account for an increasing proportion of new AIDS and HIV cases in the United States, but public debate and policy regarding the effectiveness of various HIV prevention programs for them must cite data from other countries, from non-street-recruited IDUs already in treatment, or other programs, and from infection rates for pathogens other than HIV. Methods: Participants were recruited from the street at six sites (Baltimore [Maryland], New York [two sites], Chicago [Illinois], San Jose [California], Los Angeles [California], and at a state women's correctional facility [Connecticut]), interviewed with a standard questionnaire, and located and reinterviewed at one or more follow-up visits (mean, 7.8 months later). HIV serostatus and participation in various programs and behaviors that could reduce HIV infection risk were determined at each visit. Results: In all, 3773 participants were recruited from the street, and 2306 (61%) were located and interviewed subsequently. Of 3562 initial serum specimens, 520 (14.6%) were HIV-seropositive; at subsequent assessment, 19 people, all from the East Coast and Chicago, had acquired HIV. Not using previously used needles was substantially protective against HIV acquisition (relative risk [RR], 0.29; 95% confidence interval [CI], 0.11-0.80) and, in a multivariate model, was significantly associated with use of needle and syringe exchange programs (adjusted odds ratio [OR(adj)], 2.08; 95% CI, 1.15-3.85). Similarly, reduction of injection frequency was very protective against seroconversion (RR, 0.33; 95% CI, 0.14-0.80), and this behavior was strongly associated with participation in drug treatment programs (OR(adj), 3.54; 95% CI, 2.50-5.00). In a separate analysis, only 37.5% of study-participants had sufficient new needles to meet their monthly demand. Conclusions: In this large multicity study of IDUs in the United States, several HIV prevention strategies appeared to be individually and partially effective; these results indicate the continued need for, and substantial gaps in, effective approaches to preventing HIV infection in drug users.Prospects for a public health perspective on psychoactive drug use
Des Jarlais, D. C. (n.d.).Publication year
2000Journal title
American journal of public healthVolume
90Issue
3Page(s)
335-337Structural interventions to reduce HIV transmission among injecting users
AbstractDes Jarlais, D. C. (n.d.).Publication year
2000Journal title
AIDSVolume
14Issue
11Page(s)
S41-S46AbstractObjective: To review current knowledge of 'structural' interventions to reduce HIV transmission among injecting drug users. Structural interventions are defined as programs or policies that change the environments in which risk behavior occurs, without attempting to change knowledge, attitudes or social interaction patterns of the persons at risk. Structural interventions may either facilitate enactment of existing motives to avoid HIV transmission or make enacting risk behavior more difficult. Methods: Nonquantitative literature review. Results and conclusions: Preventing HIV infection among injecting drug users must be considered within the context of the continuing global spread of psychoactive drug use, and injecting drug use in particular. Some policies that are designed to reduce drug use may tend to increase HIV transmission among persons who do inject drugs. Evaluation of structural interventions can be difficult, as populations of drug users are usually the relevant unit of analysis. Typically, pre versus post comparisons must be used, hopefully with multiple pre and post data points. Structural interventions are often associated with 'large effects', increasing confidence that the intervention is the cause of the reduction in HIV-risk behavior. Increasing the availability of sterile injection equipment, through pharmacy sales or syringe exchange or both, is the most common and best-studied structural intervention for injecting drug users. The studies to date indicate that this usually, but not always, leads to large reductions in HIV-risk behavior. Involving drug users in the design and implementation of HIV-prevention programs can be considered a 'meta-structural' intervention that should lead to programs with increased effectiveness. (C) 2000 Lippincott Williams and Wilkins.AIDS 1999. Behavioral and social science: overview.
Des Jarlais, D., & Caraël, M. (n.d.).Publication year
1999Journal title
AIDS (London, England)Volume
13Page(s)
S235-237Audio-computer interviewing to measure HIV-risk behaviour (multiple letters) [2]
Taylor, A., Goldberg, D., Dempsey, K., Des Jarlais, D. C., Turner, C., & Gribble, J. (n.d.). In Lancet (1–).Publication year
1999Volume
354Issue
9179Page(s)
678-679Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: A quasi-randomised trial
AbstractDes Jarlais, D. C., Paone, D., Milliken, J., Turner, C. F., Miller, H., Gribble, J., Shi, Q., Hagan, H., & Friedman, S. R. (n.d.).Publication year
1999Journal title
LancetVolume
353Issue
9165Page(s)
1657-1661AbstractBackground. We aimed to assess audio-computer-assisted self-interviewing (audio-CASI) as a method of reducing under-reporting of HIV risk behaviour among injecting drug users. Methods. Injecting drug users were interviewed at syringe-exchange programmes in four US cities. Potential respondents were randomly selected from participants in the syringe exchanges, with weekly alternate assignment to either traditional face-to-face interviews or audio-CASI. The questionnaire included items on sociodemographic characteristics, drug use, and HIV risk behaviours for 30 days preceding the interview. We calculated odds ratios for the difference in reporting of HIV risk behaviours between interview methods. Findings. 757 respondents were interviewed face-to-face, and 724 were interviewed by audio-CASI. More respondents reported HIV risk behaviours and other sensitive behaviours in audio-CASI than in face-to-face interviews (odds ratios for reporting of rented or bought used injection equipment in audio-CASI vs face-to-face interview 2.1 [95% CI 1.4-3.3] p = 0.001; for injection with borrowed used injection equipment 1.5 [1.1-2.2] p = 0.02; for renting or selling used equipment 2.3 [1.3-4.0] p = 0.003). Interpretation. Although validation of these self-reported behaviours was not possible, we propose that audio-CASI enables substantially more complete reporting of HIV risk behaviour. More complete reporting might increase understanding of the dynamics of HIV transmission and make the assessment of HIV-prevention efforts easier.Doing a shotgun: A drug use practice and its relationship to sexual behaviors and infection risk
AbstractPerlman, D. C., Henman, A. R., Kochems, L., Paone, D., Salomon, N., & Des Jarlais, D. C. (n.d.).Publication year
1999Journal title
Social Science and MedicineVolume
48Issue
10Page(s)
1441-1448AbstractThere has been a rise in the frequency with which inhalational routes such as smoking are used for illicit drug use. A growing population of new inhalational drug users augments the pool of individuals at risk for transition to injection drug use. Further, illicit drug smoking has been implicated in the transmission of a variety of pathogens by the respiratory route, and crack smoking has been associated with an increased risk of HIV infection, particularly through the exchange of high-risk sex for drugs. Shotguns are an illicit drug smoking practice in which smoked drugs are exhaled or blown by one user into the mouth of another user. We conducted a series of ethnographic observations to attempt to characterize more fully the practice of shotgunning, the range of associated behaviors, and the settings and contexts in which this practice occurs. Shotguns may be seen as a form of drug use which, has close ties to sexual behaviors, and which has both pragmatic and interpersonal motivations, combining in a single phenomenon the potential direct and indirect risk of disease transmission by sexual, blood borne and respiratory routes. These data support the need to develop and evaluate comprehensive risk reduction interventions, which take into consideration the relationships between interpersonal and sexual behaviors and specific forms of drug use.Geographic proximity, policy and utilization of syringe exchange programmes
AbstractRockwell, R., Des Jarlais, D. C., Friedman, S. R., Perlis, T. E., & Paone, D. (n.d.).Publication year
1999Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
11Issue
4Page(s)
437-442AbstractThe objective of the research was to assess the effects of geographic proximity on the utilization of syringe exchange among injection drug users (IDUs) in New York City. Between 1994 and 1996, 805 IDUs were interviewed with a structured questionnaire. Geographic proximity was defined as living within a ten-minute walk. Eighty-one per cent of IDUs who lived close typically used a syringe exchange compared to 59% of those who lived further away. In multiple logistic regression analysis, those who lived close remained (adjusted odds ratio of 2.89; 95% CI 2.06 to 4.06, p = 0.001) more likely to use syringe exchange. Those who lived close were less likely to have engaged in receptive syringe sharing at last injection (adjusted odds ratio = 0.45, 95% CI 0.24 to 0.86, p = 0.015). In conclusion, locating exchange services in areas convenient to large numbers of IDUs may be critical for prevention of HIV infection.HIV risk behaviours of current sex workers attending syringe exchange: The experiences of women in five US cities
AbstractPaone, D., Cooper, H., Alperen, J., Shi, Q., & Des Jarlais, D. C. (n.d.).Publication year
1999Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
11Issue
3Page(s)
269-280AbstractExisting research indicates that sex workers who inject drugs are vulnerable to HIV infection through both risky sexual and drug use practices. This study is the first attempt to learn whether this increased risk persists among current sex workers who participate in syringe exchange programmes (SEPs). With data from interviews with randomly selected participants in five US cities, we compared the demographic characteristics, sexual risk behaviours, drug use practices, emotional and physical health, and SEP utilization patterns of currently active female sex workers who attend SEPs with female SEP participants who do not engage in sex work. Data indicate that women enrolled in SEPs who were currently trading sex typically reported greater HIV risk than women non-sex workers. Current sex workers reported higher levels of risk for every drug risk variable examined in bivariate analysis. They were more likely than other women to inject with a syringe previously used by someone else, to inject daily and to attend shooting galleries; they were less likely to use a condom with their primary partners and to report higher levels of psychological distress than their counterparts. The relationship between sex work status and risky injection practices persisted when potential confounders were controlled for in multivariate alalysis. SEPs can serve a pivotal role in providing sex workers with services and referrals which would help them reduce risk behaviours.Knowledge of tuberculosis among drug users: Relationship to return rates for tuberculosis screening at a syringe exchange
AbstractSalomon, N., Perlman, D. C., Friedmann, P., Perkins, M. P., Ziluck, V., Jarlais, D. C., & Paone, D. (n.d.).Publication year
1999Journal title
Journal of Substance Abuse TreatmentVolume
16Issue
3Page(s)
229-235AbstractTuberculosis is an important health issue among drug users. We sought to evaluate active drug users' (DUs) knowledge of tuberculosis (TB) and to assess the relationship between TB knowledge and attitudes and tuberculin skin test (TST) return rates at a syringe exchange program. DUs were recruited at a syringe exchange program in New York City, were interviewed and offered TSTs, and received $15.00 upon returning for TST reading. The questionnaire evaluated knowledge of TB transmission, prevention, and treatment. From March 13, 1995 to January 31, 1996, 610 of 650 (94%) of DUs approached agreed to participate. Of these, 80% had previous TSTs within the past 2 years and 20% were known to be HIV infected. Almost all knew that TB is contagious and more than two thirds knew that TB is treatable and that TB preventive therapy existed. However, fewer than half knew that HIV-related TB could be treated, 30% thought TB could be treated without a medical doctor, and the majority (70%) thought a reactive TST implied infectivity. The rate of return for TST reading was 93%. In multivariate analysis, those who knew that HIV-related TB was curable were more likely to return for TST reading (odds ratio 2.0; 95% confidence interval 1.04 to 3.95; p = .03). The high acceptance and return rates suggest that TB services can be incorporated into syringe exchange programs. However, several important gaps in TB knowledge existed in this population at high risk of TB, which may impact on adherence and which support the need for TB education for drug users.Modulators of 'activated motivation': Event-specific condom use by drug injectors who have used condoms to prevent HIV/AIDS
AbstractFriedman, S. R., Chapman, T. F., Perlis, T. E., Sotheran, J. L., Rockwell, R., Paone, D., Marmor, M., & Des Jarlais, D. C. (n.d.).Publication year
1999Journal title
AIDS and BehaviorVolume
3Issue
2Page(s)
85-98AbstractSince sexual transmission of HIV among and from drug injectors is a frequent source of infection, condom use by them is important for prevention. This paper focuses on predictors of condom use at last sex by drug injectors with 'activated motivation,' that is, by those who already are trying to use condoms to reduce HIV risk. Principal subjects are 1,240 drug injectors who report activated motivation to use condoms to prevent HIV and who had had sex within 6 months before the interview. Many used condoms at last sexual event with primary partners (65%) and with casual partners (80%). Condom use with primary partners increased over time, and was higher among those who knew they were HIV-positive or who talked about AIDS with sexual partners, but was lower among those who knew they were HIV-negative, who were Black, Hispanic, women, younger, or high school graduates, or who used crack with their partners at the sexual event. Condom use with casual partners was lower among women, older drug injectors, and those who were high on alcohol along with their partners, and tended to be more likely among those who know they are infected. Condom use with both primary and casual partners was greater with partners who did not themselves inject drugs. Programs should urge drug injectors who are trying to use condoms to avoid HIV transmission that having sex while using psychoactive substances may be a barrier to their doing so even if they want to use condoms and have done so in the past. Finally, research should be conducted to determine if persons with activated motivation should receive HIV prevention assistance that is different from that offered those who lack risk-reduction motivation or those who want to reduce their risk behaviors, but have been unable to implement the desired changes.Networks, norms and solidaristic/altruistic action against aids among the demonized
AbstractFriedman, S. R., Neaigus, A., Jose, B., Curtis, R., Ildefonso, G., Goldstein, M., & Des Jarlais, D. C. (n.d.).Publication year
1999Journal title
Sociological FocusVolume
32Issue
2Page(s)
127-142AbstractDrug injectors have simultaneously faced a devastating HIV I AIDS epidemic and an intense program of government repression and media demonization known as the “War on Drugs.” We address patterns of association (networks) among drug injectors; how these networks shape their norms toward condom use and safer sex; the extent to which drug injectors take it upon themselves to promulgate safer sex norms to others; and, on a different level of analysis, the extent to which drug injectors have created organizations to reduce HIV transmission and to deal with other problems. Data from 767 street-recruited Brooklyn drug injectors indicate that about half of their drug- injector network ties, and of their sexual network ties, have lasted for at least five years; perceived peer norms supportive of condom use are widespread; almost half had told others (in the last month) that they should use condoms, and this was particularly likely among those in an ethnographically defined core group; consistent condom use with non-drug-injectors is reported for 44 percent of such relationships, and is most likely if the drug injector is HIV-infected, if the relationship is not *very close,” if peer norms support condom use and among those without network ties to the ethnographic core group. Observational and historical research on drug users’ organizations is used to describe the activities of “users’ groups” around the world. In spite of the pressures they have been under, drug users’ organizations exist in many cities and are active in anti-HIV efforts. Thus, norms and networks affect risk networks; and norms themselves vary by social network location and by social role. In spite of being subjected to intense repression and stigma, drug users have acted to shape their own culture, to protect themselves and others against HIV/AIDS and, to some extent, have engaged in collective action through formal organizations. The possibility of dialectic response seems to extend even to the most oppressed, dependent and stigmatized members of humanity.Predictors and risk-taking consequences of drug use among HIV-infected women
AbstractNovotná, L., Wilson, T. E., Minkoff, H. L., McNutt, L. A., DeHovitz, J. A., Ehrlich, I., & Des Jarlais, D. C. (n.d.).Publication year
1999Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
20Issue
5Page(s)
502-507AbstractObjective: To determine rates of drug use among women with HIV, and to examine associations between drug use, health, risk behavior, and sexually transmitted diseases (STD). Design: A longitudinal cohort study of 260 women with confirmed HIV-positive serostatus. Methods: Each participant contributed a self-report interview, a clinical examination, laboratory testing of cultures for Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and urinalysis for the presence of metabolites of cocaine and opiates. Data were examined on 140 women at 1-year follow-up. Women were defined as drug users if they reported crack, cocaine, or heroin use in the 6 months before the interview or if they had a positive toxicologic test result for cocaine or opiates. Results. 34% of those in the sample were classified as positive for drug use. Drug use was associated with the number of sexual partners, age at first intercourse, prevalence of STDs, and lower quality of life. STDs were present at baseline in 33.7% and 15.5% of drug users and nonusers, respectively. Drug use among this population was also associated at both baseline and follow-up with the likelihood of having a Karnofsky score below 80, and with overall perceived general health. Conclusions. Drug users in this cohort were more likely to engage in behaviors that place them at risk for STDs, to have elevated STD prevalence, and to have lower perceived health across several indices. Identification of drug use and treatment for it need to be a central component of HIV care for women.Preventing HIV infection among injecting drug users: Intuitive and counter-intuitive findings
AbstractDes Jarlais, D. C. (n.d.).Publication year
1999Journal title
Applied and Preventive PsychologyVolume
8Issue
1Page(s)
63-70AbstractThe disease now called AIDS was first reported among injecting drug users in 1981. This article reviews the last 15 years of research on preventing HIV infection and AIDS among injecting drug users. Many of the findings were surprising in the context of previous understandings of the illicit injection of psychoactive drugs - both with respect to the much-larger-than-expected size of the epidemic and the much-greater-than-expected potential for behavior change among drug injectors (IDU). The research is reviewed within a framework of eight issues: the importance of the problem in the United States, the global diffusion of injecting drug use, the global diffusion of HIV among IDUs, potential rapid spread of HIV among IDUs, risk reduction among IDUs, community-level prevention, syringe exchange programs, and developing a public-health perspective on psychoactive drug use.Psychoactive drug use and progression of HIV infection
AbstractDes Jarlais, D. C. (n.d.).Publication year
1999Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
20Issue
3Page(s)
272-274AbstractEarly in the history of the AIDS epidemic there was clear evidence of differences in the outcomes of HIV infection between injecting drug users and men who have sex with men. There were also some indications that high levels of nonsterile drug injection may increase the progression of HIV infection. Recent epidemiologic studies indicate no differences in rates of progression to AIDS among drug injectors, men who have sex with men, or persons infected through heterosexual contact. In vitro and animal studies suggest that the effects of different psychoactive drugs on HIV infection may be negative, positive, or mixed, and that the effects of a psychoactive drug on immune functioning may differ among acute administration, chronic administration, or cessation of chronic administration. Although the current epidemiologic data do not provide support for the hypothesis that psychoactive drug use will have any important effects on the course of HIV infection, possible interactions between psychoactive drugs and antiviral medications and medication adherence issues among drug users are important areas for AIDS research. Relations between psychoactive drug use, the nervous system, and the immune system are a promising area for basic research.Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City
AbstractDes Jarlais, D. C., Friedman, S. R., Perlis, T., Chapman, T. F., Sotheran, J. L., Paone, D., Monterroso, E., & Neaigus, A. (n.d.).Publication year
1999Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
20Issue
1Page(s)
67-72AbstractObjective: To examine HIV risk behavior and HIV infection among new initiates into illicit drug injection in New York City. Design and Methods: Cross-sectional surveys of injecting drug users (IDUs) recruited from a large detoxification treatment program (n = 2489) and a street storefront research site (n = 2630) in New York City from 1990 through 1996. Interviews covering demographics, drug use history, and HIV risk behavior were administered; serum samples were collected for HIV testing. Subjects were categorized into two groups of newer injectors: very recent initiates (just began injecting through 3 years) and recent initiates (injecting 4-6 years); and long-term injectors (injecting ↓ years). Results: 954 of 5119 (19%) of the study subjects were newer injectors, essentially all of whom had begun injecting after knowledge about AIDS was widespread among IDUs in the city. New injectors were more likely to be female and white than long-term injectors, and new injectors were more likely to have begun injecting at an older age (median age at first injection for very recent initiates, 27 years; median age at first injection for recent initiates, 25 years; compared with median age at first injection for long-term injectors, 17 years). The newer injectors generally matched the long-term injectors in frequencies of HIV risk behavior; no significant differences were found among these groups on four measures of injection risk behavior. HIV infection was substantial among the newer injectors: HIV prevalence was 11% among the very recent initiates and 18% among the recent initiates. Among the new injectors, African Americans, Hispanics, females, and men who engaged in male-male sex were more likely to be infected. Conclusions: The new injectors appear to have adopted the reduced risk injection practices of long-term injectors in the city. HIV infection among new injectors, however, must still be considered a considerable public health problem in New York City.Similarities and differences by race/ethnicity in changes of HIV seroprevalence and related behaviors among drug injectors in New York City, 1991-1996
AbstractFriedman, S. R., Chapman, T. F., Perlis, T. E., Rockwell, R., Paone, D., Sotheran, J. L., & Des Jarlais, D. C. (n.d.).Publication year
1999Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
22Issue
1Page(s)
83-91AbstractObjective: To measure differences and similarities in the prevalence of HIV infection and of related risk and protective behaviors among New York City black, white, and Hispanic drug injectors during a period of decreasing HIV prevalence. Methods: Drug injectors were interviewed at a drug detoxification clinic and a research storefront in New York City from 1990 to 1996. All subjects had injected drugs within the last six months. Phlebotomy for HIV testing was conducted after pretest counseling. Analysis compares the first half (period) of this recruitment interval with the second half. Results: HIV seroprevalence declined among each racial/ethnic group. In each period, white drug injectors were significantly less likely to be infected than either blacks or Hispanics. Similar declines were found in separate analyses by gender, length of time since first injection, and by recruitment site. After adjustment for changes in sample composition over time, blacks and Hispanics remained significantly more likely to be infected than whites. Interactions indicate that the decline may be greatest among Hispanics and slowest among blacks. A wide variety of risk behaviors declined in each racial/ethnic group; and syringe exchange use increased in each group. Few respondents reported injecting with members of a different racial group at their last injection event. Conclusions: HIV prevalence and risk behaviors seem to be falling among each racial/ethnic group of drug injectors. Black and Hispanic injectors continue to be more likely to be infected. Declining prevalence among whites poses some risk of politically based decisions to reduce prevention efforts. Overall, these results show that risk reduction can be successful among all racial/ethnic groups of drug injectors and suggest that continued risk reduction programs may be able to attain further declines in infection rates in each group.Syringe exchange in the United States, 1996: A national profile
AbstractPaone, D., Clark, J., Shi, Q., Purchase, D., & Des Jarlais, D. C. (n.d.).Publication year
1999Journal title
American journal of public healthVolume
89Issue
1Page(s)
43-46AbstractObjectives. This paper provides 1996 information on the status of US syringe exchange programs and compares these findings with data from our 1994 survey. Methods. In November 1996, questionnaires were mailed to 101 syringe exchange programs. Program directors were contacted to conduct telephone interviews based on the mailed questionnaires. Data collected included number of syringes exchanged, syringe exchange program operations, legal status, and services offered. Results. Eighty-seven programs participated in the survey. A total of 46 (53%) were legal, 20 (23%) were illegal but tolerated, and 21 (24%) were illegal-underground. Since 1994, there has been a 54% increase in the number of cities and a 38% increase in the number of states with syringe exchange programs. Eighty-four programs reported exchanging approximately 14 million syringes, a 75% increase from 1994. Syringe exchange programs also provided a variety of other services and supplies, and legal programs were more likely than illegal ones to provide these services. Conclusion. Despite continued lack of federal funding, syringe exchange programs expanded in terms of the number of syringes exchanged, the geographic distribution of programs, and the range of services offered.The message not heard: Myth and reality in discussions about syringe exchange [9]
Friedman, S. R., Curtis, R., Jose, B., Flom, P. L., Neaigus, A., & Des Jarlais, D. C. (n.d.). In AIDS (1–).Publication year
1999Volume
13Issue
6Page(s)
738-739Treatment for drug dependence
AbstractDes Jarlais, D. C., & Hubbard, R. (n.d.).Publication year
1999Journal title
Proceedings of the Association of American PhysiciansVolume
111Issue
2Page(s)
126-130AbstractDrug abuse treatment is a major method for reducing the health and social problems associated with dependence on psychoactive drugs. Drug dependence is very well established in the United States, where cyclical rises and falls in the use of different drugs often occur. Heroin and cocaine use are spreading rapidly throughout the world as a whole, particularly in developing countries. The need for effective treatments for drug dependence is likely to increase in the foreseeable future. Currently three major forms of long-term drug abuse treatment exist: methadone maintenance, in which an agonist medication is used to normalize physiological functioning; residential therapeutic communities, which are based on 'resocializing' the drug user; and outpatient drug-free programs, which utilize a wide variety of counseling and psychotherapy approaches. Multiple large treatment outcome studies have been conducted among persons receiving treatment for drug dependence and have shown consistent effects in reducing the use of psychoactive drugs, though complete elimination of drug use is an infrequent outcome. Length of time in drug treatment is the best single predictor of positive post-treatment outcomes. HIV infection has become an extremely important adverse consequence associated with the injection of psychoactive drugs. Multiple studies have shown that drug abuse treatment is an effective method for preventing HIV infection among injecting drug users.Willingness of injection drug users to participate in an HIV vaccine efficacy trial in Bangkok, Thailand
AbstractMacQueen, K. M., Vanichseni, S., Kitayaporn, D., Lin, L. S., Buavirat, A., Naiwatanakul, T., Raktham, S., Mock, P., Heyward, W. L., Des Jarlais, D. C., Choopanya, K., & Mastro, T. D. (n.d.).Publication year
1999Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
21Issue
3Page(s)
243-251AbstractWe assessed willingness to participate in an HIV recombinant gp120 bivalent subtypes B/E candidate vaccine efficacy trial among 193 injection drag users (IDUs) attending drag treatment clinics in Bangkok, Thailand. IDUs previously enrolled in a prospective cohort study were invited to group sessions describing a potential trial, then completed questionnaires assessing comprehension and willingness to participate. A week later, they completed a follow-up questionnaire that again assessed comprehension and willingness to participate, as well as barriers to and positive motives for participation, with whom (if anyone) they talked about the information, and whether others thought participation was a good, bad, or neutral idea. At baseline, 51% were definitely willing to participate, and at follow-up 54%; only 3% were not willing to participate at either time. Comprehension was high at baseline and improved at follow-up. Participants who viewed altruism, regular HIV tests, and family support for participation as important were more willing to volunteer. Frequency of incarceration and concerns about the length of the trial, possible vaccine-induced accelerated disease progression, and lack of family support were negatively associated with willingness. Overall, IDUs comprehended the information needed to make a fully informed decision about participating in an rgp120 vaccine efficacy trial and expressed a high level of willingness to participate in such a trial."Single-use" needles and syringes for the prevention of HIV infection among injection drug users
AbstractDes Jarlais, D. C. (n.d.).Publication year
1998Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
18Page(s)
S52-S56AbstractProviding single-use injection equipment to persons who inject illicit drugs would appear to be an effective method for reducing HIV transmission. However, interviews with manufacturers, syringe exchange program staff, and drug users revealed numerous difficulties with such a technologic solution. All designs for such equipment can be defeated and should probably be called difficult-to-reuse equipment. There are problems with consumer acceptance of difficult-to-reuse equipment and with safe disposal of large amounts of biohazardous waste. Despite these problems, it would be useful to conduct additional research, particularly on the potential for placing difficult-to-reuse equipment into shooting galleries.A multicentre study on the causes of death among Italian injecting drug users. AIDS has overtaken overdose as the principal cause of death
AbstractMezzelani, P., Quaglio, G. L., Venturini, L., Lugoboni, F., Friedman, S. R., & Des Jarlais, D. C. (n.d.).Publication year
1998Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
10Issue
1Page(s)
61-67AbstractThe causes of death among injecting drug users (IDUs) are still being discussed worldwide. We analysed the causes of death among IDUs attending 26 centres for drug users in North-Eastern Italy from 1985 to 1994. The study of a total number of 1022 deaths reveals the following: (1) AIDS has become the primary cause of death among IDUs since 1991 and is rising even in an area with a moderate HIV seroprevalence; (2) the mean age of death in AIDS patients proved higher than among patients who died of other causes (which may be due to the long incubation period of AIDS); (3) our data do not reveal higher HIV seroprevalence among IDUs who died of overdose and suicide as opposed to IDUs who died of other causes; (4) the mortality rate in IDUs is significantly higher when compared to that of the general population in the same age group.