Holly Hagan

Professor Emeritus

Professional overview

Dr. Holly Hagan is Professor Emeritus at the School of Global Public Health. Trained as an infectious disease epidemiologist, Dr. Hagan’s work has sought to understand the causes and consequences of substance use disorders.  Her research has examined blood-borne and sexually-transmitted infections among people who use drugs. She is an internationally-recognized expert in the etiology, epidemiology, natural history, prevention and treatment of hepatitis C virus infection among PWUD, and in 2014 her work was recognized by the US Department of Health and Human Services with the President’s Award for Leadership in the Control of Viral Hepatitis in the United States. Dr. Hagan served on the Institute of Medicine Committee on the Prevention and Control of Viral Hepatitis in the United States, and she has been an advisor to the US Department of Health and Human Services, the CDC, and the Canadian Institutes of Health on national programs to detect, diagnose and treat HCV infections. She was recently appointed to the National Academy of Medicine Committee on the Examination of the Integration of Opioid and Infectious Disease Prevention Efforts in Select Programs.

Dr. Hagan is the Director of the NIDA P30 Center for Drug Use and HIV|HCV Research at Global Public Health, which provides research support to investigators throughout NYU and in two other NYC institutions. In 2017, she was selected by NIDA to chair the Executive Steering Committee for the Rural Opioid Initiative funded by NIH, CDC, SAMHSA and the Appalachian Regional Commission. Her research has shifted to examining the impact of the opioid crisis more broadly, to include studying the epidemiology of fatal and non-fatal overdose among PWUD. She was chosen by the American Foundation for AIDS Research to be the Principal Investigator for the New York State Opioid Prevention Center pilot study, which will examine the safety and effectiveness of the Supervised Consumption Sites to be implemented in New York City and in upstate NY. 

Education

PhD Epidemiology, University of Washington, Seattle, WA

MPH Epidemiology, University of Massachusetts, Amherst, MA

BA Russian Studies, Evergreen State College, Olympia, WA

Publications

Publications

Public health benefit of peer-referral strategies for detecting undiagnosed HIV infection among high-risk heterosexuals in New York City

Gwadz, M., Cleland, C. M., Perlman, D. C., Hagan, H., Jenness, S. M., Leonard, N. R., Ritchie, A. S., & Kutnick, A. (n.d.).

Publication year

2017

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

74

Issue

5

Page(s)

499-507

10.1097/QAI.0000000000001257

Abstract

Abstract

Identifying undiagnosed HIV infection is necessary for the elimination of HIV transmission in the United States. The present study evaluated the efficacy of 3 community-based approaches for uncovering undiagnosed HIV among heterosexuals at high-risk (HHR), who are mainly African American/Black and Hispanic. Heterosexuals comprise 24% of newly reported HIV infections in the United States, but experience complex multilevel barriers to HIV testing. We recruited African American/Black and Hispanic HHR in a discrete urban area with both elevated HIV prevalence and poverty rates. Approaches tested were (1) respondent-driven sampling (RDS) and confidential HIV testing in 2 sessions (n = 3116); (2) RDS and anonymous HIV testing in one session (n = 498); and (3) venuebased sampling (VBS) and HIV testing in a single session (n = 403). The main outcome was newly diagnosed HIV infection. RDS with anonymous testing and one session reached HHR with less HIV testing experience and more risk factors than the other approaches. Furthermore, RDS with anonymous (4.0%) and confidential (1.0%) testing yielded significantly higher rates of newly diagnosed HIV than VBS (0.3%). Thus peer-referral approaches were more efficacious than VBS for uncovering HHR with undiagnosed HIV, particularly a single-session/anonymous strategy, and have a vital role to play in efforts to eliminate HIV transmission.

The Interaction of Risk Network Structures and Virus Natural History in the Non-spreading of HIV Among People Who Inject Drugs in the Early Stages of the Epidemic

Dombrowski, K., Khan, B., Habecker, P., Hagan, H., Friedman, S. R., & Saad, M. (n.d.).

Publication year

2017

Journal title

AIDS and Behavior

Volume

21

Issue

4

Page(s)

1004-1015

10.1007/s10461-016-1568-6

Abstract

Abstract

This article explores how social network dynamics may have reduced the spread of HIV-1 infection among people who inject drugs during the early years of the epidemic. Stochastic, discrete event, agent-based simulations are used to test whether a “firewall effect” can arise out of self-organizing processes at the actor level, and whether such an effect can account for stable HIV prevalence rates below population saturation. Repeated simulation experiments show that, in the presence of recurring, acute, and highly infectious outbreaks, micro-network structures combine with the HIV virus’s natural history to reduce the spread of the disease. These results indicate that network factors likely played a significant role in the prevention of HIV infection within injection risk networks during periods of peak prevalence. They also suggest that social forces that disturb network connections may diminish the natural firewall effect and result in higher rates of HIV.

Trends in HIV and HCV Risk Behaviors and Prevalent Infection Among People Who Inject Drugs in New York City, 2005-2012

Neaigus, A., Reilly, K. H., Jenness, S. M., Hagan, H., Wendel, T., Gelpi-Acosta, C., & Marshall, D. M. (n.d.).

Publication year

2017

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

75

Page(s)

S325-S332

10.1097/QAI.0000000000001407

Abstract

Abstract

Background: We assess trends in HIV and hepatitis C virus (HCV) risk behaviors and prevalent infection among people who inject drugs (PWID) in New York City (NYC). Methods: PWID in NYC were sampled using respondent-driven sampling in 2005, 2009, and 2012 (serial cross sections) for the Centers for Disease Control and Prevention-sponsored National HIV Behavioral Surveillance study. Participants were interviewed about their current (≤12 months) risk behaviors and tested for HIV and HCV. The crude and adjusted risk ratio (RR) and 95% confidence interval (95% CI) for linear time trends were estimated using generalized estimating equations regression with a modified Poisson model. Results: The sample comprised 500, 514, and 525 participants in 2005, 2009, and 2012, respectively. Significant (P< 0.05) linear trends in risk behaviors included a decline in unsafe syringe sources (60.8%, 31.3%, 46.7%; RR = 0.86, 95% CI: 0.81 to 0.92), an increase in all syringes from syringe exchanges or pharmacies (35.4%, 67.5%, 50.3%; RR = 1.15, 95% CI: 1.09 to 1.22), and an increase in condomless vaginal or anal sex (53.6%, 71.2%, 70.3%; RR = 1.14, 95% CI: 1.09 to 1.19). Receptive syringe sharing (21.4%, 27.0%, 25.1%), sharing drug preparation equipment (45.4%, 43.4%, 46.7%), and having ≥2 sex partners (51.2%, 44.0%, 50.7%) were stable. Although HIV seroprevalence declined (18.1%, 12.5%, 12.2%), HCV seroprevalence was high (68.2%, 75.8%, 67.1%). In multivariate analysis, adjusting for sample characteristics significantly associated with time, linear time trends remained significant, and the decline in HIV seroprevalence gained significance (adjusted RR = 0.76, 95% CI: 0.64 to 0.91, P = 0.003). Conclusions: This trend analysis suggests declining HIV prevalence among NYC PWID. However, HCV seroprevalence was high and risk behaviors were considerable. Longitudinal surveillance of HIV and HCV risk behaviors and infections is needed to monitor trends and for ongoing data-informed prevention among PWID.

What happened to the HIV epidemic among non-injecting drug users in New York City?

Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Campbell, A. N., Tross, S., Cooper, H. L., Hagan, H., & Perlman, D. C. (n.d.).

Publication year

2017

Journal title

Addiction

Volume

112

Issue

2

Page(s)

290-298

10.1111/add.13601

Abstract

Abstract

Background and aims: HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. Design: Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. Setting: Mount Sinai Beth Israel drug treatment programs in New York City, USA. Participants: We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice. Measures: Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005–10 versus 2011–14. Findings: HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005–10 to 8% in 2011–14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000–7/1000). Conclusions: HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.

Associations of place characteristics with HIV and HCV risk behaviors among racial/ethnic groups of people who inject drugs in the United States

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Publication year

2016

Journal title

Annals of Epidemiology

Volume

26

Issue

9

Page(s)

619-630.e2

10.1016/j.annepidem.2016.07.012

Abstract

Abstract

Purpose Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States. Methods PWID were recruited from 19 metropolitan statistical areas for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and metropolitan statistical areas where PWID lived. Multilevel models, stratified by racial/ethnic groups, were used to assess relationships of place-based characteristics to condomless sex and injection-related risk behavior (sharing injection equipment). Results Among black PWID, living in the South (vs. Northeast) was associated with injection-related risk behavior (adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.21–4.17; P =.011), and living in counties with higher percentages of unaffordable rental housing was associated with condomless sex (AOR = 1.02, 95% CI = 1.00–1.04; P =.046). Among white PWID, living in ZIP codes with greater access to drug treatment was negatively associated with condomless sex (AOR = 0.93, 95% CI = 0.88–1.00; P =.038). Conclusions Policies that increase access to affordable housing and drug treatment may make environments more conducive to safe sexual behaviors among black and white PWID. Future research designed to longitudinally explore the association between residence in the south and injection-related risk behavior might identify specific place-based features that sustain patterns of injection-related risk behavior.

Bisexual Behavior Among Male Injection Drug Users in New York City

Reilly, K. H., Neaigus, A., Wendel, T., Marshall, D. M., & Hagan, H. (n.d.).

Publication year

2016

Journal title

AIDS and Behavior

Volume

20

Issue

2

Page(s)

405-416

10.1007/s10461-015-1257-x

Abstract

Abstract

Drug using men who have sex with men and women (MSMW) may be at high risk for HIV infection and transmitting HIV to sex partners. In 2012, injection drug users (IDUs) were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent-driven sampling. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (95 %CI) to determine correlates of bisexual behavior in the past 12 months. Of 333 participants, 47(14.1 %) reported MSMW. Variables independently associated (p < 0.05) with MSMW included bisexual sexual identity (vs. “straight”) (adjusted odds ratio (aOR) 92.6; 95 % CI 18.9, 454.5), Bronx residence [vs. Manhattan (aOR 8.4; 95 %CI 1.6,43.7)], past 12 month behaviors of having sex with ≥3 sex partners (aOR 18.1; 95 % CI 3.3,98.4), “sold” sex (aOR 8.5; 95 % CI 2.3, 31.5), “bought” sex (aOR 0.2; 95 % CI 0.1, 0.9), and injection methamphetamine use (aOR 20.5; 95 % CI 3.0, 139.7). MSM IDUs are an important subgroup to consider for HIV interventions, as they may not be reached through HIV prevention programming aimed at MSM.

Community Sexual Bridging Among Heterosexuals at High-Risk of HIV in New York City

Neaigus, A., Jenness, S. M., Reilly, K. H., Youm, Y., Hagan, H., Wendel, T., & Gelpi-Acosta, C. (n.d.).

Publication year

2016

Journal title

AIDS and Behavior

Volume

20

Issue

4

Page(s)

722-736

10.1007/s10461-015-1244-2

Abstract

Abstract

Community sexual bridging may influence the socio-geographic distribution of heterosexually transmitted HIV. In a cross-sectional study, heterosexual adults at high-risk of HIV were recruited in New York City (NYC) in 2010 for the Centers for Disease Control and Prevention-sponsored National HIV Behavioral Surveillance system. Eligible participants were interviewed about their HIV risk behaviors and sexual partnerships and tested for HIV. Social network analysis of the geographic location of participants’ recent sexual partnerships was used to calculate three sexual bridging measures (non-redundant ties, flow-betweenness and walk-betweenness) for NYC communities (defined as United Hospital Fund neighborhoods), which were plotted against HIV prevalence in each community. The analysis sample comprised 494 participants and 1534 sexual partnerships. Participants were 60.1 % male, 79.6 % non-Hispanic black and 19.6 % Hispanic race/ethnicity; the median age was 40 years (IQR 24–50); 37.7 % had ever been homeless (past 12 months); 16.6 % had ever injected drugs; in the past 12 months 76.7 % used non-injection drugs and 90.1 % engaged in condomless vaginal or anal sex; 9.6 % tested HIV positive (of 481 with positive/negative results). Sexual partnerships were located in 33 (78.6 %) of 42 NYC communities, including 13 “high HIV-spread communities”, 7 “hidden bridging communities”, 0 “contained high HIV prevalence communities”, and 13 “latent HIV bridging communities”. Compared with latent HIV bridging communities, the population racial/ethnic composition was more likely (p < 0.0001) to be black or Hispanic in high HIV-spread communities and to be black in hidden bridging communities. High HIV-spread and hidden bridging communities may facilitate the maintenance and spread of heterosexually transmitted HIV in black and Hispanic populations in NYC.

Consistent estimates of very low HIV incidence among people who inject drugs: New York City, 2005-2014

Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Campbell, A. N., Tross, S., Smith, L., Cooper, H. L., Hagan, H., & Perlman, D. (n.d.).

Publication year

2016

Journal title

American journal of public health

Volume

106

Issue

3

Page(s)

503-508

10.2105/AJPH.2015.303019

Abstract

Abstract

Objectives. To compare methods for estimating low HIV incidence among persons who inject drugs. Methods. We examined 4 methods in New York City, 2005 to 2014: (1) HIV seroconversions among repeat participants, (2) increase of HIV prevalence by additional years of injection among new injectors, (3) the New York State and Centers for Disease Control and Prevention stratified extrapolation algorithm, and (4) newly diagnosed HIV cases reported to the New York City Department of Health and Mental Hygiene. Results. The 4 estimates were consistent: (1) repeat participants: 0.37 per 100 person-years (PY; 95% confidence interval [CI] = 0.05/100 PY, 1.33/100 PY); (2) regression of prevalence by years injecting: 0.61 per 100 PY (95% CI = 0.36/100 PY, 0.87/100 PY); (3) stratified extrapolation algorithm: 0.32 per 100 PY (95% CI = 0.18/100 PY, 0.46/100 PY); and (4)newly diagnosed cases of HIV: 0.14 per 100PY (95%CI = 0.11/100 PY, 0.16/100 PY). Conclusions. All methods appear to capture the same phenomenon of very low and decreasing HIV transmission among persons who inject drugs. Public Health Implications. If resources are available, the use ofmultiple methodswould provide better information for public health purposes.

Effectiveness of needle/syringe programmes and opiate substitution therapy in preventing HCV transmission among people who inject drugs

Platt, L., Reed, J., Minozzi, S., Vickerman, P., Hagan, H., French, C., Jordan, A., Degenhardt, L., Hope, V., Hutchinson, S., Maher, L., Palmateer, N., Taylor, A., & Hickman, M. (n.d.).

Publication year

2016

Journal title

Cochrane Database of Systematic Reviews

Volume

2016

Issue

1

10.1002/14651858.CD012021

Abstract

Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the impact of needle/syringe programmes with and without opiate substitution therapy (OST) on the incidence of HCV infection among people who inject drugs (PWID). To assess the effect of OST alone on the incidence of HCV infection among PWID. Research questions: How effective are needle/syringe programmes (NSP) with and without the use of OST for reducing HCV incidence among PWID? How effective is OST alone for reducing HCV incidence among PWID? How does the effect of NSP and OST vary according to duration of treatment (i.e.

Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015

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Publication year

2016

Journal title

The Lancet HIV

Volume

3

Issue

8

Page(s)

e361-e387

10.1016/S2352-3018(16)30087-X

Abstract

Abstract

Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1–3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5–2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6–40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7–1·9 million) in 2005, to 1·2 million deaths (1·1–1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Funding Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.

Experiences of discrimination and hiv risk among men who have sex with men in new york city

Reilly, K. H., Neaigus, A., Jenness, S. M., Wendel, T., Marshall, D. M., & Hagan, H. (n.d.).

Publication year

2016

Journal title

American Journal of Men's Health

Volume

10

Issue

6

Page(s)

505-514

10.1177/1557988315575998

Abstract

Abstract

The extent of gay-related discrimination in New York City (NYC) and the demographic and behavioral factors correlated with experiences of gay-related discrimination are not well understood. The Centers for Disease Control and Prevention–sponsored National HIV Behavioral Surveillance System, a cross-sectional study, was conducted in NYC in 2011. Men who have sex with men were venue-sampled, interviewed, and offered HIV testing. Frequencies of types of gay-related discrimination experienced in the past 12 months were calculated. Associations between types of discrimination and demographic and HIV risk variables were examined through the estimation of prevalence ratios (PRs) and 95% confidence intervals (CIs). More than half (53.2%) of all study participants reported having experienced any gay-related discrimination in the past 12 months; 45.0% reported that they had been called names or insulted; 23.6% reported receiving poorer services than other people in restaurants, stores, other businesses, or agencies; 22.0% reported being treated unfairly at work or school; 15.1% reported being physically attacked or injured; and 6.7% reported being denied or given lower quality health care. HIV-positive status (adjusted PR [aPR] = 2.9; 95% CI = 1.5, 5.6) and drug use in the past 12 months (aPR = 0.3; 95% CI = 0.1, 0.7) were independently associated with reports of having been denied or given lower quality health care. High rates of reported gay-related discrimination suggest that greater efforts are needed to reduce gay-related discrimination in affected communities. Future research is needed to better understand the extent of gay-related discrimination in NYC, particularly with regard to the relationship between HIV status and health care access.

Explaining racial/ethnic dietary patter ns in relation to type 2 diabetes: An analysis of NHAN ES 2007-2012

Nowlin, S. Y., Cleland, C. M., Vadiveloo, M., Parekh, N., Melkus, G. D. E., & Hagan, H. (n.d.).

Publication year

2016

Journal title

Ethnicity and Disease

Volume

26

Issue

4

Page(s)

529-536

10.18865/ed.26.4.529

Abstract

Abstract

Objective: The purpose of this article is to examine sociodemographic and health behavior factors associated with dietary intake as measured by the healthy eating index (HEI-2010) for persons with and without diabetes (T2D). Design: A secondary data analysis of three NHANES data cycles spanning 2007-2012. Multiple linear regression assessed racial/ ethnic differences in HEI-2010 scores in those without T2D, with T2D, and with undiagnosed T2D. Participants: The sample included nonpregnant adults aged ≥20 years who had two days of reliable dietary recall data. Outcome Measures: Total scores for the HEI-2010. Results: For those without T2D, there was a significant association between race/ ethnicity and HEI score, with non-Hispanic Blacks achieving significantly lower scores than their non-Hispanic White counterparts. Differences in HEI-2010 score were also associated with age, sex, smoking status and time spent in the United States. Racial/ ethnic differences in dietary patterns were present, but not significant in those with undiagnosed or diagnosed T2D. Conclusions: Racial/ethnic disparities in dietary patterns are present in individuals without T2D, but differences are not statistically significant in those with undiagnosed or diagnosed T2D. Non-Hispanic Blacks without T2D received significantly lower HEI-2010 scores than non-Hispanic Whites. Further research is necessary to determine whether or not similarities in dietary intake across racial/ethnic groups with T2D will be reflected in diabetes-related health outcomes in this population.

Exploring factors associated with recent HIV testing among heterosexuals at high risk for HIV infection recruited with venue-based sampling

Gwadz, M., Cleland, C. M., Jenness, S., Silverman, E., Hagan, H., Ritchie, A. S., Leonard, N., McCright-Gill, T., Martinez, B. Y., Swain, Q. L., Kutnick, A., & Sherpa, D. (n.d.).

Publication year

2016

Journal title

Journal of AIDS and Clinical Research

Volume

7

Issue

2

Page(s)

544

10.4172/2155-6113.1000544

From Long-Term Injecting to Long-Term Non-Injecting Heroin and Cocaine Use: The Persistence of Changed Drug Habits

Jarlais, D. C., Arasteh, K., Feelemyer, J., McKnight, C., Barnes, D. M., Tross, S., Perlman, D. C., Campbell, A. N., Cooper, H. L., & Hagan, H. (n.d.).

Publication year

2016

Journal title

Journal of Substance Abuse Treatment

Volume

71

Page(s)

48-53

10.1016/j.jsat.2016.08.015

Abstract

Abstract

Objectives Transitioning from injecting to non-injecting routes of drug administration can provide important individual and community health benefits. We assessed characteristics of persons who had ceased injecting while continuing to use heroin and/or cocaine in New York City. Methods We recruited subjects entering Mount Sinai Beth Israel detoxification and methadone maintenance programs between 2011 and 2015. Demographic information, drug use histories, sexual behaviors, and “reverse transitions” from injecting to non-injecting drug use were assessed in structured face-to-face interviews. There were 303 “former injectors,” operationally defined as persons who had injected at some time in their lives, but had not injected in at least the previous 6 months. Serum samples were collected for HIV and HCV testing. Results Former injectors were 81% male, 19% female, 17% White, 43% African-American, and 38% Latino/a, with a mean age of 50 (SD = 9.2), and were currently using heroin and/or cocaine. They had injected drugs for a mean of 14 (SD = 12.2) years before ceasing injection, and a mean of 13 (SD = 12) years had elapsed since their last injection. HIV prevalence among the sample was 13% and HCV prevalence was 66%. The former injectors reported a wide variety of reasons for ceasing injecting. Half of the group appeared to have reached a point where relapse back to injecting was no longer problematic: they had not injected for three or more years, were not deliberately using specific techniques to avoid relapse to injecting, and were not worried about relapsing to injecting. Conclusions Former injectors report very-long term behavior change toward reduced individual and societal harm while continuing to use heroin and cocaine. The behavior change appears to be self-sustaining, with full replacement of an injecting route of drug administration by a non-injecting route of administration. Additional research on the process of long-term cessation of injecting should be conducted within a “combined prevention and care” approach to HIV and HCV infection among persons who use drugs.

It's Never Just HIV: Exposure to an HIV Prevention Media Campaign and Behavior Change among Men Who Have Sex with Men Participating in the National HIV Behavioral Surveillance System in New York City

Reilly, K. H., Neaigus, A., Shepard, C. W., Cutler, B. H., Sweeney, M. M., Rucinski, K. B., Jenness, S. M., Wendel, T., Marshall, D. M., & Hagan, H. (n.d.).

Publication year

2016

Journal title

LGBT health

Volume

3

Issue

4

Page(s)

314-318

10.1089/lgbt.2015.0016

Abstract

Abstract

Purpose: The aim of this study was to assess the exposure to and impact of the It's Never Just HIV mass media campaign aimed at HIV negative men who have sex with men (MSM) in New York City. Methods: Questions about the campaign were included in the local questionnaire of the Centers for Disease Control and Prevention (CDC)-sponsored National HIV Behavioral Surveillance (NHBS) study of MSM in NYC conducted in 2011. Participants in this cross-sectional study were recruited using venue-based sampling. Results: Among 447 NYC National HIV Behavioral Surveillance study participants who self-reported HIV negative or unknown status and answered questions about the NYC Department of Health and Mental Hygiene's It's Never Just HIV campaign, more than one-third (n = 173, 38.7%) reported having seen the campaign. Latinos (34.8%) and blacks (34.4%) were less likely to report seeing the campaign compared to whites (47.7%). Most of those who reported seeing the campaign saw it on the subway (80.1%). Only 9.4% of those who saw the campaign reported having changed their sexual or health behaviors in response to the campaign. Conclusions: These data suggest that thousands of HIV-uninfected MSM in NYC have been reached by the campaign and recalled its message.

Providing ART to HIV Seropositive Persons Who Use Drugs: Progress in New York City, Prospects for “Ending the Epidemic”

Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Hagan, H., Cooper, H. L., Campbell, A. N., Tross, S., & Perlman, D. C. (n.d.).

Publication year

2016

Journal title

AIDS and Behavior

Volume

20

Issue

2

Page(s)

353-362

10.1007/s10461-015-1028-8

Abstract

Abstract

New York City has experienced the largest HIV epidemic among persons who use psychoactive drugs. We examined progress in placing HIV seropositive persons who inject drugs (PWID) and HIV seropositive non-injecting drug users (NIDU) onto antiretroviral treatment (ART) in New York City over the last 15 years. We recruited 3511 PWID and 3543 NIDU from persons voluntarily entering drug detoxification and methadone maintenance treatment programs in New York City from 2001 to 2014. HIV prevalence declined significantly among both PWID and NIDU. The percentage who reported receiving ART increased significantly, from approximately 50 % (2001–2005) to approximately 75 % (2012–2014). There were no racial/ethnic disparities in the percentages of HIV seropositive persons who were on ART. Continued improvement in ART uptake and TasP and maintenance of other prevention and care services should lead to an “End of the AIDS Epidemic” for persons who use heroin and cocaine in New York City.

Racialized risk environments in a large sample of people who inject drugs in the United States

Failed generating bibliography.

Publication year

2016

Journal title

International Journal of Drug Policy

Volume

27

Page(s)

43-55

10.1016/j.drugpo.2015.07.015

Abstract

Abstract

Background: Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. Methods: As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. Results: Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). Conclusion: PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.

Response to the calculation of population attributable fractions of risk factors for hepatitis C transmission: Authors' reply

Hagan, H., Jordan, A. E., & Cleland, C. M. (n.d.). In AIDS (1–).

Publication year

2016

Volume

30

Issue

10

10.1097/QAD.0000000000001091

Risk environments, race/ethnicity, and HIV status in a large sample of people who inject drugs in the United States

Failed generating bibliography.

Publication year

2016

Journal title

PloS one

Volume

11

Issue

3

10.1371/journal.pone.0150410

Abstract

Abstract

Introduction: We analyzed relationships between place characteristics and being HIV-negative among black, Latino, and white people who inject drugs (PWID) in the US. Methods: Data on PWID (N = 9077) were from the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance. Administrative data were analyzed to describe the 968 ZIP codes, 51 counties, and 19 metropolitan statistical areas (MSAs) where they lived. Multilevel multivariable models examined relationships between place characteristics and HIV status. Exploratory population attributable risk percents (e-PAR %s) were estimated. Results: Black and Latino PWID were more likely tobe HIV-negative if they lived in less economically disadvantaged counties, or in MSAs with less criminal-justice activity (i.e., lower drug-related arrest rates, lower policing/corrections expenditures). Latino PWID were more likely to be HIV-negative in MSAs with more Latino isolation, less black isolation, and less violent crime. E-PAR%s attributed 8-19% of HIV cases among black PWID and 1-15% of cases among Latino PWID to place characteristics. Discussion: Evaluations of structural interventions to improve economic conditions and reduce drug-related criminal justice activity may show evidence that they protect black and Latino PWID from HIV infection.

Spontaneous viral clearance of hepatitis C virus (HCV) infection among people who inject drugs (PWID) and HIV-positive men who have sex with men (HIV+ MSM): A systematic review and meta-analysis

Smith, D. J., Jordan, A. E., Frank, M., & Hagan, H. (n.d.).

Publication year

2016

Journal title

BMC Infectious Diseases

Volume

16

Issue

1

10.1186/s12879-016-1807-5

Abstract

Abstract

Background: Hepatitis C virus (HCV) infection causes significant morbidity and mortality among people who inject drugs (PWID) and HIV+ men who have sex with men (MSM). Characterizing spontaneous viral clearance of HCV infection among PWID and HIV+ MSM is important for assessing the burden of disease and treatment strategies in these populations. Methods: Electronic and other searches of medical literature were conducted. Reports were eligible if they presented original data from upper-middle-and high-income countries on laboratory-confirmed HCV infection and spontaneous viral clearance among PWID or HIV+ MSM. Pooled estimates of spontaneous viral clearance were generated using fixed-effect and random-effects models. Meta-regression examined potential predictors related to individual characteristics and research methodology. Results: The meta-analysis estimated that spontaneous viral clearance occurs in 24.4% of PWID and 15.4% of HIV+ MSM. In univariate meta-regression among PWID, male sex and age were significantly associated with spontaneous viral clearance, and in multivariate analysis, male sex and HIV positivity were predictors of spontaneous viral clearance; among HIV+ MSM no variables were found to affect spontaneous viral clearance. Conclusion: The variability in estimates of spontaneous viral clearance between HIV+ MSM and PWID suggests the impact of HIV co-infection and HCV re-infection. Due to limited data on additional factors that may affect the natural history of HCV, more research is needed to further understand spontaneous viral clearance in these risk groups. Protocol registration: The protocols for the PWID and HIV+ MSM research were registered with PROSPERO (CRD42014008805; CRD42013006462).

The HCV care continuum among people who use drugs: Protocol for a systematic review and meta-analysis

Reed, J. R., Jordan, A. E., Perlman, D. C., Smith, D. J., & Hagan, H. (n.d.).

Publication year

2016

Journal title

Systematic reviews

Volume

5

Issue

1

10.1186/s13643-016-0293-6

Abstract

Abstract

Introduction: The diagnosis, management, and treatment for hepatitis C virus (HCV) infection (the "HCV care continuum") have improved in recent years. People who use drugs (PWUD) have a prevalence of HCV infection from 30 to 70 %, yet rates of testing, engagement in care, and treatment for HCV are disproportionately low compared to other populations. Delineating the progression of PWUD through the steps in the HCV care continuum in the USA is important in informing efforts to improve HCV outcomes among PWUD. Methods/design: Scientific databases will be searched using a comprehensive automated search strategy; gray literature and reference lists will be manually searched. Eligible reports will provide original research data related to the HCV care continuum in the USA including proportions of PWUD engaging in the following discrete steps: screening/testing, engagement in care (including receiving an HCV clinical assessment), treatment initiation and completion, and rates of those with successful HCV treatment. A quality-rating tool will be developed to ascertain the level of bias (including selection bias) in each report, and a quality score will be assigned to each eligible report. A tool adapted from the Pragmatic Explanatory Continuum Indicator Summary-2 instrument will be developed to assess the extent to which an included report reflects an effectiveness or efficacy study design. Pooled estimates and measures of association will be calculated using random effects models, and heterogeneity will be assessed at each stage of data synthesis. Discussion: Through this review, we hope to quantify the proportion of PWUD at each progressive step and to help identify key individual, social, and structural points of leakage in the HCV care continuum for PWUD. In meeting these objectives, we will identify predictors to progress along the HCV care continuum, which can be used to inform policy to directly improve HCV care for PWUD.

Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City

Gelpí-Acosta, C., Pouget, E. R., Reilly, K. H., Hagan, H., Neaigus, A., Wendel, T., & Marshall, D. M. (n.d.).

Publication year

2016

Journal title

Substance Use and Misuse

Volume

51

Issue

7

Page(s)

870-881

10.3109/10826084.2016.1155616

Abstract

Abstract

Background: Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites. Objective: Understand the persistence of these HIV behaviors. Methods: In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression. Results: A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants. Conclusions: The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.

Trends in condom use among MSM in the United States: The role of antiretroviral therapy and seroadaptive strategies

Failed generating bibliography.

Publication year

2016

Journal title

AIDS

Volume

30

Issue

12

Page(s)

1985-1990

10.1097/QAD.0000000000001139

Abstract

Abstract

Objective: Evaluate changes in condomless anal sex at last sex among men who have sex with men (MSM) and assess if these changes are associated with the adoption of serosorting and biomedical prevention. Design: The National HIV Behavioral Surveillance is a crosssectional survey done in up to 21 cities in 2005, 2008, 2011 and 2014. Methods: MSM were recruited through venue-based sampling. Among men reporting at least one male partner, we evaluated changes in condomless anal sex at last sex with a partner with (1) HIV-concordant (proxy for serosorting) or (2) HIV-discordant (discordant/unknown) status. We hypothesized that if concordant condomless sex was increasing while discordant was stable/declining, the increases could be driven by more men attempting to serosort. We used generalized estimating equations assuming a Poisson distribution and robust variance estimator to explore whether temporal changes in the outcomes varied by selected characteristics. We also assessed changes in condomless anal sex by antiretroviral therapy (ART) use among HIV-positive MSM. Results: Among 5371 HIV-positive MSM, there were increases in concordant (19% in 2005 to 25% in 2014, P<0.001) and discordant condomless sex (15 to 19%, P<0.001). The increases were not different by ART use. Among 30547 HIV-negative MSM, concordant (21 to 27%, P<0.001) and discordant condomless sex (8 to 13%, P<0.001) increased. Conclusion: Our data suggest that condom use decreased among MSM and that the trends are not explained by serosorting or ART. Promotion of condoms and increased access to preexposure prophylaxis are vital to ensure that the benefits of ART in reducing transmission of HIV are not undermined.

Binge drinking and risky sexual behavior among HIV-negative and unknown HIV status men who have sex with men, 20 US cities

Hess, K. L., Chavez, P. R., Kanny, D., DiNenno, E., Lansky, A., Paz-Bailey, G., Taus-sig, J., Gern, R., Hoyte, T., Salazar, L., White, J., Todd, J., Bautista, G., Flynn, C., Sifakis, F., German, D., Isenberg, D., Driscoll, M., Hurwitz, E., … Kuo, I. (n.d.).

Publication year

2015

Journal title

Drug and alcohol dependence

Volume

147

Page(s)

46-52

10.1016/j.drugalcdep.2014.12.013

Abstract

Abstract

Background: Men who have sex with men (MSM) represent over half of new HIV infections in the United States. It is important to understand the factors associated with engaging in risky sexual behavior to develop effective prevention interventions. Binge drinking (≥5 drinks on ≥1 occasion) is the most common form of excessive alcohol consumption. This study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status. Methods: Using the 2011 National HIV Behavioral Surveillance system and multivariable Poisson models with robust error estimates, we assessed the association between binge drinking and sexual risk behaviors among current drinkers. Prevalence ratios (PR) and 95% confidence intervals (CI) are presented. Results: Overall, 85% of MSM were current drinkers, and 59% of MSM who drank reported ≥1 episode of binge drinking in the preceding 30 days. In multivariable models, binge drinking was associated with condomless anal intercourse (CAI) at last sex with an HIV-positive or unknown status partner (receptive: PR 1.3, 95% CI 1.1-1.6; insertive: PR 1.2, 95% CI 1.0-1.4), having exchanged sex for money or drugs at last sex (PR: 1.4, 95% CI 1.1-1.7), having concurrent partners in the past year (PR: 1.1, 95% CI 1.1-1.2), and having more CAI partners in the past year (PR: 1.2, 95% CI 1.0-1.4) compared to non-binge drinkers. Conclusions: Evidence-based strategies for reducing binge drinking could help reduce risky sexual behavior among MSM.

Early linkage to HIV care and antiretroviral treatment among men who have sex with men-20 Cities, United States, 2008 and 2011

Hoots, B. E., Finlayson, T. J., Wejnert, C., Paz-Bailey, G., Taussig, J., Gern, R., Hoyte, T., Salazar, L., White, J., Todd, J., Bautista, G., Flynn, C., Sifakis, F., German, D., Isenberg, D., Driscoll, M., Hurwitz, E., Miminos, [No V., Doherty, R., … Kuo, I. (n.d.).

Publication year

2015

Journal title

PloS one

Volume

10

Issue

7

10.1371/journal.pone.0132962

Abstract

Abstract

Early linkage to care and antiretroviral (ARV) treatment are associated with reduced HIV transmission. Male-to-male sexual contact represents the largest HIV transmission category in the United States; men who have sex with men (MSM) are an important focus of care and treatment efforts. With the release of the National HIV/AIDS Strategy and expanded HIV treatment guidelines, increases in early linkage to care and ARV treatment are expected.We examined differences in prevalence of early linkage to care and ARV treatment among HIV-positiveMSM between 2008 and 2011. Data are from the National HIV Behavioral Surveillance System, which monitors behaviors among populations at high risk of HIV infection in 20 U.S. cities with high AIDS burden. MSM were recruited through venuebased, time-space sampling. Prevalence ratios comparing 2011 to 2008 were estimated using linearmixed models. Early linkage was defined as an HIV clinic visit within 3 months of diagnosis. ARV treatment was defined as use at interview. Prevalence of early linkage to care was 79%(187/236) in 2008 and 83%(241/291) in 2011. Inmultivariable analysis, prevalence of early linkage did not differ significantly between years overall (P = 0.44). Prevalence of ARV treatment was 69% (790/1,142) in 2008 and 79%(1,049/1,336) in 2001. In multivariable analysis, ARV treatment increased overall (P = 0.0003) and among most sub-groups. Black MSM were less likely than white MSM to report ARV treatment (P = 0.01).While early linkage to care did not increase significantly between 2008 and 2011, ARV treatment increased among most sub-groups. Progress is being made in getting MSM on HIV treatment, but more efforts are needed to decrease disparities in ARV coverage.