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
Combined HIV prevention, the New York City Condom Distribution Program, and the evolution of safer sex behavior among persons who inject drugs in New York City
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Hagan, H., Cooper, H. L., & Perlman, D. C. (n.d.).Publication year
2014Journal title
AIDS and BehaviorVolume
18Issue
3Page(s)
443-451AbstractExamine long term sexual risk behaviors among persons who inject drugs (PWID) in New York City following implementation of "combined" prevention programming, including condom social marketing. Quantitative interviews and human immunodeficiency virus (HIV) testing were conducted among PWID entering Beth Israel Medical Center drug treatment programs 1990-2012. Data were analyzed by four time periods corresponding to the cumulative implementation of HIV prevention interventions. 7,132 subjects were recruited from 1990 to 2012; little change in sexual behavior occurred among HIV seronegative subjects, while HIV seropositive subjects reported significant decreases in being sexually active and significant increases in consistent condom use. HIV transmission risk (being HIV positive and engaging in unprotected sex) declined from 14 % in 1990-1995 to 2 % in 2007-2012 for primary sexual partners and from 6 to 1 % for casual partners. Cumulative implementation of combined prevention programming for PWID was associated with substantial decreases in sexual risk behavior among HIV seropositives.Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals?
AbstractFriedman, S. R., West, B. S., Tempalski, B., Morton, C. M., Cleland, C. M., Des Jarlais, D. C., Hall, H. I., & Cooper, H. L. (n.d.).Publication year
2014Journal title
Annals of EpidemiologyVolume
24Issue
4Page(s)
304-311AbstractPurpose: We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? Methods: Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. Results: Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. Conclusions: Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.Education and counseling in the methadone treatment setting improves knowledge of viral hepatitis
Estimating number of diagnosed persons living with HIV in the United States engaged in unprotected serodiscordant risk behavior with unsuppressed viral load
Holtgrave, D. R., Hall, H. I., Des Jarlais, D. C., Mizuno, Y., & Purcell, D. W. (n.d.). In Journal of Acquired Immune Deficiency Syndromes (1–).Publication year
2014Volume
65Issue
3Page(s)
e125-e128Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
Hepatitis C virus infection among HIV-positive men who have sex with men: Protocol for a systematic review and meta-analysis
AbstractHagan, H., Neurer, J., Jordan, A. E., Des Jarlais, D. C., Wu, J., Dombrowski, K., Khan, B., Braithwaite, R. S., & Kessler, J. (n.d.).Publication year
2014Journal title
Systematic reviewsVolume
3Issue
1AbstractBackground: Outbreaks of hepatitis C virus (HCV) infection have been reported in HIV-positive men who have sex with men (MSM) in North America, Europe and Asia. Transmission is believed to be the result of exposure to blood during sexual contact. In those infected with HIV, acute HCV infection is more likely to become chronic, treatment for both HIV and HCV is more complicated and HCV disease progression may be accelerated. There is a need for systematic reviews and meta-analyses to synthesize the epidemiology, prevention and methods to control HCV infection in this population. Methods/design: Eligible studies will include quantitative empirical data related to sexual transmission of HCV in HIV-positive MSM, including data describing incidence or prevalence, and associations between risk factors or interventions and the occurrence or progression of HCV disease. Care will be taken to ensure that HCV transmission related to injection drug use is excluded from the incidence estimates. Scientific databases will be searched using a comprehensive search strategy. Proceedings of scientific conferences, reference lists and personal files will also be searched. Quality ratings will be assigned to each eligible report using the Newcastle-Ottawa scale. Pooled estimates of incidence rates and measures of association will be calculated using random effects models. Heterogeneity will be assessed at each stage of data synthesis. Discussion: HIV-positive MSM are a key HCV-affected population in the US and other high-income countries. This review seeks to identify modifiable risk factors and settings that will be the target of interventions, and will consider how to constitute a portfolio of interventions to deliver the greatest health benefit. This question must be considered in relation to the magnitude of HCV infection and its consequences in other key affected populations, namely, young prescription opioid users who have transitioned to illicit opiate injection, and older injection drug users among whom HCV prevalence and incidence are extremely high. This review is part of a series of systematic reviews and meta-analyses that will synthesize the evidence across all these population groups and develop recommendations and decision tools to guide public health resource allocation. Trial registration: PROSPERO registration number: CRD42013006462.HSV-2 co-infection as a driver of HIV transmission among heterosexual non-injecting drug users in New York City
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C., Perlman, D. C., Feelemyer, J., Hagan, H., & Cooper, H. L. (n.d.).Publication year
2014Journal title
PloS oneVolume
9Issue
1AbstractObjective: To examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City. Methods: Subjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995-1999 and 2005-2011. All reported current heroin and/or cocaine use and no 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 estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs. Results: 785 subjects were recruited from 1995-1999, and 1764 subjects from 2005-2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection. Conclusions: The increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.Pharmacies as providers of expanded health services for people who inject drugs: A review of laws, policies, and barriers in six countries
AbstractHammett, T. M., Phan, S., Gaggin, J., Case, P., Zaller, N., Lutnick, A., Kral, A. H., Fedorova, E. V., Heimer, R., Small, W., Pollini, R., Beletsky, L., Latkin, C., & Des Jarlais, D. C. (n.d.).Publication year
2014Journal title
BMC health services researchVolume
14Issue
1AbstractBackground: People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings. Methods. Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders. Results: Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers. Discussion. Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.Prescription opioid misuse and its relation to injection drug use and hepatitis C virus infection: Protocol for a systematic review and meta-analysis
AbstractJordan, A. E., Jarlais, D. D., & Hagan, H. (n.d.).Publication year
2014Journal title
Systematic reviewsVolume
3Issue
1AbstractBackground: The production, prescription, and consumption of opioid analgesics to treat non-cancer pain have increased dramatically in the USA in the past decade. As a result, misuse of these opioids has increased; overdose and transition to riskier forms of drug use have also emerged. Research points to a trend in transition to drug injection among those misusing prescription opioids, where clusters of acute hepatitis C virus (HCV) infection are now being reported. This systematic review and meta-analysis aims to synthesize the prevalence of prescription opioid misuse in the USA and examine the rate of transition to injection drug use and incident HCV in these new people who inject drugs (PWID).Methods/design: Eligible studies will include quantitative, empirical data including national survey data. Scientific databases will be searched using a comprehensive search strategy; proceedings of scientific conferences, reference lists, and personal communications will also be searched. Quality ratings will be assigned to each eligible report using the Newcastle-Ottawa Scale. Pooled estimates of incidence rates and measures of association will be calculated using random effects models. Heterogeneity will be assessed at each stage of data synthesis. Discussion: A unique typology of drug use is emerging which is characterized by antecedent prescription opioid misuse among PWID. As the epidemic of prescription opioid misuse matures, this will likely serve as a persistent source of new PWID. Persons who report a recent transition to drug injection are characterized by high rates of HCV seroincidence of 40 per 100 person years or higher. Given the potential for the persistence and escalation of the consequences of prescription opioid misuse in the USA, there is a critical need for synthesis of the current state of the epidemic in order to inform future public health interventions and policy. Systematic review registration: PROSPERO CRD42014008870.Self-reported testing, HIV status and associated risk behaviours among people who inject drugs in Europe: Important differences between East and West
AbstractUusküla, A., Raag, M., Folch, C., Prasad, L., Karnite, A., Van Veen, M. G., Eritsyan, K., Rosinska, M., Des Jarlais, D. C., & Wiessing, L. (n.d.).Publication year
2014Journal title
AIDSVolume
28Issue
11Page(s)
1657-1664AbstractAims: To describe HIV-related risk behaviours, HIV testing and HIV status among people who inject drugs (PWIDs) in the 2000 in European countries with highprevalence HIV epidemics among PWID. Methods: Data from 12 cross-sectional studies among PWID from seven countries were used. Meta-analysis was used to synthesize the data and meta-regression to explain heterogeneity [in addition to deriving adjusted odds ratios (AORmeta)]. Results: Data on 1791 PWID from western (the West) and 3537 from central and eastern (the East) European countries were available. The mean age of participating PWIDs was 30.6 years (SD 7.9), 75% were men, and 36% [95% confidence interval 34-37%) were HIV-infected (30% West, 38% East); 22% had not previously been tested for HIV. The prevalence of reported high-risk behaviour was significantly higher among PWID from the East. Comparison of HIV-infected and uninfected PWID within countries yielded similar results across all countries: HIV-infected PWID were less likely to be sexually active [AORmeta 0.69 (0.58-0.81)], reported less unprotected sex [AORmeta 0.59 (0.40-0.83)], but reported more syringe sharing [AORmeta 1.70 (1.30- 2.00)] and more frequent injecting [AORmeta 1.40 (1.20-1.70)] than their HIVuninfected counterparts. Conclusion: Despite the absolute differences in reported risk behaviours among PWID in western and eastern Europe, the associations of risk behaviours with HIV status were similar across the sites and regions. There is a substantial potential for further HIV transmission and acquisition based on the continuous risk behaviours reported. HIV prevention and harm reduction interventions targeting PWID should be evaluated.Syringe Exchange in the United States: A National Level Economic Evaluation of Hypothetical Increases in Investment
The new death among IV drug users
Des Jarlais, D. C., Casriel, C., & Friedman, S. (n.d.). In AIDS (1–).Publication year
2014Page(s)
135-150Transitions 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)
Viral hepatitis among drug users in methadone maintenance: Associated factors, vaccination outcomes, and interventions
A decline in the prevalence of injecting drug users in Estonia, 2005-2009
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
Assessment of methadone clinic staff attitudes toward hepatitis C evaluation and treatment
Association between TLR3 rs3775291 and resistance to HIV among highly exposed Caucasian intravenous drug users
Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis
Economic recession and emergence of an HIV-1 outbreak among drug injectors in Athens metropolitan area: A longitudinal study
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