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
Tuberculosis screening at a syringe exchange program.
Perlman, D. C., Perkins, M. P., Solomon, N., Kochems, L., Des Jarlais, D. C., & Paone, D. (n.d.).Publication year
1997Journal title
American journal of public healthVolume
87Issue
5Page(s)
862-863Underestimating cocaine use during pregnancy [1]
Rosenberg, K. D., Bateman, D. M., & Des Jarlais, D. C. (n.d.). In American journal of public health (1–).Publication year
1997Volume
87Issue
4Page(s)
687An international collaborative study of the effects of coinfection with human T-lymphotropic virus type II on human immunodeficiency virus type 1 disease progression in injection drug users
AbstractHershow, R. C., Galai, N., Fukuda, K., Graber, J., Vlahov, D., Rezza, G., Klein, R. S., Des Jarlais, D. C., Vitek, C., Khabbaz, R., Freels, S., Zuckerman, R., Pezzotti, P., & Kaplan, J. E. (n.d.).Publication year
1996Journal title
Journal of Infectious DiseasesVolume
174Issue
2Page(s)
309-317AbstractTo determine whether human T-lymphotropic virus (HTLV) type II coinfection affects progression of human immunodeficiency virus type 1 (HIV) infection, longitudinal data on 370 HIV-infected injection drug users (IDUs) with known HIV seroconversion dates from four cohort studies were pooled. HTLV infection was determined by EIA and confirmed and typed by Western blot. Proportional hazards models were used to determine whether HTLV-II infection was associated with AIDS or AIDS-related mortality. Regression analyses were used to compare declines in CD4 cell percents in singly and dually infected persons. Of 370 IDUs, 61 (16%) were HTLV-II-coinfected. During follow-up, 43 (12%) developed and 24 (6%) died of AIDS. HTLV-II coinfection was not associated with progression to AIDS (relative hazard [RH], .82; 95% confidence interval [CI], 0.34-1.94]) or AIDS mortality (RH, 1.69; 95% CI, 0.62-4.60). Rates of decline in CD4 cell percent were similar in singly and dually infected IDUs. These results suggest that HTLV-II does not affect the progression of HIV infection.Drug legalization, harm reduction, and drug policy [3]
Smart, D. C., Wilbur, D. W., Baum, O. S., Kanin, H. J., Des Jarlais, D. C., Friedman, S. R., Paone, D., Voth, E. A., & DuPont, R. L. (n.d.). In Annals of internal medicine (1–).Publication year
1996Volume
124Issue
8Page(s)
775-777Drug legalization, harm reduction, and drug policy.
Des Jarlais, D. C., Friedman, S. R., & Paone, D. (n.d.). In Annals of internal medicine (1–).Publication year
1996Volume
124Issue
8Page(s)
777Has the United Kingdom averted an epidemic of HIV-1 infection among drug injectors?
Stimson, G. V., Des Jarlais, D. C., Wodak, A., McKeganey, N., Dunn, J., Laranjeira, R., & Ball, A. (n.d.).Publication year
1996Journal title
AddictionVolume
91Issue
8Page(s)
1085-1088High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug injectors
AbstractNeaigus, A., Friedman, S. R., Jose, B., Goldstein, M. F., Curtis, R., Ildefonso, G., & Des Jarlais, D. C. (n.d.).Publication year
1996Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
11Issue
5Page(s)
499-509AbstractIn a cross-sectional study of 174 new injecting drug users (IDUs) in New York City who had injected for ≤6 years, we examined whether those who both share syringes and have personal risk networks that include high-risk injectors are particularly likely to he infected with HIV. Subjects were street recruited between July 1991 and January 1993, were interviewed about their risk behaviors in the prior 2 years and their personal risk networks with other IDUs in the prior 30 days, and were tested for HIV: 20% were HIV seropositive. Among those who both shared syringes and had a personal risk network member who injected more than trace a day. 40% were HIV seropositive (versus 14% for others, p < 0.001). In simultaneous multiple logistic regression, the interaction of both sharing syringes and having a personal risk network member who injected more than once a day remained independently and significantly associated with being HIV seropositive (OR, 3.57: 95% C1, 1.22, 10.43; p < 0.020), along with Latino race/ethnicity and exchanging sex for money or drugs. These findings suggest that the combination of sharing syringes with having a high-risk personal network is a risk factor for HIV infection among new IDUs. Studies of risk factors for HIV infection among new IDUs and interventions to reduce the spread of HIV among them should focus on their risk networks as well as their risk behaviors.HIV epidemiology and interventions among injecting drug users
Des Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1996Journal title
International Journal of STD and AIDSVolume
7Page(s)
57-61HIV incidence among injecting drug users in New York City syringe-exchange programmes
AbstractDes Jarlais, D. C., Marmor, M., Paone, D., Titus, S., Shi, Q., Perlis, T., Jose, B., & Friedman, S. R. (n.d.).Publication year
1996Journal title
LancetVolume
348Issue
9033Page(s)
987-991AbstractBackground. There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants. Methods. We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness Initiative cohort (n = 133 continuing exchangers and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. Findings. HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. Interpretation. We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.HIV prevention in developed countries
AbstractCoates, T. J., Aggleton, P., Gutzwiller, F., Jarlais, D. D., Kihara, M., Kippax, S., Schechter, M., & Van De Hoek, J. A. R. (n.d.).Publication year
1996Journal title
LancetVolume
348Issue
9035Page(s)
1143-1148AbstractHIV prevention in developed countries is marked by impressive successes and dismal failures. The successes point the way to what works; the failures highlight obstacles that must be overcome. Successes include important behavioural changes among gay and bisexual men, antiviral use to prevent vertical transmission, and securing the safety of the blood supply. New strategies are needed to reach the residual of individuals continuing with unsafe practices (a special hazard in high-prevalence areas); to reach young people who are beginning to engage in sexual relations and injection drug use; and to overcome political opposition to prevention strategies.Incidence of HIV infection in a New York City methadone maintenance treatment program [1]
Orr, M. F., Glebatis, D., Friedmann, P., Des Jarlais, D. C., & Prevots, D. R. (n.d.). In JAMA (1–).Publication year
1996Volume
276Issue
2Page(s)
99Injection drug use and emerging blood-borne diseases [2]
Des Jarlais, D. C., Stimson, G. V., Hagan, H., & Friedman, S. R. (n.d.). In JAMA (1–).Publication year
1996Volume
276Issue
13Page(s)
1034Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use
AbstractShore, R. E., Marmor, M., Titus, S., & Des Jarlais, D. C. (n.d.).Publication year
1996Journal title
Journal of Substance Abuse TreatmentVolume
13Issue
3Page(s)
241-248AbstractThe objective of this study was to determine what sociodemographic, lifestyle, or drug-related characteristics predict temporal changes in self- reported drug injection frequencies among HIV-seronegative injection-drug users (IDUs) who were being given HIV testing and risk reduction counseling. The 277 subjects were given 4-11 quarterly interviews including a detailed history of drug use and other HIV risk factors. HIV risk reduction counseling, and venipuncture for HIV antibody testing. A regression slope of change over time in drug injection frequency was calculated for each subject, and categories were created of decreasing temporal slope, increasing slope, relapse (decrease initially, then increase), or no substantial change. Only 44% of subjects decreased their drug injection frequencies despite repetitive HIV testing and counseling. In multivariate logistic analyses, decreasing temporal trends were associated with consistent enrollment in methadone maintenance (p < .1), whereas increasing trends conversely were associated with inconsistent enrollment (p < .01) and also with an absence of crack use (p < .01). Relapses were significantly associated with needle sharing with multiple partners and a low frequency of smoking. The data suggest that methadone maintenance facilitates a positive response to HIV risk reduction counseling. However, the fact that only a minority of subjects displayed a decreasing temporal trend in drug injection frequencies emphasizes the need for improved therapeutic and counseling techniques.Syringe-exchange programs in the United States: Where are we now?
Paone, D., Des Jarlais, D., Clark, J., & Shi, Q. (n.d.).Publication year
1996Journal title
AIDS and Public Policy JournalVolume
11Issue
3Page(s)
144-147Syringe-mediated drug sharing among injecting drug users: Patterns, social context and implications for transmission of blood-borne pathogens
AbstractGrund, J. P. C., Friedman, S. R., Stern, L. S., Jose, B., Neaigus, A., Curtis, R., & Des Jarlais, D. C. (n.d.).Publication year
1996Journal title
Social Science and MedicineVolume
42Issue
5Page(s)
691-703AbstractDrug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public discussion have focused primarily on the sharing of syringes and needles. While the focus on syringe sharing has sparked important interventions (bleach distribution, syringe exchange) it may have obscured the social relationship in which injecting equipment is used. Drug sharing plays a crucial role in the social organization of the drug using subculture. In this paper, various drug sharing practices and other distinguishable aspects of the injecting process - collectively termed Syringe-Mediated Drug Sharing (SMDS) - are described. All of these behaviors may put injecting drug users (IDUs) at risk for infection. The purpose of this paper is to stimulate scientific inquiry into SMDS behaviors and the social contexts which shape them. Descriptions are based primarily on field studies in Rotterdam and New York City. Recommendations for safer injecting training and education are proposed, as are directions for future research.The protective effect of AIDS-related behavioral change among injection drug users: A cross-national study
AbstractDes Jarlais, D. C., Friedmann, P., Hagan, H., & Friedman E., S. R. (n.d.).Publication year
1996Journal title
American journal of public healthVolume
86Issue
12Page(s)
1780-1785AbstractObjective. This study assessed the relationship between self-reported acquired immunodeficiency syndrome (AIDS) behavioral change and human immunodeficiency virus (HIV) serostatus among injection drug users. Methods. The study sample involved 4419 injection drug users recruited from drug abuse treatment and nontreatment settings in 11 cities in North America, South America, Europe, Asia, and Australia, The World Health Organization multisite risk behavior questionnaire was used, and either blood or saliva samples for HIV testing were obtained. Subjects were asked, "Since you first heard about AIDS, have you done anything to avoid getting AIM?" Results. The protective odds ratio for behavioral change against being infected with HIV was 0.50 (95% confidence interval = 0.42, 0.59). White there was important variation across sites, the relationship remained consistent across both demographic and drug use history subgroups. Conclusions. Injection drug users are capable of modifying their HIV risk behaviors and reporting accurately on behavioral changes. These behavioral changes are associated with their avoidance of HIV infection.The transition from underground to legal syringe exchange: The New York City experience
AbstractKochems, L. M., Paone, D., Des Jarlais, D. C., Ness, I., Clark, J., & Friedman, S. R. (n.d.).Publication year
1996Journal title
AIDS Education and PreventionVolume
8Issue
6Page(s)
471-489AbstractThe most common method of syringe exchange program (SEP) development in the United States has been for SEPs to be started by activists without funding and then to become a government-funded community-based organization. This developmental process, which has not been studied to date, involves major organizational change. We report our findings on three New York City syringe exchanges experiencing this type of transition. Our data illustrate that following legalization, increased legitimacy and funding allowed all three SEPs to expand the size and scope of their programs (e.g., adding hours, sites, referral services, and the ability to support user groups), resulting in a rapid growth in participation (over 15,000 in 18 months). Regulation accompanying legalization posed significant challenges to SEPs, including added record-keeping and reporting tasks, increased demand for referrals, and accommodating evaluation, which affected already overburdened staffs. The transition process poses significant challenges to these developing organizations as well as opportunities for improved services.Weight loss associated with HIV seroconversion among injection-drug users
AbstractMarmor, M., Titus, S., Harrison, C., Cord-Cruz, E. A., Shore, R. E., Vogler, M., Krasinski, K., Mildvan, D., & Des Jarlais, D. C. (n.d.).Publication year
1996Journal title
Journal of Acquired Immune Deficiency Syndromes and Human RetrovirologyVolume
12Issue
5Page(s)
514-518AbstractTo describe symptoms associated with human immunodeficiency virus (HIV) seroconversion, we studied a cohort of 366 injection-drug users (IDUs) with a study design that included recall every 3 months to collect symptom histories using a structured questionnaire. Eleven HIV seroconversions were observed in 621.5 person years at risk (PYAR), equivalent to 1.8 seroconversions/100 PYAR. Cox regression analysis showed age ≤35 years to be a significant risk factor for HIV seroconversion after controlling for gender, race, and the frequency of drug injection. An embedded case-control analysis then compared symptom histories of HIV seroconverters with those of age-(±5 years) and visit number-matched controls who remained HIV seronegative for ≤3 months longer than the HIV-seroconverters. Multivariate case-control analysis adjusted for injection frequency yielded significant associations of HIV seroconversion with histories of weight loss ≤4.5 kg (seven of 11 cases; odds ratio [OR] 11.6, 95% confidence interval [CI] 3.1, 43.1) and oral ulcers (three of 11 cases; OR = 7.6, 95% CI = 1.2, 48.2) in the 3 months before the subjects' first HIV-seropositive study visit. We conclude that histories of recent symptoms reported by HIV-seroconverting IDUs differ from those reported by non-HIV-seroconverting IDUs, and weight loss may be particularly common among IDUs experiencing primary HIV infection.Crack cocaine and hiv in the inner city
AbstractSugarman, K., Herman, M., Fernando, D., Edlin, B. R., Faruque, S., Mccoy, C. B., Word, C. O., Des Jarlais, D. C., & Padian, N. (n.d.). In New England Journal of Medicine (1–).Publication year
1995Volume
332Issue
18Page(s)
1233-1235AbstractTo the Editor: Our observations at our substance-abuse program for pregnant women and mothers correspond to those of Edlin and colleagues (Nov. 24 issue).1 Women addicted to “crack” cocaine are at substantially increased risk of contracting human immunodeficiency virus (HIV) infection as a result of their engaging in prostitution to support their addiction. We agree with the call for more substance-abuse treatment. In their Sounding Board article, Des Jarlais and colleagues (Nov. 24 issue)2 stress the importance of devoting resources to teaching safer sex strategies to drug addicts but do not explicitly mention the need to devote more funds to.Ethical issues in research on preventing HIV infection among injecting drug users
AbstractDes Jarlais, D. C., Gaist, P. A., & Friedman, S. R. (n.d.).Publication year
1995Journal title
Science and engineering ethicsVolume
1Issue
2Page(s)
133-144AbstractThe ethical issues in conducting research on preventing HIV infection are among the most complex of any area of human subjects research. This article is an update of a 1987 article that addressed potential conflicts between research design and ethics with respect to AIDS prevention among injecting drug users. The present article reviews current ethical issues that arise in the design and conduct of HIV/AIDS prevention research focused on injecting drug users.Harm reduction--a framework for incorporating science into drug policy.
Des Jarlais, D. C. (n.d.).Publication year
1995Journal title
American journal of public healthVolume
85Issue
1Page(s)
10-12HIV/AIDS-related behavior change among injecting drug users in different national settings
AbstractDes Jarlais, D. C., Friedman, S. R., Friedmann, P., Wenston, J., Sotheran, J. L., Choopanya, K., Vanichseni, S., Raktham, S., Goldberg, D., Frischer, M., Green, S., Lima, E. S., Bastos, F. I., & Telles, P. R. (n.d.).Publication year
1995Journal title
AIDSVolume
9Issue
6Page(s)
611-617AbstractObjectives: To identify factors associated with effective AIDS behavior change among injecting drug users (IDU) in different national settings. Design: Cross-sectional surveys of IDU, with determination of HIV status. Trends in city HIV seroprevalence among IDU also used to validate effectiveness of behavior change. Setting and participants: Subjects recruited from drug-use treatment programs and outreach efforts in Bangkok, Thailand (n = 601), Glasgow, Scotland (n = 919), New York City, USA (n = 2539), and Rio de Janeiro, Brazil (n = 466). Results: Evidence for the effectiveness of self-reported risk reduction was available for all cities. Univariate followed by multiple logistic regression analyses were used to identify factors associated with self-reported AIDS behavior change. Separate analyses were conducted for each city. Talking about AIDS with drug-using friends was significantly associated with behavior change in all four cities. Talking with sex partners about AIDS, educational level, knowing that someone can be HIV-infected and still look healthy, and having been tested previously for HIV were each significantly associated with behavior change in three of the four cities. Conclusions: Despite the substantial differences in these national settings, there were common factors associated with effective risk reduction. In particular, risk reduction appears to occur through social processes rather than through individual attitude change. HIV prevention programs need to explicitly incorporate social processes into their work.Injecting drug use research
Des Jarlais, D. C., Case, P., Nelson, K., & Goldberg, D. (n.d.).Publication year
1995Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
7Issue
1Page(s)
96-99Maintaining low HIV seroprevalence in populations of 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, M. E., & Myers, T. (n.d.).Publication year
1995Journal title
JAMAVolume
274Issue
15Page(s)
1226-1231AbstractObjectives. - To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUs), but where seroprevalence has nevertheless remained low (<5%) during at least 5 years. Design and Setting. - A literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUs. Participants. - Injecting drug users recruited from both drug treatment and nontreatment settings in each city. Interventions. - A variety of HIV prevention activities for IDUs had been implemented in each of the five cities. Results. - There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low, (2) provision of sterile injection equipment, and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one third or more of the IDUs reporting recent unsafe injections. Conclusions. - In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUs, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUs are at risk for rapid spread of HIV.Operational issues in syringe exchanges: The New York City tagging alternative study
AbstractPaone, D., Des Jarlais, D. C., Caloir, S., Clark, J., & Jose, B. (n.d.).Publication year
1995Journal title
Journal of Community HealthVolume
20Issue
2Page(s)
111-123AbstractIt is estimated that 50% of the approximate 200,000 intravenous drug users (IDUs) in New York City (NYC) are infected with HIV. Syringe exchange, a common method of HIV prevention in many countries was legalized in NYC in 1992. As syringe exchange has gained public support and the number of functioning exchanges has grown in the country, more attention has been given to the study of operational characteristics of syringe exchanges. Syringe exchanges may be considered health service delivery organizations, and the specific methods of service delivery may greatly influence their effectiveness in reducing HIV risk behavior among injecting drug users. Improving operational characteristics of syringe exchanges requires both careful data collection, in order to reduce ambiguity in interpretation, and methods for cumulating knowledge, so that previous learning experiences need not be repeated with each new exchange. We report here on the practice of marking ("tagging") syringes distributed by exchanges in NYC during the period from 1990 through 1994. During this period the NYC exchanges operated illegally as underground exchanges, and then received legal status and expanded greatly. Developing regulations that reflect the reality of the program operations while allowing for monitoring and oversight is a complicated process, especially when implemented in states that maintain paraphernalia and prescription laws and where "unauthorized" possession of injection equipment remains a criminal activity under existing legal statutes. The particular situation in NYC which required the revision of existing regulations during a period of rapid program expansion and implementation of a large system of syringe exchange further illustrates the multiple pressures which accompany such a process. In order to implement meaningful regulations which maximize the public health benefits of syringe exchange programs on an individual and community level, recommendations are made.