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
Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program
AbstractHagan, H., Des Jarlais, D. C., Friedman, S. R., Purchase, D., & Alter, M. J. (n.d.).Publication year
1995Journal title
American journal of public healthVolume
85Issue
11Page(s)
1531-1537AbstractObjectives. This case-control study examined the association between syringe exchange use and hepatitis B and C in injection drug users. Methods. Case patients included 28 injection drug users with acute hepatitis B and 20 with acute hepatitis C reported to the health department in a sentinel hepatitis surveillance county; control subjects were injection drug users with no markers of exposure to hepatitis B or C (n = 38 and 26, respectively) attending health department services during the same period. Data were abstracted from clinic records. Results. Seventy-five percent of case patients with hepatitis B and 26% of control subjects had never used the exchange; similar proportions were found for the hepatitis C case and control groups. After adjustment for demographic characteristics and duration of injecting drugs, nonuse of the exchange was associated with a sixfold greater risk of hepatitis B (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 1.5, 20.4) and a sevenfold greater risk of hepatitis C (OR = 7.3; 95% CI = 1.6, 32.8). Conclusions. The results suggest that use of the exchange led to a significant reduction in hepatitis B and hepatitis C in the county and may have also prevented a substantial proportion of human immunodeficiency virus infections in injection drug users.Regulating controversial programs for unpopular people: Methadone maintenance and syringe exchange programs
AbstractDes Jarlais, D. C., Paone, D., Friedman, S. R., Peyser, N., & Newman, R. G. (n.d.).Publication year
1995Journal title
American journal of public healthVolume
85Issue
11Page(s)
1577-1584AbstractOne third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.Sex, drugs, and syringe exchange in New York City: women's experiences.
AbstractPaone, D., Caloir, S., Shi, Q., & Des Jarlais, D. C. (n.d.).Publication year
1995Journal title
Journal of the American Medical Women's AssociationVolume
50Issue
3Page(s)
109-114AbstractThe sex and drug human immunodeficiency virus (HIV) risk factors of drug-injecting women participating in New York City syringe exchange programs were studied and racial/ethnic differences examined. African-American women reported injecting least frequently and had lower rates of injecting with borrowed or used syringes. Women attending syringe exchange reported high levels of sexual risk behavior, and syringe exchange provides an opportunity for a sexual risk reduction intervention. Women were more likely to "always" use condoms with causal partners than with primary partners. About 60% of the women engaging in commercial sex work reported "always" using condoms. Three independent predictors for consistent condom use with primary partners were: knowing one's HIV status, any risky injection during the past 30 days, and being African-American, compared with white or Latina. The profile of African-American women attending syringe exchange in New York City suggests a higher level of stabilization than is found in the other groups of women. White women appear to be more socially isolated and to engage in higher risk behaviors. Although women attending New York City syringe exchange programs have significantly reduced risky drug injection, consistent with other studies, sexual risk behavior has remained at a high level. Syringe exchange and drug treatment programs have a great opportunity to target drug-injecting women for sexual risk reduction interventions.Topic-focused bibliography: Syringe exchange: HIV prevention, key findings, and future directions
AbstractPaone, D., Des Jarlais, D. C., Gangloff, R., Milliken, J., & Friedman, S. R. (n.d.).Publication year
1995Journal title
Substance Use and MisuseVolume
30Issue
12Page(s)
1647-1683AbstractHIV among injecting drug users (IDUs) has now been documented in over 60 countries in the world, and there are an additional 40 countries where injecting drug use has been reported including widespread epidemics in Southeast and southern Asia and in Latin America. At present HIV infection is almost always fatal, and there is no promise that a preventive vaccine will become available soon. Given the enormity of the HIV epidemic among IDUs and the critical need to reduce the spread of HIV transmission to and from IDUs, prevention efforts are essential. Syringe-exchange programs have become a major component of HIV prevention strategies in most developed countries and work within the philosophy of harm reduction. Increasing access to sterile syringes has been met with considerable controversy. Opponents of syringe exchange have generally argued that increasing access to sterile syringes would simultaneously increase the number of injecting drug users, increase the frequency of injection for already active IDUs, and appear to "condone" an illegal behavior. To date many research studies and four major reviews of syringe exchange literature have been conducted. All studies thus far have shown no increase in illicit drug injection associated with syringe exchanges, and significant decrease in drug risk behaviors.Tuberculosis in drug users
AbstractPerlman, D. C., Salomon, N., Perkins, M. P., Yancovitz, S., Paone, D., & Des Jarlais, D. C. (n.d.).Publication year
1995Journal title
Clinical Infectious DiseasesVolume
21Issue
5Page(s)
1253-1264AbstractThe rise in tuberculosis (TB) has disproportionately affected specific populations. Historically, many patients with TB became iatrogenic opiate addicts through therapeutic use of these drugs for symptom control. Demographic trends reshaped the relationship between drug use and TB into one in which drug use became a risk factor for tuberculosis as a result of the overlap of epidemiological and social factors associated with both drug use and TB. The spread of human immunodeficiency virus infection has amplified the spread of TB among drug users. We review the epidemiology of TB in drug users as well as the factors relevant to screening and compliance in drug-using populations. Drug users constitute a high-risk group for whom screening, prevention of infection, diagnosis, and treatment pose particular challenges. The development of TB services capable of engaging drug users (those both in and out of drug treatment programs) has potential for disrupting a significant chain of rapid TB transmission.Tuberculosis knowledge among New York City injection drug users
AbstractWolfe, H., Marmor, M., Maslansky, R., Nichols, S., Simberkoff, M., Jarlais, D. D., & Moss, A. (n.d.).Publication year
1995Journal title
American journal of public healthVolume
85Issue
7Page(s)
985-988AbstractStructured interviews measuring tuberculosis knowledge were administered to 494 New York City injection drug users, 31% of whom reported a history of having a reactire tuberculin skin test. Medical records review of a subsample confirmed the validity of self-reported data. Most respondents understood the mechanisms of tuberculosis transmission. Three fourths of the subjects did not fully understand the distinction between a reactive skin test and active tuberculosis, but those who reported a history of skin test reactivity were twice as likely to understand this distinction. Forty percent of subjects did not understand the importance of medication adherence. Misunderstanding, based on a recent lack of tuberculosis education, may contribute to the fear and confusion that interfere with efforts to control tuberculosis.Using retrospective behavioral data to determine HIV risk factors among street-recruited drug injectors
AbstractDasgupta, S., Friedman, S. R., Jose, B., Neaigus, A., Rosenblum, A., Goldsmith, D. S., Kleinman, P. H., & Des Jarlais, D. C. (n.d.).Publication year
1995Journal title
Journal of Drug IssuesVolume
25Issue
1Page(s)
161-171AbstractThis paper investigates whether the time period during which retrospective behavioral data are collected affects the results of studies of HIV risk factors. In particular, we address the concern that questionnaires probing behaviors in the recent past may not isolate the risk behaviors involved at the time of actual HIV infection. During 1987 and 1988, 278 street-recruited injecting drug users (IDUs) in New York City were interviewed about their sexual behaviors, medical history, drug-injection behaviors in the prior ten years, and specific needle-use behaviors during 1985–86 and thereafter. Among the 278 subjects, 52% were HIV-seropositive. In univariate analysis, serostatus was significantly related to: a) total drug-injection frequency during 1983–84 and 1985–86; b) mean monthly total drug-injection frequency during 1977 to 1987; c) cocaine injection frequencies during 1983–84 and 1985–86, and during the last thirty days; and d) injecting in shooting galleries and using previously used cookers during 1985–86. Significant predictors of seroprevalence in stepwise logistic regression were total drug and cocaine injection frequencies during 1983–84, years of injection, residence in the Bronx, not being Hispanic and history of any sexually transmitted disease. The data confirm previous reports on behavioral risk factors for HIV serostatus. Re-analysis using drug-injection frequency data for different time periods indicates that in the context of an “older” HIV epidemic like that in New York City, analysis of risk factors may be less sensitive to time periods than had previously been feared, although it may be true that data for behaviors in “the last thirty days” cover a sufficiently atypical period as to produce misleading results.AIDS and the use of injected drugs
Des Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1994Journal title
SCI.AM.Volume
270Issue
2Page(s)
56-62AIDS risk reduction and reduced HIV seroconversion among injection drug users in Bangkok
AbstractDes Jarlais, D. C., Choopanya, K., Vanichseni, S., Plangsringarm, K., Sonchai, W., Carballo, M., Friedmann, P., & Friedman, S. R. (n.d.).Publication year
1994Journal title
American journal of public healthVolume
84Issue
3Page(s)
452-455AbstractHuman immunodeficiency virus (HIV) seroconversion was studied in a group of 173 injection drug users in Bangkok, Thailand, who had been previously tested for HIV and were interviewed and retested in the fall of 1989. Ten percent of the group had seroconverted. Two factors protected against HIV seroconversion: having stopped sharing injection equipment in response to the acquired immunodeficiency syndrome (AIDS) and having a regular sexual partner. The association between self-reported deliberate risk reduction and reduced HIV seroconversion among persons continuing to inject illicit drugs indicates that injection drug users can change their behavior in response to AIDS and will accurately report on the behavior change, and that the changes can protect against HIV infection.Bleach use and HIV seroconversion among new york city injection drug users
AbstractTitus, S., Marmor, M., Des Jarlais, D., Kim, M., Wolfe, H., & Beatrice, S. (n.d.).Publication year
1994Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
7Issue
7Page(s)
700-704AbstractWe employed a nested case-control study design to evaluate the efficacy of bleach-cleaning of needles and syringes among injecting drug users (IDUs) as a means of preventing human immunodeficiency virus (HIV) infection. Sixteen HIV-seroconverters who responded to bleach use questions and who reported injecting with shared or used equipment in the 6 months prior to their first positive visit were compared with 89 controls. Controls had remained HIV-seronegative at two or more visits, reported injecting with shared or used equipment, responded to bleach-cleaning questions, and were seen at recall visits ± 6 months from the date of seroconversion of the index case. Risk factors associated with HIV seroconversion in univariate analyses were a history of sexual intercourse with an HIV-infected partner and the frequency of speedball (mixed heroin and cocaine) injections. After adjusting for confounders, we found no evidence that bleach use protected against HIV infection.Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs
AbstractFriedman, S. R., Jose, B., Neaigus, A., Goldstein, M., Curtis, R., Ildefonso, G., Mota, P., & Des Jarlais, D. C. (n.d.).Publication year
1994Journal title
AIDSVolume
8Issue
3Page(s)
357-361AbstractObjectives: To study how condom use in injecting drug users' (IDU) relationships differs according to whether they are HIV-infected, and to whether their sex partner is an IDU. Design and methods: A total of 317 street-recruited IDU were HIV-antibody tested and interviewed about 421 relationships with particular sex partners. Results: Condoms were consistently (100%) used in sex between partners (during the previous 30 days) in 33% of these relationships, and their use was significantly more frequent in relationships of seropositive IDU and in relationships with non-IDU partners. In relationships between seropositive IDU and non-IDU, consistent condom use was reported to be high (68%); this remained unchanged under multivariate controls. Conclusions: Self-reported condom use by IDU in New York, with its relatively mature epidemic appears to be concentrated where it may most reduce the spread of HIV to non-IDU heterosexuals, i.e., in relationships between infected IDU and non-IDU partners. Differential condom use by serostatus and by partners' drug injection should be incorporated into mathematical models of the HIV epidemic. Causes of the high level of condom use in this subset of relationships may include drug injector altruism and pressure by sex partners; prevention programs should develop ways to use both of these factors to motivate increased condom use.Continuity and Change Within an HIV Epidemic: Injecting Drug Users in New York City, 1984 Through 1992
AbstractDes Jarlais, D., Friedman, S. R., Sotheran, J. L., Wenston, J., Marmor, M., Yancovitz, S. R., Frank, B., Beatrice, S., & Mildvan, D. (n.d.).Publication year
1994Journal title
JAMA: The Journal of the American Medical AssociationVolume
271Issue
2Page(s)
121-127AbstractTo examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. —Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. —Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. —Community-based AIDS prevention programs, including underground syringe exchanges. —Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. —The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716×109/L (716/μL) to 0.575×109/L (P<.009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P<.001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. —The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission.Continuity and Change Within an HIV Epidemic: Injecting Drug Users in New York City, 1984 Through 1992
AbstractJarlais, D. C., Friedman, S. R., Sotheran, J. L., Wenston, J., Marmor, M., Yancovitz, S. R., Frank, B., Beatrice, S., & Mildvan, D. (n.d.).Publication year
1994Journal title
JAMA: The Journal of the American Medical AssociationVolume
271Issue
2Page(s)
121-127AbstractTo examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. —Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. —Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. —Community-based AIDS prevention programs, including underground syringe exchanges. —Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. —The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716×109/L (716/μL) to 0.575×109/L (P<.009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P<.001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. —The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission.Cross‐national studies of AIDS among injecting drug users
AbstractJARLAIS, D. C. (n.d.).Publication year
1994Journal title
AddictionVolume
89Issue
4Page(s)
383-392AbstractHIV infection among injecting drug users has become a world‐wide public health problem. This raises fundamental questions about the modifiability of drug‐using behavior and of the influence of different national settings upon the modification of drug use behavior. Data from the World Health Organization Multi‐site Study of HIV and Injecting Drug Use and studies of HIV among drug injectors in New York City (the US component of the WHO study) are used to address these questions. There is no clear relationship between HIV seroprevalence and current levels of risk behavior in the WHO cities, and the range in seroprevalence is much greater than the range in current risk behavior. Nonetheless, historical trend data enable us to discern at least two broad patterns in different cities. HIV epidemics appear to have been successfully prevented among IDUs in some cities, in that seroprevalence has remained low and stable over several years. These cities are characterized by community outreach programs and good access to sterile injection equipment. On the other hand, high‐servoprevalence epidemics have also occurred in many different cities. Stabilization of seroprevalence has eventually also occurred in these cities, but this still includes moderate rates of new HIV infections. How to reverse high‐seroprevalence situations remains one of the more difficult questions in HIV epidemiology. The epidemiology of HIV infection among injecting drug users also needs to include analyses of the impacts of decisions by political and public health leaders. A three‐category scheme for classifying political decisions is offered: data‐free decisions, data‐based decisions, and data‐proof decisions.Estimation of time since infection using longitudinal disease‐marker data
AbstractDubin, N., Berman, S., Marmor, M., Tindall, B., Jarlais, D. D., & Kim, M. (n.d.).Publication year
1994Journal title
Statistics in MedicineVolume
13Issue
3Page(s)
231-244AbstractWe propose a method to estimate the usually unknown time since infection for individuals infected with human immunodeficiency virus type 1 (HIV‐1). If we assume the time since infection has an exponential prior distribution, then under the model the conditional distribution of time since infection, given the CD4 level at the time of the first positive HIV‐1 antibody test, is a truncated normal density. We applied the method to prevalent cohort data both from intravenous drug users and from homosexual/bisexual men. For the intravenous drug users the estimated mean time since infection was 15.0 months from infection at a presumed mean CD4 level of 1060 cells/ml to first positive antibody test at a CD4 level of 597 cells/ml, which was the average CD4 at enrolment for infected subjects. For the homosexual/bisexual men the estimated mean time since infection was 16.7 months from infection at a presumed mean CD4 level of 699 cells/ml to first positive antibody test at an average CD4 level of 577 cells/ml. We performed a validation study using initially seronegative subjects in these cohorts who seroconverted to HIV‐1‐positive antibody status during the follow‐up period. For the intravenous drug users, data were too few to provide definitive verification of the method. In the cohort of homosexual/bisexual men, however, there was a total of 70 seroconverters with relevant data. Among them, the median absolute difference between the midpoint of the known seroconversion interval and the estimated mean infection date was 4.6 months, conditional on CD4‐lymphocyte measurements taken approximately 18 months subsequent to infection. Conditional on CD4 approximately 30 months after infection, this median difference increased modestly to 8.2 months. Our analysis suggested that the underlying mathematical model tends to overestimate short times since infection and underestimate long times since infection. We consider potential corrective modifications to the model.Fortnightly Review: Methadone maintenance treatment in opiate dependence: A review
Farrell, M., Ward, J., Mattick, R., Hall, W., Stimson, G. V., Des Jarlais, D., Gossop, M., & Strang, J. (n.d.).Publication year
1994Journal title
BMJVolume
309Issue
6960Page(s)
997Implications of directly observed therapy in tuberculosis control measures among IDUs
AbstractCurtis, R., Friedman, S. R., Neaigus, A., Jose, B., Goldstein, M., & Des Jarlais, D. C. (n.d.).Publication year
1994Journal title
Public Health ReportsVolume
109Issue
3Page(s)
319-327AbstractTuberculosis (TB) is a rapidly growing problem among injecting drug users (IDU), especially those infected with human immunodeficiency virus. The authors review IDUs' responses to current TB control strategies and discuss the implications of their findings for the proposed implementation of directly observed therapy (DOT), a method for ensuring that patients take prescribed medication. Field workers carried out 210 ethnographic interviews with 68 IDUs in a Brooklyn, NY, community during 1990-93. Case studies suggested that many IDUs are uninformed about TB and often misinformed about their personal TB status. Ethnographic interviews and observations indicated that the threat of TB-related involuntary detainment may lead IDUs to avoid TB diagnostic procedures, treatment for TB, or drug abuse treatment, and to avoid AIDS outreach workers and other health-related services. IDUs who tested positive for the purified protein derivative (PPD) of TB sometimes have left hospitals before definitive diagnoses were made, because of a perceived lack of respectful treatment, fear of detention, or lack of adequate methadone therapy to relieve the symptoms of withdrawal from drugs. Current TB diagnosis and treatment systems are, at best, inadequate. The threat of TB-related detention discourages some IDUs from seeking any type of health care. There is an urgent need to educate IDUs about TB and to educate and sensitize health care providers about the lifestyles of IDUs. DOT may help in servicing this difficult-to-serve population, particularly if techniques are incorporated that have been developed for other successful public health interventions for IDUs.Models for treating tuberculosis in narcotic-addicted patients
Newman, R. G., & DesJarlais, D. C. (n.d.). In Journal of Substance Abuse Treatment (1–).Publication year
1994Volume
11Issue
1Page(s)
61Preparations for AIDS vaccine trials. Retention, behavior change, and HIV- seroconversion among injecting drug users (IDUs) and sexual partners of IDUs
AbstractMarmor, M., Titus, S., Wolfe, H., Krasinski, K., Maslansky, R., Simberkoff, M., Beatrice, S., Nichols, S., & Des Jarlais, D. C. (n.d.).Publication year
1994Journal title
AIDS Research and Human RetrovirusesVolume
10Page(s)
S207-S213AbstractThe likelihood that subjects in human immunodeficiency virus (HIV) vaccine efficacy trials will alter their behavioral risks for HIV infection over time must be considered in evaluating the feasibility of such trials and in estimating the necessary sample sizes to be enrolled. Potential subjects for future vaccine efficacy trials include injecting drug users (IDUs) and others who may be difficult to retain in studies and who may alter HIV-risk-related behaviors substantially over time. We have investigated behavior change, retention, and HIV seroconversion among 577 New York City resident IDUs and sexual partners of IDUs enlisted between July 1 and December 31, 1992. We attempted to see all subjects every 3 months for interviews, blood donation and HIV testing. We were able to retain 68% of subjects in the study through the third scheduled recall at 7.5-10.5 months after enlistment. HIV seroconversion through March 1, 1994, was 1.33/100 person-years at risk. There was a significant inverse relationship between HIV seroconversion and retention at the 9-month recall after adjusting for age, gender, and the amount of locator information provided by subjects at enlistment. Among subjects seen at each of the scheduled visits at 3, 6, and 9 months after enrollment, modest but statistically significant behavior changes that reduced risk were observed in self-reported drug injection frequency, heroin injection frequency, sexual contact with IDUs, and sharing of needles/syringes. The magnitude of these changes in risk, however, was small and may be transient. The behavior changes observed to date do not appear to be large enough to substantially alter calculations of sample sizes needed in future HIV vaccine efficacy trials.Regulating Syringe Exchange Programs: A Cautionary Note
Jarlais, D. C., Paone, D., Peyser, N., Newman, R. G., & Friedman, S. R. (n.d.). In JAMA: The Journal of the American Medical Association (1–).Publication year
1994Volume
272Issue
6Page(s)
431-432Retention of patients who entered methadone maintenance via an interim methadone clinic
AbstractFriedmann, P., Des Jarlais, D. C., Peyser, N. P., Nichols, S. E., Drew, E., & Newman, R. G. (n.d.).Publication year
1994Journal title
Journal of Psychoactive DrugsVolume
26Issue
2Page(s)
217-221AbstractTime in treatment is considered an important predictor of good outcomes for drug abuse treatment. Patientretention would be of particular concern for low-service types of treatment. Interim methadone maintenance was developed as an alternative to waiting lists and as a method of providing HIV risk-reduction services to heroin addicts waiting for treatment, and does not include the regular counseling required in comprehensive methad one treatment. This analys is compares the retention of patients first admitted to an interim methadone clinic versus that of patients admitted directly to a comprehensive methadone clinic. The two groups did not differ with regard to demographic characteristics and drug of abuse at the time of admission. The two groups did not differ with respect to demographics. The three-, six-, and 12-month retention rates of patients first admitted to the interim clinic were 78%, 69%, and 62%, respectively. The three-, six-, and 12-month retention rates for patients admitted directly to a traditional methad one clinic were 84%, 76%, and 68%, respectively. Life-table analysis revealed that the two groups did not differ significantly with regard to retention ( p=0.17). Interim treatment does not appear to adversely affect overall retention in treatment. Three and six-month retention rates of interim clinic patients fall within the range of six-month nationwide retention rates reported by the GAO. Factors associated with discharge from treatment are examined for both groups.Risk factors for HIV–1 seroprevalence among drug injectors in the cocaine–using environment of Rio de Janeiro
AbstractLIMA, E. S., FRIEDMAN, S. R., BASTOS, F. I., TELLES, P. R., FRIEDMANN, P., WARD, T. P., & JARLAIS, D. C. (n.d.).Publication year
1994Journal title
AddictionVolume
89Issue
6Page(s)
689-698AbstractTo determine risk factors for HIV–1 among drug injectors in Rio de Janeiro, where cocaine is the dominant drug of injection, subjects were recruited using the criteria and interview instrument of the World Health Organization's Cross–National Study of HIV infection and risk behaviour in injecting drug users. HIV antibody test results were derived both from serum tests and from self–reports of previous tests (documented evidence of self–reported seropositivity was required). The analytical sample consists of 123 subjects, recruited both at drug abuse treatment sites and at street locations. Of 27 subjects with both serological and self–reported antibody status data, 20 reported previous negative tests; of these three had positive sera and may have seroconverted. Seven subjects reporting prior positive serostatus all tested positive. For the 123 subjects, seroprevalence was 34%. Independent significant risk factors in multivariate logistic regression with backwards elimination are: years of injection greater than 5; being a male who has had sex with men in the previous 5 years; and not having taken deliberate steps to protect oneself against AIDS. These findings indicate that homosexual/bisexual male drug injectors may be a bridge group through which HIV is entering drug–injecting networks in Rio de Janeiro. Efforts by drug injectors to reduce their risk of infection seem to have protective effects. This underscores the importance of HIV prevention efforts aimed at drug injectors.Self-help and science in the treatment of addiction
Des Jarlais, D. C. (n.d.).Publication year
1994Journal title
Journal of Substance Abuse TreatmentVolume
11Issue
2Page(s)
109-110Syringe and Needle Exchange to Prevent HIV Infection-Reply
Des Jarlais, D. C., Friedman, S. R., & Sotheran, J. L. (n.d.). In JAMA: The Journal of the American Medical Association (1–).Publication year
1994Volume
271Issue
23Page(s)
1826Targeted HIV-Prevention Programs
AbstractDes Jarlais, D. C., Padian, N. S., & Winkelstein, W. (n.d.).Publication year
1994Journal title
New England Journal of MedicineVolume
331Issue
21Page(s)
1451-1453AbstractThere had been 243,423 deaths from AIDS in the United States through June 30, 1994.1 About 40,000 new infections with the human immunodeficiency virus (HIV) occur annually.2 Given the human suffering, lost economic productivity, and medical costs associated with HIV infection, the present level of new infections is unacceptable. One problem with current prevention efforts is a lack of resources. The budget of the Centers for Disease Control and Prevention (CDC), the leading federal agency for HIV prevention, allocates less than $200 million for programs to change high-risk behavior (Jones TS, CDC: personal communication). Since costs for medical care are…