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
Transitions from injecting to non-injecting drug use: Potential protection against HCV infection
AbstractDes Jarlais, D. C., McKnight, C., Arasteh, K., Feelemyer, J., Perlman, D. C., Hagan, H., & Cooper, H. L. (n.d.).Publication year
2014Journal title
Journal of Substance Abuse TreatmentVolume
46Issue
3Page(s)
325-331AbstractTransitions from injecting to non-injecting drug use have been reported from many different areas, particularly in areas with large human immunodeficiency virus (HIV) epidemics. The extent to which such transitions actually protect against HIV and HCV has not been determined. A cross-sectional survey with HIV and hepatitis C (HCV) testing was conducted with 322 former injectors (persons who had injected illicit drugs but permanently transitioned to non-injecting use) and 801 current injectors recruited in New York City between 2007 and 2012. There were no differences in HIV prevalence, while HCV prevalence was significantly lower among former injectors compared to current injectors. Years injecting functioned as a mediating variable linking former injector status to lower HCV prevalence. Transitions have continued well beyond the reduction in the threat of AIDS to injectors in the city. New interventions to support transitions to non-injecting drug use should be developed and supported by both drug treatment and syringe exchange programs.TREND (Transparent Reporting of Evaluations with Nonrandomized Designs)
AbstractJarlais, D. C. (n.d.). In Guidelines for Reporting Health Research (1–).Publication year
2014Page(s)
156-168AbstractThe Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement grew out of the meta-analysis work on HIV prevention interventions being conducted by the Centers for Disease Control Prevention Research Synthesis (PRS) project in the late 1990s and early 2000s. The objective of the TREND statement was to improve the completeness and reporting of evaluations with nonrandomized designs. The TREND statement emphasizes reporting the theoretical bases of interventions. Clear statement of the theories underlying the interventions, with measurement of the intervening processes, can serve to provide a conceptual basis for assessing the likelihood that the intervention did "cause" the outcome even in the absence of a truly randomized trial. This chapter discusses the development process, evidence of effectiveness of guideline, endorsement and adherence, cautions and limitations or mistakes and/or misconceptions and creators' preferred bits for the TREND statement.Viral hepatitis among drug users in methadone maintenance: Associated factors, vaccination outcomes, and interventions
AbstractPerlman, D. C., Jordan, A. E., McKnight, C., Young, C., Delucchi, K. L., Sorensen, J. L., Des Jarlais, D. C., & Masson, C. L. (n.d.).Publication year
2014Journal title
Journal of Addictive DiseasesVolume
33Issue
4Page(s)
322-331AbstractDrug users are at high risk of viral Hepatitis A, B, and C. The prevalence of Hepatitis A, Hepatitis B, and Hepatitis C, associated factors, and vaccine seroconversion among drug treatment program participants in a randomized controlled trial of hepatitis care coordination were examined. Of 489 participants, 44 and 47% required Hepatitis A/Hepatitis B vaccinations, respectively; 59% were Hepatitis C positive requiring linkage to care. Factors associated with serologic statuses, and vaccine seroconversion are reported; implications for strategies in drug treatment settings are discussed. Results suggest generalizable strategies for drug treatment programs to expand viral hepatitis screening, prevention, vaccination, and linkage to care.A decline in the prevalence of injecting drug users in Estonia, 2005-2009
AbstractUusküla, A., Rajaleid, K., Talu, A., Abel-Ollo, K., & Des Jarlais, D. C. (n.d.).Publication year
2013Journal title
International Journal of Drug PolicyVolume
24Issue
4Page(s)
312-318AbstractAims: Here we report a study aimed at estimating trends in the prevalence of injection drug use between 2005 and 2009 in Estonia. Background: Descriptions of behavioural epidemics have received little attention compared with infectious disease epidemics in Eastern Europe. Methods: The number of injection drug users (IDUs) aged 15-44 each year between 2005 and 2009 was estimated using capture-recapture methodology based on 4 data sources (2 treatment data bases: drug use and non-fatal overdose treatment; criminal justice (drug related offences) and mortality (injection drug use related deaths) data). Poisson log-linear regression models were applied to the matched data, with interactions between data sources fi{ligature}tted to replicate the dependencies between the data sources. Linear regression was used to estimate average change over time. Results: There were 24305, 12,292, 238, 545 records and 8100, 1655, 155, 545 individual IDUs identifi{ligature}ed in the four capture sources (police, drug treatment, overdose, and death registry, accordingly) over the period 2005-2009. The estimated prevalence of IDUs among the population aged 15-44 declined from 2.7% (1.8-7.9%) in 2005 to 2.0% (1.4-5.0%) in 2008, and 0.9% (0.7-1.7%) in 2009. Regression analysis indicated an average reduction of about 1600 injectors per year. Conclusion: While the capture-recapture method has known limitations, the results are consistent with other data from Estonia. Identifying the drivers of change in the prevalence of injection drug use warrants further research.A randomized trial of a hepatitis care coordination model in methadone maintenance treatment
AbstractMasson, C. L., Delucchi, K. L., McKnight, C., Hettema, J., Khalili, M., Min, A., Jordan, A. E., Pepper, N., Hall, J., Hengl, N. S., Young, C., Shopshire, M. S., Manuel, J. K., Coffin, L., Hammer, H., Shapiro, B., Seewald, R. M., Bodenheimer, H. C., Sorensen, J. L., … Perlman, D. C. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
10Page(s)
e81-e88AbstractObjectives. We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients. Methods. We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n = 245) and an intervention arm (n = 244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services. Results. Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR] = 41.8; 95% confidence interval [CI] = 19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR = 4.10; 95% CI = 2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV-HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR = 8.70; 95% CI = 5.56, 13.61). Conclusions. Hepatitis care coordination was efficacious in increasing adherence to HAV-HBV vaccination and HCV clinical evaluation among methadone patients.Addicts who survived: An oral history of narcotic use in America before 1965
AbstractCourtwright, D., Joseph, H., Des Jarlais, D., & Brown, C. (n.d.). (1–).Publication year
2013Volume
9781572339767AbstractThe authors employ the techniques of oral history to penetrate the nether world of the drug user, giving us an engrossing portrait of life in the drug subculture during the "classic" era of strict narcotic control. Praise for the hardcover edition: "A momentous book which I feel is destined to become a classic in the category of scholarly narcotic books." -Claude Brown, author of the bestseller, Manchild in the Promised Land. "The drug literature is filled with the stereotyped opinions of non-addicted, middle-class pundits who have had little direct contact with addicts. These stories are reality. Narcotic addicts of the inner cities are both tough and gentle, deceptive when necessary and yet often generous-above all, shrewd judges of character. While judging them, the clinician is also being judged." -Vincent P. Dole, M.D., The Rockefeller Institute. "What was it like to be a narcotic addict during the Anslinger era? No book will probably ever appear that gives a better picture than this one. . . . a singularly readable and informative work on a subject ordinarily buried in clichés and stereotypes." -Donald W. Goodwin, Journal of the American Medical Association " . . . an important contribution to the growing body of literature that attempts to more clearly define the nature of drug addiction. . . . [This book] will appeal to a diverse audience. Academicians, politicians, and the general reader will find this approach to drug addiction extremely beneficial, insightful, and instructive. . . . Without qualification anyone wishing to acquire a better understanding of drug addicts and addiction will benefit from reading this book." -John C. McWilliams, Pennsylvania Magazine of History and Biography "This study has much to say to a general audience, as well as those involved in drug control." -Publishers Weekly "The authors' comments are perceptive and the interviews make interesting reading." -John Duffy, Journal of American History "This book adds a vital and often compelling human dimension to the story of drug use and law enforcement. The material will be of great value to other specialists, such as those interested in the history of organized crime and of outsiders in general." -H. Wayne Morgan, Journal of Southern History "This book represents a significant and valuable addition to the contemporary substance abuse literature. . . . this book presents findings from a novel and remarkably imaginative research approach in a cogent and exceptionally informative manner." -William M. Harvey, Journal of Psychoactive Drugs "This is a good and important book filled with new information containing provocative elements usually brought forth through the touching details of personal experience. . . . There isn't a recollection which isn't of intrinsic value and many point to issues hardly ever broached in more conventional studies." -Alan Block, Journal of Social History.An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs
AbstractMeader, N., Semaan, S., Halton, M., Bhatti, H., Chan, M., Llewellyn, A., & Des Jarlais, D. C. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
6Page(s)
1963-1978AbstractThis systematic review and meta-analysis examines the effectiveness of multisession psychosocial interventions compared with educational interventions and minimal interventions in reducing sexual risk in people who use drugs (51 studies; 19,209 participants). We conducted comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and PsychINFO 1998-2012). Outcomes (unprotected sex, condom use, or a composite outcome) were extracted by two authors and synthesised using meta-analysis. Subgroup analyses and meta-regression were conducted to explore heterogeneity. Multisession psychosocial interventions had modest additional benefits compared to educational interventions (K = 46; OR 0.86; 95 % CI 0.77, 0.96), and large positive effects compared to minimal interventions (K = 7; OR 0.60; 95 % CI 0.46, 0.78). Comparison with previous meta-analyses suggested limited progress in recent years in developing more effective interventions. Multisession psychosocial and educational interventions provided similar modest sexual risk reduction justifying offering educational interventions in settings with limited exposure to sexual risk reduction interventions, messages, and resources.Assessment of methadone clinic staff attitudes toward hepatitis C evaluation and treatment
AbstractTalal, A. H., Dimova, R. B., Seewald, R., Peterson, R. H., Zeremski, M., Perlman, D. C., & Des Jarlais, D. C. (n.d.).Publication year
2013Journal title
Journal of Substance Abuse TreatmentVolume
44Issue
1Page(s)
115-119AbstractWe used a 25-item, self-administered questionnaire to assess staff's perceived barriers and willingness to engage in onsite treatment of hepatitis C virus (HCV) at the Beth Israel Medical Center methadone maintenance treatment program (MMTP) at its Harlem sites. Of 80 participants, 50% were counselors and 24% were directly involved in referral or HCV testing. Although 92% of the MMTP staff indicated that they discuss HCV evaluation and treatment with patients at least annually, 70% believed that less than 25% of patients accept referral for HCV treatment and attend their initial appointment. Most staff (66%) supported onsite HCV evaluation and treatment, although support was higher among those with a bachelor's degree or higher (p=0.046). Lack of infrastructure was perceived as the greatest obstacle to onsite treatment. Educational interventions and skill building for staff to confidently engage and support MMTP patients in HCV treatment may be necessary prerequisites for onsite HCV management in MMTPs.Association between TLR3 rs3775291 and resistance to HIV among highly exposed Caucasian intravenous drug users
AbstractHuik, K., Avi, R., Pauskar, M., Kallas, E., Jõgeda, E. L., Karki, T., Marsh, K., Des Jarlais, D., Uusküla, A., & Lutsar, I. (n.d.).Publication year
2013Journal title
Infection, Genetics and EvolutionVolume
20Page(s)
78-82AbstractBackground: TLR3 recognizes dsRNA and triggers immune responses against RNA and DNA viruses. A polymorphism in TLR3, rs3775291 (Leu412Phe), has been associated with the increased susceptibility to enteroviral myocarditis, protection against tick-borne encephalitis virus and HIV-1 infection. We investigated Caucasian intravenous drug users (IDUs) and blood donors in order to evaluate the associations between TLR3 genotypes and susceptibility to HIV infection. Materials and methods: A total of 345 Caucasian IDUs were recruited, 50% of them were HIV positive, 89% HCV and 77% HBV positive. Based on their history of needle sharing, 20 of the HIV negative IDUs were classified as highly exposed HIV seronegatives (HESNs), 68 as non-HESNs and 85 as unexposed. The control group consisting of 497 blood donors tested negative for all three viruses. TLR3 rs3775291 were determined by using TaqMan Allelic Discrimination Assay. Results: The TLR3 rs3775291 T allele frequency was similar among the HIV negative and HIV positive IDUs and blood donors - 36%, 31% and 34%, respectively. The frequency of persons possessing at least one TLR3 rs3775291 T allele was significantly higher in HESNs compared with blood donors and HIV positive IDUs (80% vs. 55%; p=0.037 and 80% vs. 53%; p=0.031, respectively). In the univariate analysis, persons who possessed at least one T allele had reduced odds of being HIV seropositive (OR=0.29, 95% CI=0.09-0.90). This association remained significant (OR=0.25, 95% CI=0.07-0.87) after the adjustment for other co-variates (HCV, HBV serostatus and duration of intravenous drug use). Conclusions: The TLR3 rs3775291 T allele has a protective effect against HIV infection among HESNs IDUs.Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis
AbstractDimova, R. B., Zeremski, M., Jacobson, I. M., Hagan, H., Des Jarlais, D. C., & Talal, A. H. (n.d.).Publication year
2013Journal title
Clinical Infectious DiseasesVolume
56Issue
6Page(s)
806-816AbstractBackground. Hepatitis C virus (HCV)-infected drug users (DUs) have largely been excluded from HCV care. We conducted a systematic review and meta-analysis of the literature on treatment completion and sustained virologic response (SVR) rates in DUs. We assessed the effects of different treatment approaches and services to promote HCV care among DUs as well as demographic and viral characteristics. Methods. Studies of at least 10 DUs treated with pegylated interferon/ribavirin that reported SVR were analyzed. Heterogeneity was assessed (Cochran test) and investigated (meta-regression), and pooled rates were estimated (random effects).Results. Thirty-six studies comprising 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95% confidence interval [CI], 77.1%-88.9%). Among studies that included addiction-treated and untreated patients during HCV therapy, the higher the proportion of addiction-treated patients, the higher the HCV treatment completion rate (P <. 0001). After adjusting for human immunodeficiency virus (HIV)/HCV coinfection, sex, and treatment of addiction, support services during antiviral therapy increased treatment completion (P <. 0001). The pooled SVR rate was 55.5% (95% CI, 50.6%-60.3%). Genotype 1/4 (P =. 0012) and the proportion of HIV-coinfected DUs (P =. 0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV coinfection, the SVR rate was positively correlated with involvement of a multidisciplinary team (P <. 0001). Conclusions. Treatment of addiction during HCV therapy results in higher treatment completion. Our pooled SVR rate is similar to that obtained in registration trials in the general population. Treatment of addiction during HCV therapy will likely be important for HCV-infected DUs undergoing treatment with more complex regimens including direct-acting antivirals.Economic recession and emergence of an HIV-1 outbreak among drug injectors in Athens metropolitan area: A longitudinal study
AbstractParaskevis, D., Nikolopoulos, G., Fotiou, A., Tsiara, C., Paraskeva, D., Sypsa, V., Lazanas, M., Gargalianos, P., Psichogiou, M., Skoutelis, A., Wiessing, L., Friedman, S. R., Des Jarlais, D. C., Terzidou, M., Kremastinou, J., Malliori, M., & Hatzakis, A. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
11AbstractBackground: During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak. Methods: Our study employed high resolution HIV-1 phylogenetic and phylogeographic analyses. We examined also longitudinal data of ecological variables such as the annual growth of gross domestic product (GDP) of Greece in association with HIV-1 and HCV sentinel prevalence in IDUs, unemployment and homelessness rates and HIV transmission networks in Athens IDUs before and during economic recession (2008-2012). Results: IDU isolates sampled in 2011 and 2012 suggested transmission networks in 94.6% and 92.7% of the cases in striking contrast with the sporadic networking (5%) during 1998-2009. The geographic origin of most HIV-1 isolates was consistent with the recently documented migratory waves in Greece. The decline in GDP was inversely correlated with annual prevalence rates of HIV and HCV and with unemployment and homelessness rates in IDUs (all p<0.001). The slope of anti-HCV prevalence in the sentinel populations of IDUs and in "new" drug injectors was found 120 and 1.9-fold (p = 0.007, p = 0.08 respectively) higher in 2008-2012 (economic recession) compared with 2002-2006. The median (25th, 75th) size of transmission networks were 34 (12, 58) and 2 (2, 2) (p = 0.057) in 2008-2012 and 1998-2007, respectively. The coverage of harm reduction services was low throughout the study period. Conclusions: Scaling-up harm reduction services and addressing social and structural factors related to the current economic crisis should be urgently considered in environments where HIV-1 outbreaks may occur.Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: A systematic review
AbstractAbdul-Quader, A. S., Feelemyer, J., Modi, S., Stein, E. S., Briceno, A., Semaan, S., Horvath, T., Kennedy, G. E., & Des Jarlais, D. C. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
9Page(s)
2878-2892AbstractNeedle-syringe programs (NSP) have been effective in reducing HIV and hepatitis C (HCV) infection among people who inject drugs (PWID). Achieving sustainable reductions in these blood-borne infections requires addressing structural factors so PWID can legally access NSP services. Systematic literature searches collected information on NSP coverage and changes in HIV or HCV infection prevalence or incidence at the population level. Included studies had to document biomarkers (HIV or HCV) coupled with structural-level NSP, defined by a minimum 50 % coverage of PWID and distribution of 10 or more needles/syringe per PWID per year. Fifteen studies reported structural-level NSP and changes in HIV or HCV infection prevalence/incidence. Nine reported decreases in HIV prevalence, six in HCV infection prevalence, and three reported decreases in HIV incidence. The results support NSP as a structural-level intervention to reduce population-level infection and implementation of NSP for prevention and treatment of HIV and HCV infection.Gender disparities in HIV infection among persons who inject drugs in Central Asia: A systematic review and meta-analysis
AbstractDes Jarlais, D. C., Boltaev, A., Feelemyer, J., Bramson, H., Arasteh, K., Phillips, B. W., & Hagan, H. (n.d.).Publication year
2013Journal title
Drug and alcohol dependenceVolume
132Page(s)
S7-S12AbstractObjective: Disparities in HIV infection, with females having higher rates of HIV infection than males, have been noted among persons who inject drugs (PWID) in many countries. We examined male/female HIV disparities among PWID in Central Asia and compared these disparities with patterns worldwide. Methods: A systematic review and meta-analyses were conducted for studies reporting HIV prevalence by gender among PWID. To be included in the analyses, reports had to contain (1) samples of PWID from Central Asia, (2) HIV data based on laboratory testing, (3) HIV prevalence reported for males and females, and (4) samples that were not recruited on the basis of HIV status. Results: Data were abstracted from 11 studies in 5 countries in Central Asia: China, Kazakhstan, Russia, Tajikistan, and Uzbekistan; the total sample size was 12,225. The mean weighted OR for HIV prevalence among females to males was 0.913 (95% CI 0.07, 1.26), with high heterogeneity among studies (I2=70.0%) and a possible publication bias among studies with small sample sizes (Eggers test=-1.81, 95% CI -5.18, 0.54). Conclusions: The non-significant higher HIV prevalence among male PWID in Central Asia contrasts with the worldwide findings which show slightly higher HIV prevalence among female PWID. This may reflect the relative recency of the HIV epidemics in Central Asia. The findings also suggest there may be factors that protect female PWID from HIV in some settings. Further examination of transmission dynamics in Central Asia is necessary to better understand the HIV epidemic among PWID.Harm reduction
AbstractNormand, J., Li, J. H., Thomson, N., & Jarlais, D. D. (n.d.).Publication year
2013Journal title
Journal of Food and Drug AnalysisVolume
21Issue
4Page(s)
S10-S12AbstractThe "Harm Reduction" session was chaired by Dr Jacques Normand, Director of the AIDS Research Program of the United States National Institute on Drug Abuse. The three presenters (and their presentation topics) were: Dr Don Des Jarlais (High coverage needle/ syringe programs for people who inject drugs in low and middle income countries: a systematic review), Dr Nicholas Thomson (Harm reduction history, response, and current trends in Asia), and Dr Jih-Heng Li (Harm reduction strategies in Taiwan).Hiv infection among people who inject drugs: The challenge of racial/ethnic disparities
AbstractJarlais, D. C., McCarty, D., Vega, W. A., & Bramson, H. (n.d.).Publication year
2013Journal title
American PsychologistVolume
68Issue
4Page(s)
274-285AbstractRacial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial/ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to antiretroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the United States. Persons who inject drugs appear to be changing drug use norms and rituals to reduce their risks. The challenges are to (a) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time and (b) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs.HSV-2 Infection as a Cause of Female/Male and Racial/Ethnic Disparities in HIV Infection
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C., Perlman, D. C., Cooper, H. L., & Hagan, H. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
6AbstractObjectives:To examine the potential contribution of herpes simplex virus 2 (HSV-2) infection to female/male and racial/ethnic disparities in HIV among non-injecting heroin and cocaine drug users. HSV-2 infection increases susceptibility to HIV infection by a factor of two to three.Methods:Subjects were recruited from entrants to the Beth Israel drug detoxification program in New York City 2005-11. All subjects reported current use of heroin and/or cocaine and no lifetime injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were calculated for associations between HSV-2 infection and increased susceptibility to HIV.Results:1745 subjects were recruited from 2005-11. Overall HIV prevalence was 14%. Females had higher prevalence than males (22% vs. 12%) (p<0.001), African-Americans had the highest prevalence (15%), Hispanics an intermediate prevalence (12%), and Whites the lowest prevalence (3%) (p<.001). There were parallel variations in HSV-2 prevalence (females 86%, males 51%, African-Americans 66%, Hispanics 47%, Whites 36%), HSV-2 prevalence was strongly associated with HIV prevalence (OR = 3.12 95% CI 2.24 to 4.32). PAR%s for HSV-2 as a cause of HIV ranged from 21% for Whites to 50% for females. Adjusting for the effect of increased susceptibility to HIV due to HSV-2 infection greatly reduced all disparities (adjusted prevalence = males 8%, females 11%; Whites 3%, African-Americans 10%, Hispanics 9%).Conclusions:Female/male and racial/ethnic variations in HSV-2 infection provide a biological mechanism that may generate female/male and racial/ethnic disparities in HIV infection among non-injecting heroin and cocaine users in New York City. HSV-2 infection should be assessed as a potential contributing factor to disparities in sexually transmitted HIV throughout the US.Is the HCV-HIV co-infection prevalence amongst injecting drug users a marker for the level of sexual and injection related HIV transmission?
AbstractVickerman, P., Martin, N. K., Roy, A., Beattie, T., Jarlais, D. D., Strathdee, S., Wiessing, L., Hickman, M., Bao, Y. P., Caiaffa, W., Ralón, G., Rossi, D., Camoni, L., Suligoi, B., Bergant, N., Christensen, P. B., Duarte, Óscar, Santos, S., Ribeiro, C., … Hogge, M. (n.d.).Publication year
2013Journal title
Drug and alcohol dependenceVolume
132Issue
1Page(s)
172-181AbstractBackground: Amongst injecting drug users (IDUs), HIV is transmitted sexually and parenterally, but HCV is transmitted primarily parenterally. We assess and model the antibody prevalence of HCV amongst HIV-infected IDUs (denoted as HCV-HIV co-infection prevalence) and consider whether it proxies the degree of sexual HIV transmission amongst IDUs. Methods: HIV, HCV and HCV-HIV co-infection prevalence data amongst IDU was reviewed. An HIV/HCV transmission model was adapted. Multivariate model uncertainty analyses determined whether the model's ability to replicate observed data trends required the inclusion of sexual HIV transmission. The correlation between the model's HCV-HIV co-infection prevalence and estimated proportion of HIV infections due to injecting was evaluated. Results: The median HCV-HIV co-infection prevalence (prevalence of HCV amongst HIV-infected IDUs) was 90% across 195 estimates from 43 countries. High HCV-HIV co-infection prevalences (>80%) occur in most (75%) settings, but can be lower in settings with low HIV prevalence (<10%) or high HIV/HCV prevalence ratios (HIV prevalence divided by HCV prevalence > 0.75). The model without sexual HIV transmission reproduced some data trends but could not reproduce any epidemics with high HIV/HCV prevalence ratios (>0.85) or low HCV-HIV co-infection prevalence (<60%) when HIV prevalence > 10%. The model with sexual HIV transmission reproduced data trends more closely. The proportion of HIV infections due to injecting correlated with HCV-HIV co-infection prevalence; suggesting that up to 80/60/<20% of HIV infections could be sexually transmitted in settings with HCV-HIV co-infection prevalence between 50-60/70-80/>90%. Conclusion: Substantial sexual HIV transmission may occur in many IDU populations; HCV-HIV co-infection prevalence could signify its importance.Knowing quitters predicts smoking cessation in a homeless population
AbstractGoldade, K., Jarlais, D. D., Everson-Rose, S. A., Guo, H., Thomas, J., Gelberg, L., Joseph, A. M., & Okuyemi, K. S. (n.d.).Publication year
2013Journal title
American Journal of Health BehaviorVolume
37Issue
4Page(s)
517-524AbstractObjectives: To examine the impact of knowing quitters on cessation among homeless smokers. Methods: Secondary analysis of data derived from a community-based randomized controlled trial of 430 homeless smokers. We conducted multivariable logistic regression analysis to determine whether knowing quitters impacted the likelihood of cessation (salivary cotinine ≤ 20 ng/ml) at 26-week follow-up. Results: Multivariable logistic regression showed cessation was more likely for smokers who knew ≥ 5 quitters compared with those who knew no quitters (Odds Ratio = 3.79, CI = 1.17, 12.27, p = .008), adjusting for age, education, income, and time to first cigarette in morning. Conclusions: Knowing former smokers was associated with increased likelihood of achieving smoking abstinence among homeless smokers.Metropolitan Social Environments and Pre-HAART/HAART Era Changes in Mortality Rates (per 10,000 Adult Residents) among Injection Drug Users Living with AIDS
AbstractFriedman, S. R., West, B. S., Pouget, E. R., Hall, H. I., Cantrell, J., Tempalski, B., Chatterjee, S., Hu, X., Cooper, H. L., Galea, S., & Des Jarlais, D. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
2AbstractBackground: Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs) with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents) after highly active antiretroviral therapy (HAART) was developed. Methods: This is an ecological cohort study of 86 large US metropolitan areas from 1993-2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents) from 1993-1995 to 2004-2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993-1995 mortality rates to (partially) control for pre-HAART epidemic history and study how other independent variables affected the outcomes. Results: In multivariable models, pre-HAART to HAART era increases in 'hard drug' arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. Conclusions: Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be considered.Migration Narratives: Expanding Methods to Examine the Interaction of Person and Environment Among Aging Gay Men
AbstractVan Sluytman, L., Braine, N., Acker, C., Friedman, S., & DesJarlais, D. C. (n.d.).Publication year
2013Journal title
Journal of Gerontological Social WorkVolume
56Issue
3Page(s)
219-236AbstractAs they age, gay and bisexual men are embedded in multiple environments and communities. This article reanalyzes data collected as part of a larger qualitative study of crystal methamphetamine use in New York City. Focusing on the migration narratives of 30 racially/ethnically diverse men, age 40 years old and older, recruited from multiple venues several key areas emerged: ostracization, lack of affirmation as well as movement activities. Interactively they transformed social practices and increased spaces to explore sexuality, build community engagements and exchange resources. This study suggests that assessment of gay men (and other marginalized groups) may be enhanced through application of migration narratives.Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: A randomized controlled trial
AbstractOkuyemi, K. S., Goldade, K., Whembolua, G. L., Thomas, J. L., Eischen, S., Sewali, B., Guo, H., Connett, J. E., Grant, J., Ahluwalia, J. S., Resnicow, K., Owen, G., Gelberg, L., & Des Jarlais, D. (n.d.).Publication year
2013Journal title
AddictionVolume
108Issue
6Page(s)
1136-1144AbstractAims: To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers. Design: Two-group randomized controlled trial with 26-week follow-up. Participants and setting: A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA. Intervention and measurements: All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine. Findings: Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P=0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (-13.7±11.9 for MI versus -13.5±16.2 for standard care). Conclusions: Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.Perceptions of drug users regarding Hepatitis C screening and care: A qualitative study
AbstractJordan, A. E., Masson, C. L., Mateu-Gelabert, P., McKnight, C., Pepper, N., Bouche, K., Guzman, L., Kletter, E., Seewald, R. M., Des-Jarlais, D. C., Sorensen, J. L., & Perlman, D. C. (n.d.).Publication year
2013Journal title
Harm Reduction JournalVolume
10Issue
1AbstractBackground: Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood.Methods: Fourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions.Results: Many drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility.Conclusion: Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.Risk for heterosexual HIV transmission among non-injecting female partners of injection drug users in Estonia
AbstractUusküla, A., McMahon, J. M., Kals, M., Talu, A., Abel-Ollo, K., Rüütel, K., & Des Jarlais, D. C. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
3Page(s)
879-888AbstractThe HIV epidemic in Estonia, as with other eastern European countries, is currently concentrated among injection drug users (IDUs). Non-IDUs who have IDU sex partners could serve as a potential bridge in an expanding epidemic. We applied HIV transmission modelling to data collected from non-IDU/IDU heterosexual couples in Kohtla-Järve, Estonia to estimate HIV risk from IDUs to their sex partners based on self-reported sexual behaviors shared by the couple. IDUs and their current main non-injecting sex partners were recruited for an interviewer-administered survey and HIV testing. Bernoulli modelling techniques were applied to estimate the risk of HIV transmission (incidence) among HIV negative non-injecting female partners of male IDUs. The estimated HIV incidence in this population of non-injecting women with only main sexual partners in the last 6 months ranged from 3.24 to 4.94 HIV seroconversions per 100 person years depending on the value used in the models for the per act transmission rate during acute stage infection. Non-IDUs who have IDU sex partners are at high risk for HIV and could serve as a potential bridge to a more generalized epidemic. Whether this might lead to an expansion of the HIV epidemic beyond core groups in Estonia or other Eastern European countries warrants closer study.Smoking characteristics and comorbidities in the power to quit randomized clinical trial for homeless smokers
AbstractOkuyemi, K. S., Goldade, K., Whembolua, G. L., Thomas, J. L., Eischen, S., Guo, H., Connett, J., Grant, J., Ahluwalia, J. S., Resnicow, K., Owen, G., Gelberg, L., & Jarlais, D. D. (n.d.).Publication year
2013Journal title
Nicotine and Tobacco ResearchVolume
15Issue
1Page(s)
22-28AbstractIntroduction: Smoking prevalence in homeless populations is strikingly high (~ 70%); yet, little is known about effective smoking cessation interventions for this population. We conducted a community-based clinical trial, Power To Quit (PTQ), to assess the effects of motivational interviewing (MI) and nicotine patch (nicotine replacement therapy [NRT ]) on smoking cessation among homeless smokers. This paper describes the smoking characteristics and comorbidities of smokers in the study. Methods: Four hundred and thirty homeless adult smokers were randomized to either the intervention arm (NRT + MI) or the control arm (NRT + Brief Advice). Baseline assessment included demographic information, shelter status, smoking history, motivation to quit smoking, alcohol/other substance abuse, and psychiatric comorbidities. Results: Of the 849 individuals who completed the eligibility survey, 578 (68.1%) were eligible and 430 (74.4% of eligibles) were enrolled. Participants were predominantly Black, male, and had mean age of 44.4 years (S D=9.9), and the majority were unemployed (90.5%). Most participants reported sleeping in emergency shelters; nearly half had been homeless for more than a year. Nearly all the participants were daily smokers who smoked an average of 20 cigarettes/day. Nearly 40% had patient health questionnaire-9 depression scores in the moderate or worse range, and more than 80% screened positive for lifetime history of drug abuse or dependence. Conclusions: This study demonstrates the feasibility of enrolling a diverse sample of homeless smokers into a smoking cessation clinical trial. The uniqueness of the study sample enables investigators to examine the influence of nicotine dependence as well as psychiatric and substance abuse comorbidities on smoking cessation outcomes.Socio-demographic factors, health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn, Estonia: Evidence from cross-sectional surveys
AbstractVorobjov, S., Des Jarlais, D. C., Abel-Ollo, K., Talu, A., Rüütel, K., & Uusküla, A. (n.d.).Publication year
2013Journal title
International Journal of Drug PolicyVolume
24Issue
2Page(s)
150-155AbstractAim: To explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia. Methods: IDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation. Results: A total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (. n=. 156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity. Conclusions: Our results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.