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
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)
1556Intravenous Cocaine, Crack, and HIV Infection
Jarlais, D. C., & Friedman, S. R. (n.d.). In JAMA: The Journal of the American Medical Association (1–).Publication year
1988Volume
259Issue
13Page(s)
1945-1946Introduction of human immunodeficiency virus infection among parenteral drug abusers in sardinia: A seroepidemiologic study
Farci, P., Novick, D. M., Lai, M. E., Orgiana, G., Strazzera, A., Beatrice, S. T., Des Jarlais, D., & Balestrieri, A. (n.d.).Publication year
1988Journal title
American Journal of EpidemiologyVolume
127Issue
6Page(s)
1312-1314Methadone Maintenance Patients in General Medical Practice: A Preliminary Report
AbstractNovick, D. M., Pascarelli, E. F., Joseph, H., Salsitz, E. A., Richman, B. L., Des Jarlais, D. C., Anderson, M., Dole, V. P., & Nyswander, M. E. (n.d.).Publication year
1988Journal title
JAMA: The Journal of the American Medical AssociationVolume
259Issue
22Page(s)
3299-3302AbstractMedical maintenance is the treatment by primary care physicians of rehabilitated methadone maintenance patients who are stable, employed, not abusing drugs, and not in need of supportive services. In this research project, physicians with experience in drug abuse treatment provided both the pharmacologic treatment of addiction as well as therapy for other medical problems, as needed. Decisions regarding treatment were based on the individual needs of the patient and on currently accepted medical practice rather than on explicit regulations. We studied the first 40 former heroin addicts who were transferred to this program from more conventional methadone clinics. At a follow-up visit at 12 to 55 months, 33 (82.5%) of 40 patients had remained in treatment; five (12.5%) had been discharged because of cocaine abuse and two (5%) had been voluntarily discharged. Personal benefits of medical maintenance include the dignity of a standard professional atmosphere and a more flexible reporting schedule. This program has the potential for improving treatment of selected methadone maintenance patients.Needle sharing among IVDUs at risk for AIDS
Des Jarlais, D. C., & Friedman, S. R. (n.d.). In American journal of public health (1–).Publication year
1988Volume
78Issue
11Page(s)
1498Problems and dynamics of organizing intravenous drug users for AIDS prevention
Friedman, S. R., Jong, W. M., & Jarlais, D. C. (n.d.).Publication year
1988Journal title
Health Education ResearchVolume
3Issue
1Page(s)
49-57Specificity of Antibody Tests for Human Immunodeficiency Virus in Alcohol and Parenteral Drug Abusers with Chronic Liver Disease
AbstractNovick, D. M., Des Jarlais, D. C., Jeanne Kreek, M., Spira, T. J., Friedman, S. R., Gelb, A. M., Stenger, R. J., Schable, C. A., & Kalyanaraman, V. S. (n.d.).Publication year
1988Journal title
Alcoholism: Clinical and Experimental ResearchVolume
12Issue
5Page(s)
687-690AbstractParenteral drug abusers are at risk for acquired immunodeficiency syndrome (AIDS), which is caused by human immunodeficiency virus (HIV). We tested stored sera for antibody to HIV (anti‐HIV) using two enzyme‐linked immunosorbent assay (ELISA) methods and Western blot. The patients were parenteral drug abusers who had undergone percutaneous liver biopsy for chronic liver disease. Current or former alcohol abuse was noted in 88 (80%) of the 110 patients. The sensitivities of the two ELISA tests in comparison with Western blot, the more specific test for HIV, were 100 and 94%, respectively; the specificities were 94 and 99%. Western blot was positive in 36 (33%) of 110 patients. False‐positive ELISA reactions for anti‐HIV were seen in five (7%) of 70 patients with negative Western blot analyses. Compared to true‐negatives, false‐positives had significantly more years of alcohol abuse, younger ages of onset of alcohol abuse, greater frequencies of jaundice and edema, higher levels of alkaline phosphatase, total billirubin, total protein, and globulins, and lower levels of serum albumin. In a stepwise logistic regression, only hyperglobulinemia was significantly associated with a false‐positive anti‐HIV. We conclude that: (a) ELISA tests for anti‐HIV are useful for screening abusers of alcohol and parenteral drugs with chronic liver disease for HIV infection, but positive results must be confirmed with more specific tests such as Western blot; (b) false‐positive ELISA reactions in this population are associated with hyperglobulinemia; and (c) studies of HIV testing are needed in other populations of patients with alcoholism or liver disease.The Psychology of Preventing AIDS Among Intravenous Drug Users: A Social Learning Conceptualization
AbstractDes Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1988Journal title
American PsychologistVolume
43Issue
11Page(s)
865-870AbstractThis article reviews studies of AIDS risk reduction among IV drug users that have been conducted through early 1988. Almost all studies report risk reduction among the majority of subjects. Three principles are derived from the studies: Basic AIDS information is needed to generate motivation for behavior change; means for behavior change must be provided; and methods for reinforcing the new behaviors must then be provided.The sharing of drug injection equipment and the AIDS epidemic in New York City: the first decade.
Des Jarlais, D. C., Friedman, S. R., Sotheran, J. L., & Stoneburner, R. (n.d.).Publication year
1988Journal title
NIDA research monographVolume
80Page(s)
160-175Aids and preventing initiation into intravenous (iv) drug use
AbstractDes Jarlais, D. C., Kott, A., Friedman, S. R., & Casriel, C. (n.d.).Publication year
1987Journal title
Psychology & HealthVolume
1Issue
2Page(s)
179-194AbstractRisk reduction efforts aimed at current intravenous drug users need to be supplemented by efforts that reduce the numbers of drug sniffers who go on to intravenous use. A pilot study suggests that young drug sniffers avoid injecting primarily because they fear loss of control over their lives and, as a result, becoming involved in actions they abhor. None gave fear of AIDS as a reason why they did not inject their drugs—even though almost all knew that AIDS was a fatal disease spread by sharing needles while injecting drugs. They believed that two forces could lead to their becoming injectors: increasing tolerance to sniffed heroin or social pressure from friends who inject. A program to prevent initiation into intravenous drug use is proposed; this program, based on social learning theory, aims to teach drug sniffers how to avoid or cope with situations in which they might be pressured into drug injection.Aids and self-organization among intravenous drug users
Friedman, S. R., Des Jarlais, D. C., Sotheran, J. L., Garber, J., Cohen, H., & Smith, D. (n.d.).Publication year
1987Journal title
International Journal of the AddictionsVolume
22Issue
3Page(s)
201-219AIDS prevention among IV drug users: potential conflicts between research design and ethics.
Des Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1987Journal title
IRB; a review of human subjects researchVolume
9Issue
1Page(s)
6-8DECLINES IN PROPORTION OF KAPOSI'S SARCOMA AMONG CASES OF AIDS IN MULTIPLE RISK GROUPS IN NEW YORK CITY
Des Jarlais, D. C., Stoneburner, R., Thomas, P., & Friedman, S. R. (n.d.). In The Lancet (1–).Publication year
1987Volume
330Issue
8566Page(s)
1024-1025Development of AIDS, HIV seroconversion, and potential cofactors for T4 cell loss in a cohort of intravenous drug users
AbstractDes Jarlais, D. C., Friedman, S. R., Marmor, M., Cohen, H., Mildvan, D., Yancovitz, S., Mathur, U., El-Sadr, W., Spira, T. J., Garber, J., Beatrice, S. T., Abdul-Quader, A. S., & Sotheran, J. L. (n.d.).Publication year
1987Journal title
AIDSVolume
1Issue
2Page(s)
105-111AbstractA cohort of 334 intravenous (IV) drug users from New York City drug treatment programs were followed over a mean 9-month period. Among the 165 who were seropositive at enlistment, four developed clinical AIDS, for an annual rate of 3%. Elevated IgA was a significant predictor of developing AIDS. Among 72 subjects who were initially seronegative and who were re-interviewed, four were seropositive at follow-up, for a seroconversion rate of 7% per year among seronegatives. Among seropositive subjects who did not develop AIDS or fatal AIDS related complex (ARC), continued drug injection was associated with rate of T4 cell loss, and there was a non-significant trend for males to lose T4 cells more rapidly than females. While it was not possible to distinguish the mechanism underlying the relationship between continued drug injection and T4 cell loss, seropositive IV drug users should be warned that continued injection may lead to increased HIV-related immunosuppression as well as, if injection equipment is shared, risking viral transmission to others.HIV infection among intravenous drug users: epidemiology and risk reduction
AbstractDes Jarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1987Journal title
AIDSVolume
1Issue
2Page(s)
67-76AbstractResearch on the epidemiology of HIV infection among IV drug users is still at a relatively early stage. Multilocation studies that would permit better geopgraphic comparisons are greatly needed. Multi-method sudies within single geographic areas are also needed to assess possible biases with respect to sample recruitment and data collection procedures. The continuation of the epidemic provides a changing historical context that conplicates any comparisons. Despite these problems, there are some consistencies that can be seen across studies. Studies of HIV seroprevalence among IV drug users show wide variation among cities in the United States and Europe. The time that the virus was introduced into the IV drug using group within the city is one factor in explaining these differences; other cross-city factors have yet to be identified. Once HIV has been introduced into the IV drug use group within a particular geographic area, there is the possibility of rapid spread up to seroprevalence levels of 50% or greater. Thus, a currently low seroprevalence rate should not be seen as a stable situation. Frequency of injection and sharing of equipment with multiple other drug users (particularly at shooting galleries) have been frequently associated with HIV exposure. Being female, ethnicity (in the USA) and engaging in prostitution also may be associated with increased risk for HIV exposure, suggesting that prevention programs should include special consideration of sex and ethnic differences. Studies of AIDS risk reduction show that substantial proportions of IV drug users are changing their behavior to avoid exposure to HIV. This risk reduction is probably more advanced in New York, with its high seroprevalence and incidence of cases, but is also occuring in cities with lower seroprevalence and limited numbers of cases. The primary forms of risk reduction are increasing the use of sterile equipment, reducing the number of needle sharing partners, and reducing the frequency of injection. These behavior changes are very similar to the frequently indentified behavioral risk factors associated with HIV exposure, suggesting that they should be effective in at least slowing the spread of HIV among IV drug users. No linkage of risk reduction to decreases in seroconversion has yet been shown, however, and greater risk reduction is clearly required. A variety of prevention strategies will probably be needed to reduce the spread of HIV among IV drug users. Prevention of initiation into drug injection is an undeniable long-term goal for the control of HIV infection, but there is very little research being conducted in this area. Increasing the availability of drug abuse treatment and increasing the use of sterile equipment among people who continue to inject have been two commonly suggested means for reducing the spread of the virus among current IV drug users. While it is possible to see contradiction between these two strategies, the very limited available data from places where both have been put into effect indicate that the two strategies probably reinforce each other rather than detract from each other. While there is considerable evidence that AIDS prevention is quite feasible among IV drug users, the present state of knowledge on how best to achieve this is limited. Much more research and demonstration activity is needed.Intravenous drug use and the heterosexual transmission of the human immunodeficiency virus. Current trends in New York City
Des Jarlais, D. C., Wish, E., Friedman, S. R., Stoneburner, R., Yancovitz, S. R., Mildvan, D., El-Sadr, W., Brady, E., & Cuadrado, M. (n.d.).Publication year
1987Journal title
New York State Journal of MedicineVolume
87Issue
5Page(s)
283-286Nonrandom development of immunologic abnormalities after infection with human immunodeficiency virus: Implications for immunologic classification of the disease
AbstractZolla-Pazner, S., Des Jarlais, D. C., Friedman, S. R., Spira, T. J., Marmor, M., Holzman, R., Mildvan, D., Yancovitz, S., Mathur-Wagh, U., & Garber, J. (n.d.).Publication year
1987Journal title
Proceedings of the National Academy of Sciences of the United States of AmericaVolume
84Issue
15Page(s)
5404-5408AbstractBlood specimens from 165 intravenous drug users who were seropositive for the human immunodeficiency virus (HIV), from 158 seropositive homosexual men with lymphadenopathy, and from 77 patients with acquired immunodeficiency syndrome (AIDS) were assessed immunologically. Immunologic parameters were analyzed by the Guttman scalogram technique to determine if immunologic abnormalities occurred in a nonrandom pattern. The following four patterns emerged: (i) seropositivity for HIV with no immunologic abnormalities; (ii) seropositivity for HIV with a depressed T4/T8 cell ratio; (iii) seropositivity with a depressed T4/T8 cell ratio and T4-cell depletion; and (iv) seropositivity with a depressed T4/T8 cell ratio, T4-cell depletion, and lymphopenia. Ninety-two to 100% of subjects in each of the three groups of patients were found 'to scale' because the abnormalities occurred in the cumulative, ordered fashion described. This nonrandom occurrence of abnormalities indicates an ordered progression of immunologic abnormalities in individuals infected with HIV, a finding useful in the staging of both symptomatic and asymptomatic HIV-seropositive subjects.Public awareness of AIDS in Rwanda
AbstractFeldman, D. A., Friedman, S. R., & Des Jarlais, D. C. (n.d.).Publication year
1987Journal title
Social Science and MedicineVolume
24Issue
2Page(s)
97-100AbstractAIDS is a rapidly growing epidemic in Kigali, Rwanda. To understand the level of public awareness of AIDS in that city, 33 informants (15 men and 18 women) were interviewed during September, 1985. Most (66.7%) said that they first heard of the disease only within the previous eight months. About half (46.9%) could not mention one or more AIDS symptoms. Younger informants and women reported less knowledge of AIDS symptoms. While nearly everyone recognized AIDS as a stigmatized disease, most informants apparently did not know why it is stigmatized. Only about one-third of the informants (34.4%) could correctly state the mode of AIDS transmission. People who are at greatest risk for the disease, unmarried men and women, were least likely to know how it is transmitted. Half (50.0%) of those informants who responded to the question of the origins of AIDS said that it began in 'America.' While many informants are frightened by the disease, no one has yet changed their sexual behavior as a response to the epidemic. All informants agreed that more information about AIDS should be made available in Rwanda. Preventive measures against the spread of AIDS are urgently needed in central Africa.Report on the European Community Workshop on Epidemiology of HIV infections: Spread among intravenous drug abusers and the heterosexual population Robert Koch-Institute, Berlin, 12-14 November 1986
Brunet, J. B., Des Jarlais, D. C., & Koch, M. A. (n.d.).Publication year
1987Journal title
AIDSVolume
1Issue
1Page(s)
59-61Risk factors for infection with human immunodeficiency virus among intravenous drug abusers in New York City
AbstractMarmor, M., Des Jarlais, D. C., Cohen, H., Friedman, S. R., Beatrice, S. T., Dubin, N., El-Sadr, W., Mildvan, D., Yancovitz, S., Mathur, U., & Holzman, R. (n.d.).Publication year
1987Journal title
AIDSVolume
1Issue
1Page(s)
39-44AbstractWe report here the results of a survey of 308 intravenous drug abusers recruited from hospital-based methadone maintenance or drug detoxification programmes located in Manhattan, New York City. Complete interviews and serological analyses for antibodies to human immunodeficiency virus (HIV) using both enzyme-linked immunosorbent and Western blot assays were obtained from 290 (94%) of the subjects. HIV antibodies were found by both assays in 147 (50.7%) of the tested subjects; conflicting results were found in three (1%) of the subjects; and negative results on both tests were found in 140 (48.3%) of the subjects. Logistic regression analysis identified significant relative risks for HIV infection associated with the frequency of drug injection and the proportion of injections in 'shooting galleries'. Additional risk among men was associated with a history of homosexual relations. Traditional efforts taken by subjects to clean syringes between uses, such as washing with water or alcohol, showed no evidence of being protective. Programmes aimed at prevention of HIV infection should focus on reducing use of shooting galleries and sharing of needles and syringes as well as reducing intravenous drug abuse generally.Target Groups for Preventing AIDS Among Intravenous Drug Users
AbstractJarlais, D. C., & Friedman, S. R. (n.d.).Publication year
1987Journal title
Journal of Applied Social PsychologyVolume
17Issue
3Page(s)
251-268AbstractThe acquired immune deficiency syndrome (AIDS) has rapidly become the most serious medical consequence of injecting illicit drugs. Its potential impact on intravenous (IV) drug use is enormous. Human immunodeficiency virus (HIV, also known as HTLV‐III and LAV), the virus that causes AIDS, appears, usually, to lead to lifelong infection. At present there is no effective treatment, and the treatments under development may require lifelong antiviral therapy. Since most of the antibody produced in response to HIV infection does not neutralize the virus, and since there is substantial genetic variation in the virus, it will be difficult to develop a vaccine. Even after vaccines are developed, testing their safety and efficacy will be formidable problems. Until either effective treatment or vaccines are developed, control of the epidemic among IV drug users must be attempted through behavior change/prevention efforts. In this paper we will review the epidemiology of AIDS among IV drug users and characteristics of the IV drug‐use subculture relevant to prevention efforts. We will then identify different target groups for these prevention efforts, present available evidence about behavior change in these groups, and then briefly discuss how to prevent transmission of HIV to heterosexual partners who are not themselves IV drug users and to the children of IV drug users.The AIDS epidemic among blacks and Hispanics
AbstractFriedman, S. R., Sotheran, J. L., Abdul-Quader, A., Primm, B. J., Des Jarlais, D. C., Kleinman, P., Mauge, C., Goldsmith, D. S., El-Sadr, W., & Maslansky, R. (n.d.).Publication year
1987Journal title
Milbank QuarterlyVolume
65Page(s)
455-499AbstractThis article has three themes and one additional goal: AIDS has disproportionately affected minorities; There is a great need for minority community mobilization to deal with the epidemic and its effects, and for financial and other assistance of these mobilizing efforts by national institutions; Blacks and Hispanics are not just dominated and subordinated, but have developed resources and relationships that offer many benefits in fighting AIDS. As an additional goal, this article presents considerable data about different aspects of AIDS and race. These data are by no means complete. The inadequacy of the general research effort on this topic cannot be compensated for in one article, and the fact that the authors have worked primarily in the field of IV drug users and AIDS means that there are undoubted weaknesses in what we cover about race and AIDS among gay men. What we do attempt to accomplish, however, is to demonstrate the existence of important racial dimensions to AIDS and to provoke appropriate research, debate, and action.A stage model of HTLV-III LAV infection in intravenous drug users.
Des Jarlais, D. C., Friedman, S. R., Spira, T. J., Zolla-Pazner, S., Marmor, M., Holzman, R., Mildvan, D., Yancovitz, S., Mathur-Wagh, U., & Garber, J. (n.d.).Publication year
1986Journal title
NIDA research monographVolume
67Page(s)
328-334AIDS Health Education for Intravenous Drug Users
AbstractFriedman, S. R., Des Jarlais, D. C., & Sotheran, J. L. (n.d.).Publication year
1986Journal title
Health Education & BehaviorVolume
13Issue
4Page(s)
383-393AbstractIntravenous (IV) drug users are the second largest risk group for AIDS and the main source of infection for heterosexual partner and pediatric AIDS cases. IV drug users have an addiction and a subculture that make risk reduction difficult; for example, to refuse to share needles can endanger personal relationships, and carrying clean works (rather than renting them in a shooting gallery) risks arrest. In New York City, at least, knowledge about AIDS transmission is widespread among IV drug users, and most drug injectors report having changed their drug use practices to reduce their risks. The main functions of health education in areas where IV drug users have this level of knowledge are to disseminate news of new discoveries; reach those drug users who have not yet learned AIDS basics; reinforce what is already known; and provide in formation about new programs to help drug users deal with AIDS-related problems. To encourage behavior change requires going beyond simple education, however; it entails trying to change IV drug user subculture. Drug user groups in the Netherlands and in New York City are attempting to do this from within the subculture. Outside intervention requires repeated messages from multiple sources; face-to-face, interactive communication; and perhaps the use of ex-addicts as health educators.Antibody to LAV, the putative agent of AIDS, in parenteral drug abusers and methadone-maintained patients: therapeutic, historical, and ethical aspects.
Novick, D. M., Kreek, M. J., Des Jarlais, D. C., Spira, T. J., Khuri, E. T., Ragunath, J., Kalyanaraman, V. S., Gelb, A. M., & Miescher, A. (n.d.).Publication year
1986Journal title
NIDA research monographVolume
67Page(s)
318-320