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
Patterns of HIV-1 and HTLV-I/II in intravenous drug abusers from the middle atlantic and central regions of the USA
AbstractLee, H. H., Weiss, S. H., Brown, L. S., Mildvan, D., Shorty, V., Saravolatz, L., Chu, A., Ginzburg, H. M., Markowitz, N., Des Jarlais, D. C., Blattner, W. A., & Jean-Pierre, A. (n.d.).Publication year
1990Journal title
Journal of Infectious DiseasesVolume
162Issue
2Page(s)
347-352AbstractSeroprevalence of human immunodeficiency virus type 1 (HIV-1) and human T lymphotropic virus types I and II (HTLV-I/II) was determined among 1160 intravenous (iv) drug abusers from five drug treatment or medical centers (Manhattan, Brooklyn, New Jersey, Detroit, and New Orleans). HIV-1 infection ranged from 5% in New Orleans to 48% in New York City. Hispanics and blacks had a significantly higher rate of HIV-1 infection than whites (P <.01), but within each group rates were similar between males and females and by age stratum. HTLV-I/II seroprevalence increased with age from 3% in the 20–29 year age group to 37% in the group >50 years. New Orleans and Manhattan (24%) had the highest rate, and blacks (19%) had a higher rate than either Hispanics (6.3%) or whites (7.3%). No association between HIV-1 and HTLV-I/II infection was observed except in Manhattan. When compared with iv drug abusers infected only with HIV-1, dually infected subjects had more clinical symptoms related to immune deficiency but a lower prevalence of HIV antigenemia. These data document the frequent occurrence of retroviral infections in iv drug abusers. The contrast between the two classes of virus suggests that HIV-1 is more efficiently transmitted, while the age-dependent rise in HTLV-I/II seroprevalence suggests cumulative exposure of a less-transmissible agent.Psychoactive Drug Use and AIDS
Jarlais, D. C., & Friedman, S. R. (n.d.). In JAMA: The Journal of the American Medical Association (1–).Publication year
1990Volume
263Issue
3Page(s)
372Psychoactive drug use and AIDS (III)
Des Jarlais, D. C., & Friedman, S. R. (n.d.). In Journal of the American Medical Association (1–).Publication year
1990Volume
263Issue
3Page(s)
372Psychological and behavioral impact among intravenous drug users of learning HIV test results
AbstractCasadonte, P. P., Des Jarlais, D. C., Friedman, S. R., & Rotrosen, J. P. (n.d.).Publication year
1990Journal title
Substance Use and MisuseVolume
25Issue
4Page(s)
409-426AbstractIn 1984 as part of a New York City study to examine the prevalence of HIV infection in a substance-abusing population and to test the validity of HIV screening kits, 94 patients at the New York VAMC were tested. Results were made available to 50 (35 seronegative, 15 seropositive) patients in January 1986. Psychological and behavioral impact of learning test results was assessed using standardized psychiatric rating scales A comparison group of 31 nontested subjects were also evaluated. Ratings were done preresults, approximately 1-2 weeks after results, and 8-10 weeks after informing patients of their HIV status. No major stress reactions were observed. Seropositives experienced a higher level of anxiety 1-2 weeks after learning results but anxiety generally diminished; they made significant behavior changes which were maintained. Seronegatives experienced relief and maintained IV drug risk reduction behavior. Anxiety about contracting AIDS increased in nontested subjects as the study progressedShooting galleries and AIDS: Infection probabilities and 'tough' policies
Des Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1990Journal title
American journal of public healthVolume
80Issue
2Page(s)
142-144Stages in the Response of the Drug Abuse Treatment System to the AIDS Epidemic in New York City
AbstractDes Jarlais, D. C. (n.d.).Publication year
1990Journal title
Journal of Drug IssuesVolume
20Issue
2Page(s)
335-347AbstractThe acquired immunodeficiency syndrome (AIDS) has profoundly changed the nature of intravenous drug use and of treatment for intravenous drug abuse. Program staff are finding themselves confronted by the need to provide drug abuse treatment to persons who are likely to die, and challenged by the need to reduce the sharing of drug injection equipment and change the sexual behavior of their clients. In responding to these challenges, drug abuse treatment programs in New York City appear to have gone through four stages; denial, panic, coping and potential burnout. The author also presents other possible stages.Street-recruited intravenous drug users and sexual risk reduction in New York City
AbstractAbdul-Quader, A. S., Tross, S., Friedman, S. R., Kouzi, A. C., & Des Jarlais, D. C. (n.d.).Publication year
1990Journal title
AIDSVolume
4Issue
11Page(s)
1075-1079AbstractPrevious studies have reported that intravenous drug users (IVDUs) have made considerable drug-use risk reduction, but less sexual risk reduction. This paper presents findings about sexual risk reduction by street-recruited IVDUs in New York City, and examines the predictors of sexual risk reduction. Sixty-one per cent of these street-recruited IVDUs have initiated deliberate sexual risk reduction in order to avoid AIDS. For the total sample (n = 568), as well as for the male IVDUs, specific health belief and social influence factors were significant predictors of sexual risk reduction. For female IVDUs, drug-risk reduction, having a friend or acquaintance who practices sexual risk reduction, and wanting to have a(nother) child were significant predictors of sexual risk reduction. These findings suggest the importance of social support and community organization to promote risk reduction.Target Groups for Preventing AIDS Among Intravenous Drug Users: 2. The "Hard" Data Studies
AbstractDes Jarlais, D. C., Friedman, S. R., & Casriel, C. (n.d.).Publication year
1990Journal title
Journal of consulting and clinical psychologyVolume
58Issue
1Page(s)
50-56AbstractStudies were reviewed with respect to three different target groups for preventing AIDS among intravenous (IV) drug users by (a) providing drug abuse treatment for those who want to stop injecting drugs, (b) providing "safer" injection for those who are likely to continue injecting, and (c) preventing drug injection among those who are at high risk for beginning to inject. The studies reviewed were limited to those that include "hard" data: validated self-reports, seroprevalence outcomes, or self-reports of behavior that is the opposed to any of the demand characteristics generated by the research setting. For two groups of current IV drug users-those entering drug treatment and those continuing to inject-these hard data studies show rapidly induced AIDS risk reduction but suggest a need for large-scale change maintained over long time periods. In terms of preventing initial injection, alternative forms of intense drug use have emerged but have not supplanted drug injection, and basic knowledge of AIDS does not appear to deter initial drug injection.Working with heroin sniffers: Clinical issues in preventing drug injection
AbstractCasriel, C., Des Jarlais, D. C., Rodriguez, R., Friedman, S. R., Stepherson, B., & Khuri, E. (n.d.).Publication year
1990Journal title
Journal of Substance Abuse TreatmentVolume
7Issue
1Page(s)
1-10AbstractPreventing illicit drug injection would be the ideal point for preventing HIV infection and AIDS among illicit drug injectors. This paper reports on clinical issues that arose in a program for intranasal ("sniffer") heroin users who were at high risk of injecting drugs. Extensive field notes were kept by the staff of the project. A generalized mistrust of authorities, denial of problems associated with non-injected drug use, and ambivalence about injecting were the major issues that arose during subject recruitment and the group sessions. The staff underwent trial and error learning, both becoming more confident in working with heroin sniffers, and finding better results for later participants in the study.AIDS and IV drug use
Des Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1989Journal title
ScienceVolume
245Issue
4918Page(s)
578AIDS prevention programs for intravenous drug users: Diversity and evolution
AbstractDes Jarlais, D. C. (n.d.).Publication year
1989Journal title
International Review of PsychiatryVolume
1Issue
1Page(s)
101-108AbstractRecent studies show AIDS risk reduction among intravenous drug users in response to a wide variety of prevention programs. These prevention programs have ranged from simple education to the provision of drug abuse treatment. Case studies of three programs that have been in operation for relatively long times-in Amsterdam, New Jersey and New York-show evolutionary changes. The programs have to respond to the needs of their clientele as well as concerns of the political environment. The changes are often in directions radically different from the original expectations of the program designers. A unifying theme in these changes is that programs providing treatment to reduce drug injection and programs providing means for 'safer' injection should be seen as complementary rather than contradictory.An Overview of AIDS Prevention Efforts Aimed at Intravenous Drug Users Circa 1987
AbstractFriedman, S. R., Des Jarlais, D. C., & Goldsmith, D. S. (n.d.).Publication year
1989Journal title
Journal of Drug IssuesVolume
19Issue
1Page(s)
93-112AbstractAIDS prevention efforts that had been instituted by early 1987 included outreach; AIDS education within drug abuse treatment programs; antibody testing; preventing initiation in IV drug use; collective organization by drug users to confront AIDS; and efforts to change the environment of IV drug use in ways that might reduce HIV transmission. Projects differed in terms of whether they 1) oriented primarily to getting users into treatment or to risk reduction among continuing users (a false dichotomy); 2) used deterrence, skills building, group-identity, or social support to motivate risk reduction; 3) tried to change the environment of drug use, its subculture, or the individual user; and 4) vested control of the project in the hands of professionals or of the users themselves. These models can play different roles in fighting the epidemic, and new approaches need to be developed.Cocaine injection and ethnicity in parenteral drug users during the early years of the human immunodeficiency virus (hiv) epidemic in new york city
AbstractNovick, D. M., Trigg, H. L., Des Jarlais, D. C., Friedman, S. R., Vlahov, D., & Kreek, M. J. (n.d.).Publication year
1989Journal title
Journal of Medical VirologyVolume
29Issue
3Page(s)
181-185AbstractParenteral drug users have a high prevalence of infection with human immunodeficiency virus (HIV), the etiologic agent of acquired immune deficiency syndrome (AIDS). New York City has had a prolonged and extensive epidemic of HIV infection and AIDS. In this study, we analyze, in relation to antibody to HIV (anti‐HIV), available data from sera from parenteral drug users collected in New York City during 1978 through 1983 in the course of studies of liver disease. Among parenteral users of both heroin and cocaine, 30 (52%) of 58 had anti‐HIV, compared with six (13%) of 48 injectors of heroin only (P < 0.0001). Only two (11%) of 18 white patients were HIV‐infected, compared with 34 (39%) of 88 black or Hispanic patients (P = 0.03). No other factors studied were linked to anti‐HIV. In a multiple logistic regression, anti‐HIV was significantly more common in parenteral users of both cocaine and heroin (P < 0.0001), black patients (P = 0.02), and Hispanic patients (P = 0.049). We conclude that parenteral users of both cocaine and heroin as well as black and Hispanic patients were disproportionately HIV‐infected during the early years of the HIV epidemic. Use of cocaine and heroin as well as ethnicity were independently linked to anti‐HIV. Measures to prevent or treat drug use, HIV infection, and other medical problems while addressing the specific needs of cocaine users and black and Hispanic patients are urgently needed.Expectations of racial prejudice in aids research and prevention programs in the United States
AbstractDes Jaríais, D. C., Casriel, C., Síepherson, B., & Friedman, S. R. (n.d.).Publication year
1989Journal title
Drugs and SocietyVolume
5Issue
1Page(s)
1-8AbstractHIV infection and AIDS have occurred at disproportionately higher rates among Black and Hispanic persons in the United States. The HIV epidemic is occurring within an historical context of racial prejudice and inequality within the society as a whole, and of poor health care for minority communities. We report instances of expectations of racial prejudice that affected three different AIDS research/prevention activities. Failure to anticipate and appropriately respond to these expectations of racial prejudice may substantially interfere with AIDS efforts and appear to confirm the expectations. Even with the best anticipation and responses, there will be many instances in which the problem cannot be satisfactorily resolved. The association of AIDS with minority status has the potential to reinforce stigmatization of minority communities. Prevention and research activities will often be caught in lose-lose situations of either “unfairly singing out” minorities or of ignoring the problems of minority communities.HIV-1 Infection Among Intravenous Drug Users in Manhattan, New York City, From 1977 Through 1987
AbstractDes Jarlais, D. C., Friedman, S. R., Novick, D. M., Sotheran, J. L., Thomas, P., Yancovitz, S. R., Mildvan, D., Weber, J., Kreek, M. J., Maslansky, R., Bartelme, S., Spira, T., & Marmor, M. (n.d.).Publication year
1989Journal title
JAMA: The Journal of the American Medical AssociationVolume
261Issue
7Page(s)
1008-1012AbstractIntravenous drug users are the second largest group to develop the acquired immunodeficiency syndrome, and they are the primary source for heterosexual and perinatal transmission in the United States and Europe. Understanding long-term trends in the spread of human immunodeficiency virus among intravenous drug users is critical to controlling the acquired immunodeficiency syndrome epidemic. Acquired immunodeficiency syndrome surveillance data and seroprevalence studies of drug treatment program entrants are used to trace seroprevalence trends among intravenous drug users in the borough of Manhattan. The virus entered this drug-using group during the mid-1970s and spread rapidly in 1979 through 1983. From 1984 through 1987, the seroprevalence rate stabilized between 55% and 60%—well below hepatitis B seroprevalence rates. This relatively constant rate is attributed to new infections, new seronegative persons beginning drug injection, seropositive persons leaving drug injection, and increasing conscious risk reduction.In Reply
Jarlais, D. C., & Friedman, S. R. (n.d.). In JAMA: The Journal of the American Medical Association (1–).Publication year
1989Volume
262Issue
10Page(s)
1330-1331Recommendations for control and prevention of human immunodeficiency virus (HIV) infection in intravenous drug users
AbstractBrickner, P. W., Torres, R. A., Barnes, M., Newman, R. G., Des Jarlais, D. C., Whalen, D. P., & Rogers, D. E. (n.d.).Publication year
1989Journal title
Annals of internal medicineVolume
110Issue
10Page(s)
833-837AbstractConsiderable evidence indicates that intravenous drug users are emerging as the group at greatest risk for both acquiring and spreading human immunodeficiency virus (HIV) infection. Thus, all possible methods to control the spread of HIV infection in intravenous drug users should be explored. Key recommendations are that HIV antibody testing of intravenous drug users should be voluntary, because mandatory testing is counterproductive; free distribution of needles and syringes to intravenous drug users should occur only in carefully controlled circumstances to determine its effectiveness in decreasing infection rates; and drug-free and methadone maintenance treatment programs should be available on demand to all intravenous drug users as a means of reducing the spread of HIV infection. At present, the primary strategy for prevention must be education resulting in behavioral change. Education is currently the only definitive means for controlling the spread of HIV infection among intravenous drug users, their sex contacts, and to fetuses.Will Bleach Decontaminate Needles During Cocaine Binges in Shooting Galleries?
Friedman, S. R., Sterk, C., Sufian, M., & Jarlais, D. C. (n.d.). In JAMA: The Journal of the American Medical Association (1–).Publication year
1989Volume
262Issue
11Page(s)
1467A larger spectrum of severe HIV-1-related disease in intravenous drug users in New York City
AbstractStoneburner, R. L., Des Jarlais, D. C., Benezra, D., Gorelkin, L., Sotheran, J. L., Friedman, S. R., Schultz, S., Marmor, M., Mildvan, D., & Maslansky, R. (n.d.).Publication year
1988Journal title
ScienceVolume
242Issue
4880Page(s)
916-919AbstractIncreasing mortality in intravenous (IV) drug users not reported to surveillance as acquired immunodeficiency syndrome (AIDS) has occurred in New York City coincident with the AIDS epidemic. From 1981 to 1986, narcotics-related deaths increased on average 32% per year from 492 in 1981 to 1996 in 1986. This increase included deaths from AIDS increasing from 0 to 905 and deaths from other causes, many of which were infectious diseases, increasing from 492 to 1091. Investigations of these deaths suggest a causal association with human immunodeficiency virus (HIV) infection. These deaths may represent a spectrum of HIV-related disease that has not been identified through AIDS surveillance and has resulted in a large underestimation of the impact of AIDS on IV drug users and blacks and Hispanics.Biological Validation of Self‐Reported AIDS Risk Reduction among New York City Intravenous Drug Users
FRIEDMAN, S. R., DES JARLAIS, D. C., MILDVAN, D., YANCOVITZ, S. R., & GARBER, J. (n.d.).Publication year
1988Journal title
Annals of the New York Academy of SciencesVolume
529Issue
1Page(s)
257-259Gender differences in response to HIV infection.
AbstractDes Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1988Journal title
Advances in biochemical psychopharmacologyVolume
44Page(s)
159-163AbstractThere is strong epidemiologic evidence from studies of i.v. drug users in New York City for the existence of one or more gender-related cofactors in response to HIV infection. The strength of the evidence comes from the variety of data sets that indicate a gender-related cofactor and from the consistency of the pattern found: in all of the data sets, females appear to have a more "favorable" response than do males. The extent of underrepresentation of females in the cases of AIDS in i.v. drug users--a possible 35% reduction in the development of clinical AIDS-suggests that such a cofactor should be considered of practical importance. Identifying the mechanism(s) for a gender difference may lead to ways of deliberately affecting the course of the infection. Further research on the gender difference may also contribute to our understanding of interactions among the various components of the immune system and the interaction of the immune system with other behavioral and physiologic systems.HIV and intravenous drug use
AbstractDes Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1988Journal title
AIDSVolume
2Page(s)
S65-S69AbstractThere is now evidence from a wide variety of geographic areas that many intravenous drug users will change their behavior in order to reduce their risk of developing AIDS. There is even evidence from some areas that the behavior change has led to relative stabilization of seroprevalence rates, although longer-term studies will be needed to establish this definitively. AIDS behavior change in the area of sexual risk reduction appears to be much more difficult than change of drug injection behavior. Conceptual models of AIDS-related behavior change are needed, particularly models that can incorporate the injection of different drugs and variation in social and psychological characteristics among drug injectors. There is increasing evidence for a wider spectrum of HIV-related morbidity and mortality among intravenous drug users than is captured by the current surveillance definition for AIDS, again emphasizing the need for effective prevention programs.HIV infection among persons who inject illicit drugs: Problems and prospects
AbstractJarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1988Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
1Issue
3Page(s)
267-273AbstractIntravenous drug use continues as the second most common risk behavior associated with acquired immune deficiency syndrome (AIDS) in the United States and Europe. Recently there has been increased public and research attention to this problem. Five areas of public health concern for AIDS among i.v. drug users are identified and discussed: (a) the potential spread of human immunodeficiency virus (HIV) to drug users in developing countries; (b) the emergence of cocaine use associated with HIV infection; (c) ethnic differences in seroprevalence rates among i.v. drug users, with ethnic minorities tending to have higher rates; (d) difficulties in changing the sexual behavior of i.v. drug users; and (e) an increased frequency of fatal infections among HIV seropositive drug users that are not counted with the current surveillance definition of AIDS. There have been numerous studies of AIDS risk reduction among i.v. drug users, but the ultimate effect of the behavior change on spread of the virus is not yet clear. Preliminary studies from New York City, San Francisco, and Stockholm indicate a relative stabilization of seroprevalence in those cities, suggesting that the behavior changes reported in those cities may be significantly slowing the rate of viral spread.Hiv infection and intravenous drug use: Critical issues in transmission dynamics, infection outcomes, and prevention
AbstractDes Jarlais, D. C., Friedman, S. R., & Stoneburner, R. L. (n.d.).Publication year
1988Journal title
Reviews of Infectious DiseasesVolume
10Issue
1Page(s)
151-158AbstractAs the second largest group of persons to have been infected with human immunodeficiency virus (HIV), and the most likely to transmit HIV to heterosexual partners in the United States and Europe, iv drug users will play an increasingly important role in the future of the AIDS epidemic. This paper reviews five emerging critical issues regarding HIV infection among iv drug users. In epidemiology, rates of drug injection and anonymous sharing of injection equipment appear related to rapid spread of HIV among iv drug users, while heterosexual transmission from iv drug users appears to have been occurring at a relatively slow but constant rate. Data exist that support a gender-related cofactor and a continuing drug injection cofactor, but mechanisms for these potential cofactors have not been determined. Besides frank AIDS, HIV infection also appears to lead to epidemic-level increases in a variety of fatal infections among iv drug users. Several studies of prevention show active risk reduction among iv drug users, but new methods are urgently needed to increase amount of risk reduction.In Reply
Jarlais, D. C., & Friedman, S. R. (n.d.). In JAMA: The Journal of the American Medical Association (1–).Publication year
1988Volume
260Issue
11Page(s)
1556