Holly Hagan
Holly Hagan
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Professor Emeritus
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Professional overview
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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.
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Education
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PhD Epidemiology, University of Washington, Seattle, WAMPH Epidemiology, University of Massachusetts, Amherst, MABA Russian Studies, Evergreen State College, Olympia, WA
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Publications
Publications
Peer-education intervention to reduce injection risk behaviors benefits high-risk young injection drug users : A latent transition analysis of the CIDUS 3/DUIT study
AbstractMacKesy-Amiti, M. E., Finnegan, L., Ouellet, L. J., Golub, E. T., Hagan, H., Hudson, S. M., Latka, M. H., & Garfein, R. S. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
6Page(s)
2075-2083AbstractWe analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs) conducted in five U.S. cities. The trial compared a peer education intervention (PEI) with a time-matched, attention control group. Applying categorical latent variable analysis (mixture modeling) to baseline injection risk behavior data, we identified four distinct classes of injection-related HIV/HCV risk: low risk, non-syringe equipment-sharing, moderate-risk syringe-sharing, and high-risk syringe-sharing. The trial participation rate did not vary across classes. We conducted a latent transition analysis using trial baseline and 6-month follow-up data, to test the effect of the intervention on transitions to the low-risk class at follow-up. Adjusting for gender, age, and race/ethnicity, a significant intervention effect was found only for the high-risk class. Young IDU who exhibited high-risk behavior at baseline were 90 % more likely to be in the low-risk class at follow-up after the PEI intervention, compared to the control group.Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five U.S. cities
AbstractBailey, S. L., Ouellet, L. J., Mackesy-Amiti, M. E., Golub, E. T., Hagan, H., Hudson, S. M., Latka, M. H., Gao, W., & Garfein, R. S. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S18-S29AbstractObjectives: This study examined risk factors for receptive syringe sharing (RSS) during illicit drug injection by persons 15-30 years old in five U.S. cities. Methods: Participants were recruited through street outreach and respondent-driven referrals in Baltimore, Chicago, Los Angeles, New York, and Seattle between May 2002 and January 2004. Surveys of drug use, sexual behaviors, and correlates were administered through audio computer-assisted self-interviews at baseline and, for the subset of participants who enrolled in an HIV/HCV prevention intervention trial, at 3-months and 6-months post-baseline. The proportions of injections involving RSS at baseline and at follow-up were used as outcomes in multivariate models that adjusted for intervention effects. Results: At baseline, 54% of 3128 participants reported RSS in the past 3 months. RSS decreased to 21% at 6-months post-baseline for the combined trial arms. Participants were more likely to report RSS if they perceived that their peers were not against RSS and if they injected with sex partners. Lower levels of perceived risk of infection with HIV (baseline, p < .001) or HCV (follow-up, p < .001) through RSS were also significant predictors of greater RSS. Conclusions: Perceived risks, peer influences, and type of injection partner were robust predictors of RSS. Perceived risks and peer influences are particularly amenable to intervention efforts that may prevent RSS in this age group.Perceptions of genetic testing and genomic medicine among drug users
AbstractPerlman, D. C., Gelpí-Acosta, C., Friedman, S. R., Jordan, A. E., & Hagan, H. (n.d.).Publication year
2015Journal title
International Journal of Drug PolicyVolume
26Issue
1Page(s)
100-106AbstractBackground: Genetic testing will soon enter care for human immunodeficiency virus (HIV) and hepatitis C virus (HCV), and for addiction. There is a paucity of data on how to disseminate genetic testing into healthcare for marginalized populations. We explored drug users' perceptions of genetic testing. Methods: Six focus groups were conducted with 34 drug users recruited from syringe exchange programmes and an HIV clinic between May and June 2012. Individual interviews were conducted with participants reporting previous genetic testing. Results: All participants expressed acceptance of genetic testing to improve care, but most had concerns regarding confidentiality and implications for law enforcement. Most expressed more comfort with genetic testing based on individual considerations rather than testing based on race/ethnicity. Participants expressed comfort with genetic testing in medical care rather than drug treatment settings and when specifically asked permission, with peer support, and given a clear rationale. Conclusion: Although participants understood the potential value of genetic testing, concerns regarding breaches in confidentiality and discrimination may reduce testing willingness. Safeguards against these risks, peer support, and testing in medical settings based on individual factors and with clear rationales provided may be critical in efforts to promote acceptance of genetic testing among drug users.Performance of premarket rapid hepatitis C virus antibody assays in 4 national human immunodeficiency virus behavioral surveillance system sites
AbstractSmith, B. D., Teshale, E., Jewett, A., Weinbaum, C. M., Neaigus, A., Hagan, H., Jenness, S. M., Melville, S. K., Burt, R., Thiede, H., Al-Tayyib, A., Pannala, P. R., Miles, I. W., Oster, A. M., Smith, A., Finlayson, T., Bowles, K. E., & Dinenno, E. A. (n.d.).Publication year
2011Journal title
Clinical Infectious DiseasesVolume
53Issue
8Page(s)
780-786AbstractBackground. The Centers for Disease Control and Prevention (CDC) estimates that 4.1 million Americans have been infected with hepatitis C virus (HCV) and 75%-80% of them are living with chronic HCV infection, many unaware of their infection. Persons who inject drugs (PWID) account for 57.5% of all persons with HCV antibody (anti-HCV) in the United States. Currently no point-of-care tests for HCV infection are approved for use in the United States. Methods. Surveys and testing for human immunodeficiency virus (HIV) and anti-HCV were conducted among persons who reported injection drug use in the past 12 months as part of the National HIV Behavioral Surveillance System in 2009. The sensitivity and specificity of point-of-care tests (finger-stick and 2 oral fluid rapid assays) from 3 manufacturers (Chembio, MedMira, and OraSure) were evaluated in field settings in 4 US cities. Results. Sensitivity (78.9%-97.4%) and specificity (80.0%-100.0%) were variable across assays and sites. The highest assay-specific sensitivities achieved for the Chembio, MedMira, and OraSure tests were 94.0%, 78.9% and 97.4%, respectively; the highest specificities were 97.7%, 83.3%, and 100%, respectively. In multivariate analysis, false-negative anti-HCV results were associated with HIV positivity for the Chembio oral assay (adjusted odds ratio, 8.4-9.1; P , .01) in 1 site (New York City). Conclusions. Sensitive rapid anti-HCV assays are appropriate and feasible for high-prevalence, high-risk populations such as PWID, who can be reached through social service settings such as syringe exchange programs and methadone maintenance treatment programs.Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs
AbstractDes Jarlais, D. C., Arasteh, K., Hagan, H., McKnight, C. A., Perlman, D. C., & Friedman, S. R. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
SUPPL. 2Page(s)
S445-S451AbstractObjectives. We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City. Methods. Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n=1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange). Results. There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR]=3.46, 95% confidence interval [CI]=2.41, 4.96 and AOR=4.02, 95% CI=1.67, 9.69, respectively) and Hispanics vs Whites (AOR=1.76, 95% CI=1.49, 2.09 and AOR=1.49, 95% CI=1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence. Conclusions. New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection.Policy Changes and Improvements in Health Insurance Coverage Among MSM : 20 U.S. Cities, 2008–2014
AbstractHagan, H. (n.d.).Publication year
2017Journal title
AIDS and BehaviorVolume
21Issue
3Page(s)
615-618AbstractRecent policy changes have improved the ability of gay, bisexual, and other men who have sex with men (MSM) to secure health insurance. We wanted to assess changes over time in self-reported health insurance status among MSM participating in CDC’s National HIV Behavioral Surveillance (NHBS) in 2008, 2011, and 2014. We analyzed NHBS data from sexually active MSM interviewed at venues in 20 U.S. cities. To determine if interview year was associated with health insurance status, we used a Poisson model with robust standard errors. Among included MSM, the overall percentage of MSM with health insurance rose 16 % from 2008 (68 %) to 2014 (79 %) (p value for trend < 0.001). The change in coverage over time was greatest in key demographic segments with lower health insurance coverage all three interview years, by age, education, and income. Corresponding with recent policy changes, health insurance improved among MSM participating in NHBS, with greater improvements in historically underinsured demographic segments. Despite these increases, improved coverage is still needed. Improved access to health insurance could lead to a reduction in health disparities among MSM over time.Positive deviance control-case life history : A method to develop grounded hypotheses about successful long-term avoidance of infection
AbstractFriedman, S. R., Mateu-Gelabert, P., Sandoval, M., Hagan, H., & Jarlais, D. C. (n.d.).Publication year
2008Journal title
BMC public healthVolume
8AbstractBackground. Prevalence rates for long-term injection drug users in some localities surpass 60% for HIV and 80% for HCV. We describe methods for developing grounded hypotheses about how some injectors avoid infection with either virus. Methods. Subjects: 25 drug injectors who have injected drugs 8 - 15 years in New York City. 17 remain without antibody to either HIV or HCV; 3 are double-positives; and 5 are positive for HCV but not HIV. "Staying Safe" methodology compares serostatus groups using detailed biographical timelines and narratives; and information about how subjects maintain access to physical resources and social support; their strategies and tactics to remain safe; how they handle problems of addiction and demands by drug dealers and other drug users; and how their behaviors and strategies do or do not become socially-embedded practices. Grounded theory and life-history analysis techniques compare and contrast doubly-uninfected with those infected with both viruses or only with HCV. Results. Themes and initial hypotheses emerging from analyses included two master hypotheses that, if confirmed, should help shape preventive interventions: 1) Staying uninfected is not simply a question of social structure or social position. It involves agency by drug injectors, including sustained hard work and adaptation to changing circumstances. 2) Multiple intentionalities contribute to remaining uninfected. These conscious goals include balancing one's need for drugs and one's income; developing ways to avoid drug withdrawal sickness; avoiding situations where other drug users importune you to share drugs; and avoiding HIV (and perhaps HCV) infection. Thus, focusing on a single goal in prevention might be sub-optimal. Other hypotheses specify mechanisms of enacting these intentionalities. One example is finding ways to avoid extreme social ostracism. Conclusion. We have identified strategies and tactics that some doubly-uninfected IDUs have developed to stay safe. Staying Safe methodology develops grounded hypotheses. These can be tested through cohort studies of incidence and prevention trials of hypothesis-based programs to help drug injectors make their injection and sexual careers safer for themselves and others. This positive deviance control-case life history method might be used to study avoiding other infections like genital herpes among sex workers.Predictors and correlates of reduced frequency or cessation of injection drug use during a randomized HIV prevention intervention trial
AbstractMackesy-Amiti, M. E., Ouellet, L. J., Golub, E. T., Hudson, S., Hagan, H., & Garfein, R. S. (n.d.).Publication year
2011Journal title
AddictionVolume
106Issue
3Page(s)
601-608AbstractAims This study conducted a secondary analysis to examine injection cessation and decreasing frequency of injection during a multi-site randomized controlled HIV prevention intervention trial that sought to reduce sexual and injection risk behavior among young injection drug users. Design and Setting A six-session, cognitive-behavioral skills-building intervention in which participants were taught peer education skills [peer education intervention (PEI)] was compared with a time-equivalent attention control. Follow-up interviews were conducted at 3 and 6 months post-baseline. Participants Trial participants were HIV and hepatitis C virus (HCV) antibody-negative injection drug users aged 15-30 years. Participants who had at least one follow-up interview and reported injecting drugs in the previous 3 months at baseline were eligible for the present analysis (n=690). Measurements At each interview, data were collected on the number of times participants injected drugs over the previous 3 months. Findings Twenty-seven per cent of participants reported at least one 3-month period of injection cessation. In a multivariate, zero-inflated negative binomial regression adjusting for prior injection frequency, time of follow-up and psychosocial variables, PEI trial arm and smaller session size were associated significantly with injection cessation. Trial arm had no effect on the frequency of injection among those who continued to inject. Conclusions HIV prevention interventions that encourage injection drug users to take on the role of peer educator may have the additional benefit of increasing the likelihood of injection cessation. Intervention group size is also an important consideration, with smaller groups having higher rates of cessation.Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention
AbstractDrumright, L. N., Hagan, H., Thomas, D. L., Latka, M. H., Golub, E. T., Garfein, R. S., Clapp, J. D., Campbell, J. V., Bonner, S., Kapadia, F., Thiel, T. K., & Strathdee, S. A. (n.d.).Publication year
2011Journal title
Journal of HepatologyVolume
55Issue
1Page(s)
45-52AbstractBackground & Aims: Hepatitis C virus (HCV) screening can provide opportunities to reduce disease progression through counseling against alcohol use, but empirical data on this issue are sparse. We determined the efficacy of a behavioral intervention in reducing alcohol use among young, HCV-infected injection drug users (IDUs) (n = 355) and assessed whether changes in liver enzymes were associated with changes in alcohol consumption. Methods: Both the intervention and attention-control groups were counseled to avoid alcohol use, but the intervention group received enhanced counseling. Logistic regression, ANOVA, and continuous time Markov models were used to identify factors associated with alcohol use, changes in mean ALT and AST levels, and change in alcohol use post-intervention. Results: Six months post-intervention, alcohol abstinence increased 22.7% in both groups, with no difference by intervention arm. Transition from alcohol use to abstinence was associated with a decrease in liver enzymes, with a marginally greater decrease in the intervention group (p = 0.05 for ALT; p = 0.06 for AST). In multivariate Markov models, those who used marijuana transitioned from alcohol abstinence to consumption more rapidly than non-users (RR = 3.11); those who were homeless transitioned more slowly to alcohol abstinence (RR = 0.47); and those who had ever received a clinical diagnosis of liver disease transitioned more rapidly to abstinence (RR = 1.88). Conclusions: Although, behavioral counseling to reduce alcohol consumption among HCV-infected IDUs had a modest effect, reductions in alcohol consumption were associated with marked improvements in liver function. Interventions to reduce alcohol use among HCV-infected IDUs may benefit from being integrated into clinical care and monitoring of HCV infection.Predictors of accidental fatal drug overdose among a cohort of injection drug users
AbstractHagan, H., O'Driscoll, P. T., McGough, J., Hagan, H., Thiede, H., Critchlow, C., & Alexander, E. R. (n.d.).Publication year
2001Journal title
American journal of public healthVolume
91Issue
6Page(s)
984-987AbstractObjectives. This study evaluated factors associated with accidental fatal drug overdose among a cohort of injection drug users (IDUs). Methods. In a prospective cohort study of 2849 IDUs in King County, Washington, deaths were identified by electronically merging subject identifiers with death certificate records. Univariate and multivariate Cox regression analyses were performed to identify predictors of overdose mortality. Results. Thirty-two overdoses were observed. Independent predictors of overdose mortality were bisexual sexual orientation (relative risk [RR]=4,86; 95% confidence interval [CI]=2.30, 13.2), homelessness (RR=2.30; 95% CI=1.06, 5.01), infrequent injection of speedballs (RR=5.36; 95% CI=1.58, 18.1), daily use of powdered cocaine (RR=4.84; 95% CI=1.13, 20.8), and daily use of poppers (RR=22.0; 95% CI=1.74, 278). Conclusions. Sexual orientation, homelessness, and drug use identify IDUs who may benefit from targeted interventions.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.Prevalence and correlates of indirect sharing practices among young adult injection drug users in five U.S. cities
AbstractThiede, H., Hagan, H., Campbell, J. V., Strathdee, S. A., Bailey, S. L., Hudson, S. M., Kapadia, F., & Garfein, R. S. (n.d.).Publication year
2007Journal title
Drug and alcohol dependenceVolume
91Issue
SUPPL. 1Page(s)
S39-S47AbstractBackground: Sharing of drug paraphernalia to prepare, measure and divide drugs for injection remains an important residual risk factor for hepatitis C and other blood-borne infections among injection drug users (IDUs) especially as sharing of syringes for injection decreases. Methods: We analyzed data from five U.S. cities to determine the prevalence and independent correlates of non-syringe paraphernalia-sharing (NSPS) and syringe-mediated drug-splitting (SMDS) among 15-30-year-old IDUs who reported not injecting with others' used syringes (receptive syringe-sharing, RSS). Results: NSPS was reported by 54% of IDUs who did not practice RSS and was independently associated (p < 0.05) with having ≥5 injection partners, injecting with sex partners or regular injection partners, injecting in shooting galleries, peers' sharing behaviors, lower self-efficacy for avoiding NSPS, and less knowledge of HIV and HCV transmission. SMDS was reported by 26% of IDUs who did not practice RSS, and was independently associated with having ≥5 injection partners, injecting in shooting galleries, and inversely associated with unknown HIV status. Conclusions: NSPS and SMDS were common among young adult IDUs. Increased efforts to prevent these risky practices should address social and environmental contexts of injection and incorporate knowledge and skills building, self-efficacy, and peer norms.Prevalence of hepatitis C virus infection among HIV+ men who have sex with men : a systematic review and meta-analysis
AbstractJordan, A. E., Perlman, D. C., Neurer, J., Smith, D. J., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2017Journal title
International Journal of STD and AIDSVolume
28Issue
2Page(s)
145-159AbstractSince 2000, an increase in hepatitis C virus infection among HIV-infected (HIV+) men who have sex with men has been observed. Evidence points to blood exposure during sex as the medium of hepatitis C virus transmission. Hepatitis C virus prevalence among HIV + MSM overall and in relation to injection drug use is poorly characterized. In this study, a systematic review and meta-analysis examining global hepatitis C virus antibody prevalence and estimating active hepatitis C virus prevalence among HIV + MSM were conducted; 42 reports provided anti-hepatitis C virus prevalence data among HIV + MSM. Pooled prevalence produced an overall anti-hepatitis C virus prevalence among HIV + MSM of 8.1%; active HCV prevalence estimate was 5.3%–7.3%. Anti-hepatitis C virus prevalence among injection drug use and non-injection drug use HIV + MSM was 40.0% and 6.7%, respectively. Among HIV + MSM, hepatitis C virus prevalence increased significantly over time among the overall and non-injection drug use groups, and decreased significantly among injection drug use HIV + MSM. We identified a moderate prevalence of hepatitis C virus among all HIV + MSM and among non-injection drug use HIV + MSM; for both, prevalence was observed to be increasing slightly. Pooled prevalence of hepatitis C virus among HIV + MSM was higher than that observed in the 1945–1965 US birth cohort. The modest but rising hepatitis C virus prevalence among HIV + MSM suggests an opportunity to control HCV among HIV + MSM; this combined with data demonstrating a rising hepatitis C virus incidence highlights the temporal urgency to do so.Preventing Epidemics of HIV-1 among Injecting Drug Users
AbstractDes Jarlais, D. C., Hagan, H., Friedman, S. R., Friedmann, P., Goldberg, D., Frischer, M., Green, S., Tunving, K., Ljungberg, B., Wodak, A., Ross, M., Purchase, D., Millson, P., & Myers, T. (n.d.).Publication year
2003Page(s)
183-200AbstractIn many areas, the spread of HIV-1 among injecting drug users (IDUs) due to the multi-person use of drug injection equipment has occurred with extreme rapidity. In New York City, for example, HIV-1 seroprevalence among IDUs increased from under 10 per cent to over 50 per cent in a period of five years (Des Jarlais et al., 1989); in Edinburgh, HIV-1 seroprevalence among IDUs increased from zero to over 40 per cent in one year (Robertson et al., 1986); in Bangkok, HIV-1 seroprevalence increased from 2 per cent to over 40 per cent in two years (Vanichseni and Sakuntanaga, 1990); and in the state of Manipur, India, levels increased from zero to approximately 50 per cent in one year (Naik et al., 1991). HIV-1 has spread rapidly among populations where there has been a lack of awareness of AIDS as a local threat and mechanisms such as ‘shooting galleries’, ‘dealer’s works’ and professional injectors that provide rapid and efficient mixing among large numbers of IDUs (Friedman and Des Jarlais, 1991).Providing ART to HIV Seropositive Persons Who Use Drugs : Progress in New York City, Prospects for “Ending the Epidemic”
AbstractJarlais, D. C., Arasteh, K., McKnight, C. A., Feelemyer, J., Hagan, H., Cooper, H. L., Campbell, A. N., Tross, S., & Perlman, D. C. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Issue
2Page(s)
353-362AbstractNew 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.Providing support to drug users infected with hepatitis C : The role of methadone maintenance treatment staff
AbstractAstone, J. M., Strauss, S. M., Munoz-Plaza, C., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2006Journal title
Journal of Maintenance in the AddictionsVolume
3Issue
1Page(s)
33-46AbstractInjection drug users (IDUs) have the highest rate of HCV infection. Although IDUs need support to access and use HCV services, they often lack this support. Many IDUs, however, have contact with a methadone maintenance treatment program (MMTP) where they can gain access to HCV services and obtain support in using them. Unfortunately, however, IDUs often underutilize theMMTPservices that are available to them. Using qualitative data collected in 4 MMTPs, we identify some reasons for clients' lack of HCV service utilization and staff strategies that influence clients' perceptions of support in using these services.Public health and changes in illicit drug prices
AbstractHagan, H., & Hagan, H. (n.d.).Publication year
2001Journal title
American journal of public healthVolume
91Issue
9Page(s)
1350Abstract~Public health benefit of peer-referral strategies for detecting undiagnosed HIV infection among high-risk heterosexuals in New York City
AbstractGwadz, M., Cleland, C. M., Perlman, D. C., Hagan, H., Jenness, S. M., Leonard, N. R., Ritchie, A. S., & Kutnick, A. (n.d.).Publication year
2017Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
74Issue
5Page(s)
499-507AbstractIdentifying 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.Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs
AbstractJarlais, D. C., Cooper, H. L., Bramson, H., Deren, S., Hatzakis, A., & Hagan, H. (n.d.).Publication year
2012Journal title
Current Opinion in HIV and AIDSVolume
7Issue
4Page(s)
354-361AbstractPURPOSE OF REVIEW: There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities. RECENT FINDINGS: An ongoing systematic review of ethnic disparities has found that, in a pooled weighted odds ratio, ethnic minority PWID are twice as likely to be HIV seropositive than ethnic majority, PWID from the same geographic area. If implemented with sufficient quality and coverage, current HIV prevention programs probably have the capability of ending HIV transmission among both ethnic majority and minority PWID. Large-scale, evidence-based prevention programs need to be implemented in the contexts of patterns of injecting drug use that continue to evolve-with injecting practices spreading to new areas, changes in drugs injected, and some transitions from injecting to noninjecting drug use. Lack of financial resources and policies against evidence-based programming are increasingly important problems that are likely to have particularly adverse effects on ethnic minority PWID. SUMMARY: Racial/ethnic/nationality disparities in HIV infection are quite common among PWID. Addressing these disparities will be a fundamental challenge within a human rights approach to public health.Racial and ethnic disparities in predictors of glycemia : a moderated mediation analysis of inflammation-related predictors of diabetes in the NHANES 2007–2010
AbstractNowlin, S., Cleland, C. M., Parekh, N., Hagan, H., & Melkus, G. D. (n.d.).Publication year
2018Journal title
Nutrition and DiabetesVolume
8Issue
1AbstractBackground/Objective: Racial/ethnic disparities in type 2 diabetes (T2D) outcomes exist, and could be explained by nutrition- and inflammation-related differences. The objective of this study is to identify associations between race/ethnicity and glucose control among participants from NHANES 2007–2010, as influenced by diet quality, body mass, and inflammation and grouped by T2D status. Subjects/Methods: The following is a cross-sectional, secondary data analysis of two NHANES data cycles spanning 2007–2010. The association between race/ethnicity and hemoglobin A1c (HbA1c) as mediated by dietary intake score, body mass index (BMI), and C-reactive protein (CRP) was assessed, as was the strength of the difference of that association, or moderation, by T2D status. The sample included n = 7850 non-pregnant adult participants ≥ 20 years of age who had two days of reliable dietary recall data, and no missing data on key variables included in the analysis. The primary outcome examined was HbA1c. Results: The model accurately explained the variation in HbA1c measures in participants without T2D, as mediated by diet quality, BMI, and CRP. However, significant variation in HbA1c remained after accounting for aforementioned mediators when contrasting non-Hispanic White to non-Hispanic Black participants without T2D. The model was not a good fit for explaining racial/ethnic disparities in HbA1c in participants with T2D. A test of the index of moderated mediation for this model was not significant for the differences in the effect of race/ethnicity on HbA1c by T2D status (moderator). Conclusions: This study demonstrated that diet quality, BMI, and CRP mediated the effect of race/ethnicity on HbA1c in persons without T2D, but not in persons with T2D. Further research should include additional inflammatory markers, and other inflammation- and T2D-related health outcomes, and their association with racial/ethnic disparities in diabetes.Racial/ethnic disparities in HIV infection among people who inject drugs : An international systematic review and meta-analysis
AbstractDes Jarlais, D. C., Bramson, H. A., Wong, C., Gostnell, K., Cepeda, J., Arasteh, K., & Hagan, H. (n.d.).Publication year
2012Journal title
AddictionVolume
107Issue
12Page(s)
2087-2095AbstractAims: The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data. Methods: Standard systematic review/meta-analysis methods were utilized, including searching for, screening and coding published and unpublished reports and meta-analytical statistics. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for reporting methods. Disparities were measured with the odds ratio (OR) for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an OR >1.0 indicated higher prevalence among ethnic minorities. Results: Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID [OR=2.09, 95% confidence interval (CI): 1.92-2.28]. Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the United States, pooled OR=2.22 (95% CI: 2.03-2.44). There was substantial variation in ORs-I2=75.3%: interquartile range=1.38-3.56-and an approximate Gaussian distribution of the log ORs. Conclusions: Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions.Racialized risk environments in a large sample of people who inject drugs in the United States
AbstractHagan, H. (n.d.).Publication year
2016Journal title
International Journal of Drug PolicyVolume
27Page(s)
43-55AbstractBackground: 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.Re : 'Syringe exchange and risk of infection with hepatitis B and C viruses' [2] (multiple letters)
AbstractHagan, H., Voth, E. A., Hagan, H., McGough, J. P., Thiede, H., Hopkins, S. G., & Alexander, E. R. (n.d.).Publication year
2000Journal title
American Journal of EpidemiologyVolume
151Issue
2Page(s)
207-208Abstract~Reciprocal sex partner concurrency and stds among heterosexuals at high-risk of HIV infection
AbstractNeaigus, A., Jenness, S. M., Hagan, H., Murrill, C. S., & Wendel, T. (n.d.).Publication year
2013Journal title
Journal of Urban HealthVolume
90Issue
5Page(s)
902-914AbstractInconsistent findings on the relationship of sex partner concurrency to infection with HIV and other sexually transmitted diseases (STDs) may result from differences in how sex partner concurrency is conceptualized. We examine the relationship of reciprocal sex partner concurrency (RSPC) to diagnosed STDs among heterosexuals. Heterosexually active adults (N = 717) were recruited for a cross-sectional study using respondent-driven sampling (RDS) from high-HIV-risk areas in New York City (NYC, 2006-2007) and interviewed about their sexual risk behaviors, number of sex partners, last sex partners, and STD diagnoses (prior 12 months). RSPC was when both the participant and her/his last sex partner had sex with other people during their sexual relationship. Odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (95%CI) were estimated by logistic regression. The sample was 52.4 % female, 74.3 % Black; median age was 40 years. RSPC was reported by 40.7 % and any STD diagnoses by 23.4 %. Any STDs was reported by 31.5 % of those reporting RSPC vs. 17.9 % of those who did not (OR = 2.11, 95%CI = 1.49-3.0). Any STDs was independently associated with RSPC (aOR = 1.54, 95%CI = 1.02-2.32), female gender (aOR = 2.15, 95%CI = 1.43-3.23), having more than three sex partners (aOR = 1.72, 95%CI = 1.13-2.63), and unprotected anal sex (aOR = 1.65, 95%CI = 1.12-2.42). Heterosexuals in high-HIV-risk neighborhoods in sexual partnerships that involve RSPC are at greater risk of STDs and, potentially, HIV. RSPC, in addition to sexual risk behaviors and the number of sex partners, may facilitate the heterosexual spread of HIV through STD cofactors and linkage into larger STD/HIV sexual transmission networks.Recommendations for the identification of chronic hepatitis C virus infection among persons born 1945-1965
AbstractHagan, H., & Hagan, H. (n.d.).Publication year
2012Journal title
MMWR Recommendation ReportVolume
61 (RR-4)Page(s)
1-32Abstract~