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
Reconsidering the internet as an HIV/STD risk for men who have sex with men
AbstractJenness, S. M., Neaigus, A., Hagan, H., Wendel, T., Gelpi-Acosta, C., & Murrill, C. S. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
6Page(s)
1353-1361AbstractPrevious studies linking online sexual partnerships to behavioral risks among men who have sex with men (MSM) may be subject to confounding and imprecise measurement of partnership-specific risks. We examined behavioral risks associated with having only online, only offline, or both online and offline partners in the past year, the confounding effects of multiple partnerships, and partnership-specific risks among a sample of MSM from New York City recruited offline in 2008. Overall, 28% of 479 participants had an online partner in the past year, but most of those (82%) also had an offline partner. Having an online partner was associated with past-year unprotected anal intercourse (UAI) and other risks, but not after controlling for multiple partnerships. There were slightly higher levels of risk within offline partnerships, but differences were largely attributable to MSM who had both offline and online partners. Last sex partners met offline were more likely to be HIV-serodiscordant and engage in concurrent substance use with the participant. This suggests that online partnerships may not be an independent cause of behavioral risks, but a marker for risks occurring independent of Internet use.Recruitment-adjusted estimates of HIV prevalence and risk among men who have sex with men : Effects of weighting venue-based sampling data
AbstractJenness, S. M., Neaigus, A., Murrill, C. S., Gelpi-Acosta, C., Wendel, T., & Hagan, H. (n.d.).Publication year
2011Journal title
Public Health ReportsVolume
126Issue
5Page(s)
635-642AbstractObjectives. We investigated the impact of recruitment bias within the venuebased sampling (VBS) method, which is widely used to estimate disease prevalence and risk factors among groups, such as men who have sex with men (MSM), that congregate at social venues. Methods. In a 2008 VBS study of 479 MSM in New York City, we calculated venue-specific approach rates (MSM approached/MSM counted) and response rates (MSM interviewed/MSM approached), and then compared crude estimates of HIV risk factors and seroprevalence with estimates weighted to address the lower selection probabilities of MSM who attend social venues infrequently or were recruited at high-volume venues. Results. Our approach rates were lowest at dance clubs, gay pride events, and public sex strolls, where venue volumes were highest; response rates ranged from 39% at gay pride events to 95% at community-based organizations. Sixty-seven percent of respondents attended MSM-oriented social venues at least weekly, and 21% attended such events once a month or less often in the past year. In estimates adjusted for these variations, the prevalence of several past-year risk factors (e.g., unprotected anal intercourse with casual/exchange partners, $5 total partners, group sex encounters, at least weekly binge drinking, and hard-drug use) was significantly lower compared with crude estimates. Adjusted HIV prevalence was lower than unadjusted prevalence (15% vs. 18%), but not significantly. Conclusions. Not adjusting VBS data for recruitment biases could overestimate HIV risk and prevalence when the selection probability is greater for higher-risk MSM. While further examination of recruitment-adjustment methods for VBS data is needed, presentation of both unadjusted and adjusted estimates is currently indicated.Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors
AbstractHagan, H., McGough, J. P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E. R. (n.d.).Publication year
2000Journal title
Journal of Substance Abuse TreatmentVolume
19Issue
3Page(s)
247-252AbstractThe association between needle exchange, change in drug use frequency and enrollment and retention in methadone drug treatment was studied in a cohort of Seattle injection drug users (IDUs). Participants included IDUs classified according to whether they had used a needle exchange by study enrollment and during the 12-month follow-up period. The relative risk (RR) and the adjusted RR (ARR) were estimated as measures of the association. It was found that IDUs who had formerly been exchange users were more likely than never-exchangers to report a substantial (≥75%) reduction in injection (ARR = 2.85, 95% confidence limit [CL] 1.47-5.51), to stop injecting altogether (ARR = 3.5, 95% CL 2.1-5.9), and to remain in drug treatment. New users of the exchange were five times more likely to enter drug treatment than never-exchangers. We conclude that reduced drug use and increased drug treatment enrollment associated with needle exchange participation may have many public health benefits, including prevention of blood-borne viral transmission. (C) 2000 Elsevier Science Inc.Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program
AbstractHagan, H., Hagan, H., Des Jarlais, D. C., Friedman, S. R., Purchase, D., & Alter, M. J. (n.d.).Publication year
1995Journal title
American journal of public healthVolume
85Issue
11Page(s)
1531-1537AbstractObjectives. This case-control study examined the association between syringe exchange use and hepatitis B and C in injection drug users. Methods. Case patients included 28 injection drug users with acute hepatitis B and 20 with acute hepatitis C reported to the health department in a sentinel hepatitis surveillance county; control subjects were injection drug users with no markers of exposure to hepatitis B or C (n = 38 and 26, respectively) attending health department services during the same period. Data were abstracted from clinic records. Results. Seventy-five percent of case patients with hepatitis B and 26% of control subjects had never used the exchange; similar proportions were found for the hepatitis C case and control groups. After adjustment for demographic characteristics and duration of injecting drugs, nonuse of the exchange was associated with a sixfold greater risk of hepatitis B (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 1.5, 20.4) and a sevenfold greater risk of hepatitis C (OR = 7.3; 95% CI = 1.6, 32.8). Conclusions. The results suggest that use of the exchange led to a significant reduction in hepatitis B and hepatitis C in the county and may have also prevented a substantial proportion of human immunodeficiency virus infections in injection drug users.Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990-2001
AbstractDes Jarlais, D. C., Perlis, T., Arasteh, K., Torian, L. V., Hagan, H., Beatrice, S., Smith, L., Wethers, J., Milliken, J., Mildvan, D., Yancovitz, S., & Friedman, S. R. (n.d.).Publication year
2005Journal title
AIDSVolume
19Issue
SUPPL. 3Page(s)
S20-S25AbstractObjective: To assess trends in HIV, hepatitis C virus (HCV) and HIV/HCV infection among injecting drug users (IDU) from 1990 to 2001 in New York City. The 1990-2001 time period included a very large expansion of syringe exchange in New York City, from 250 000 to 3 000 000 syringes exchanged annually. Methods: Cross-sectional seroprevalence surveys of IDU entering drug abuse treatment in New York City, with sample sizes for HCV of 72 in 1990-1991 and 412 in 2000-2001. A structured risk behavior questionnaire was administered, and HIV and HCV testing were conducted. HCV testing was performed on de-linked stored serum samples. Results: Over the 1990-2001 period, HIV prevalence declined from 54 to 13%. HCV prevalence declined from 80 to 59% among HIV-seronegative individuals, and from 90 to 63% overall. The estimated HCV incidence in 2000-2001 among new injectors was 18 per 100 person-years at risk. Conclusions: The large-scale expansion of syringe exchange was temporally associated with large reductions in both HIV and HCV prevalence. The prevalence and incidence of HCV, however, still remain at high levels among IDU in New York City.Regional Patterns and Correlates of Substance Use among Young Men Who Have Sex with Men in 7 US Urban Areas
AbstractThiede, H., Valleroy, L. A., MacKellar, D. A., Celentano, D. D., Ford, W. L., Hagan, H., Koblin, B. A., LaLota, M., McFarland, W., Shehan, D. A., & Torian, L. V. (n.d.).Publication year
2003Journal title
American journal of public healthVolume
93Issue
11Page(s)
1915-1921AbstractObjectives. We sought to characterize substance use patterns in young men who have sex with men (MSM) in 7 US urban areas and sociodemographic characteristics and history associated with such use. Methods. We examined data collected from 1994 through 1998 in a venue-based, cross-sectional survey. Results. Among the 3492 participants, 66% reported use of illicit drugs; 28%, use of 3 or more drugs; 29%, frequent drug use (once a week or more); and 4%, injection drug use. These practices were more common among participants who were White, self-identified as bisexual or heterosexual, had run away, or had experienced forced sex. Conclusions. Effective drug prevention and treatment programs addressing local drug-use patterns and associated factors are urgently needed for young MSM, a population with a high rate of illicit drug use.Reply to high-quality meta-analyses are required for development of evidence in medicine
AbstractHagan, H., Des Jarlais, D. C., & Pouget, E. (n.d.).Publication year
2012Journal title
Journal of Infectious DiseasesVolume
205Issue
9Page(s)
1473Abstract~Research note : Perspectives on the hierarchy of HIV and hepatitis C disease: Consequences for drug treatment program patients
AbstractMunoz-Plaza, C., Strauss, S. M., Tiburcio, N., Astone-Twerell, J. M., Des Jarlais, D. C., Gwadz, M., Hagan, H., Osborne, A., & Rosenblum, A. (n.d.).Publication year
2010Journal title
Journal of Drug IssuesVolume
40Issue
2Page(s)
517-536AbstractInjection drug users (IDUs) face an increased risk of acquiring blood borne viral infections, including HIV and the hepatitis C virus (HCV). However, the discrepancy in funding for services to address these two diseases has implications. Although drug treatment programs have played an important role in fighting HIV/AIDS, the HCV-related services offered at these programs remain limited. Research from other countries suggests that drug users view HCV as less important than HIV, yet little is known about the extent to which our society's focus on HIV has been adopted within the drug treatment program culture. This qualitative study examines the perceptions of both staff (n = 165) and clients (n = 215) at these programs with regard to HIV and HCV and presents data on how staffs' attitudes toward HCV changed after participating in an HCV training. Clients described a services landscape at drug treatment programs that favors HIV services over those targeting HCV.Residential substance user treatment programs as venues for HCV pharmacological treatment : Client and staff perspectives
AbstractStrauss, S. M., Astone, J. M., Munoz-Plaza, C., Hagan, H., & Des Jarlais, D. (n.d.).Publication year
2005Journal title
Substance Use and MisuseVolume
40Issue
12Page(s)
1811-1829AbstractHepatitis C virus (HCV) infection is highly prevalent among drug users. While there are antiviral medications available to combat the virus, the medication regimen is quite arduous, presenting special issues for drug users. We examined the challenges and benefits of using residential substance user treatment programs as venues for clients to undergo HCV medication regimens. Analyses of qualitative data collected from clients and staff in 2003 at four residential substance user treatment programs in the U.S. indicate that challenges primarily include issues involving the medications' side effects, and both financial and communication concerns. Benefits especially involve clients' feelings that they are being proactive in addressing health issues in an environment that provides much-needed support. Findings illuminate the complex issues involved for both clients and the programs, and some steps that programs can take to better support HCV-infected clients regarding HCV medication concerns.Response to the calculation of population attributable fractions of risk factors for hepatitis C transmission : Authors' reply
AbstractHagan, H., Jordan, A. E., & Cleland, C. M. (n.d.).Publication year
2016Journal title
AIDSVolume
30Issue
10Abstract~Retention of participants in medication-assisted programs in low- and middle-income countries : An international systematic review
AbstractFeelemyer, J., Des Jarlais, D., Arasteh, K., Abdul-Quader, A. S., & Hagan, H. (n.d.).Publication year
2014Journal title
AddictionVolume
109Issue
1Page(s)
20-32AbstractBackground and aims: Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. Results: There were 58 MAT program studies, with 27047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI)=46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI=22.1, 74.6%) and methadone (56.6%, 95% CI=45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Conclusion: Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.Risk environments, race/ethnicity, and HIV status in a large sample of people who inject drugs in the United States
AbstractHagan, H. (n.d.).Publication year
2016Journal title
PloS oneVolume
11Issue
3AbstractIntroduction: 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.Screening for depressive symptoms among HCV-infected injection drug users : Examination of the utility of the CES-D and the Beck Depression Inventory
AbstractGolub, E. T., Latka, M., Hagan, H., Havens, J. R., Hudson, S. M., Kapadia, F., Campbell, J. V., Garfein, R. S., Thomas, D. L., & Strathdee, S. A. (n.d.).Publication year
2004Journal title
Journal of Urban HealthVolume
81Issue
2Page(s)
278-290AbstractThe prevalence of depression is high among injection drug users (IDUs) and among those infected with the hepatitis C virus (HCV). Moreover, one of the drugs used in the standard treatment for HCV infection (interferon) has been known to exacerbate underlying psychiatric disorders such as depression and has been associated with the development of major depressive disorder among HCV-infected patients. For these reasons, the most recent National Institutes of Health consensus statement on the management of HCV infection recommends the identification and treatment of depression prior to the start of HCV treatment. This study aimed to examine the extent of current moderate/severe depressive symptoms in a cohort of HCV-infected IDUs as measured by two screening tools, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Beck Depression Inventory (BDI). Subjects were participants in a multisite behavioral intervention trial among HCV-seropositive, human immunodeficiency virus-negative IDUs aged 18-35 years; the trial was designed to prevent secondary transmission of HCV and to enhance uptake of HCV treatment. Baseline data on demographics, risk behaviors, depression, alcohol use, and health care utilization were measured via audio computer-assisted self-interview. A factor analysis was conducted on each scale to examine the clustering of items used in each to measure depressive symptoms. Baseline depressive symptoms, as measured via the CES-D and the BDI, were also compared using Pearson's correlation coefficient. Of 193 HCV-infected individuals enrolled to date, 75.6% were male, and 65.3% were white. Median age was 25.8 years. Factor analyses revealed that these scales measured depression differently; a distinct somatic component was present in the BDI, but not the CES-D. Using cutoff scores of 23 for the CES-D and 19 for the BDI, 44.0% and 41.5% of the participants were identified as having moderate/severe depressive symptoms, respectively. Over half (56.0%) were identified as having depressive symptoms by either scale. However, there was only moderate agreement between the two scales (κ=0.46). Depressive symptoms were highly prevalent in this cohort of HCV-infected IDUs. Results indicated that both scales should be used in tandem to have the most sensitive detection of depressive symptoms, thereby maximizing the potential for HCV treatment success.Self-reported hepatitis C virus antibody status and risk behavior in young injectors
AbstractHagan, H., Campbell, J., Thiede, H., Strathdee, S., Ouellet, L., Kapadia, F., Hudson, S., & Garfein, R. S. (n.d.).Publication year
2006Journal title
Public Health ReportsVolume
121Issue
6Page(s)
710-719AbstractObjective. This study was conducted to assess the accuracy of self-reported hepatitis C virus (HCV) antibody (anti-HCV) serostatus in injection drug users (IDUs), and examine whether self-reported anti-HCV serostatus was associated with recent injection risk behavior. Methods. In five U.S. cities (Baltimore, Chicago, Los Angeles, New York, and Seattle), 3,004 IDUs from 15 to 30 years old were recruited for a baseline interview to determine eligibility for a randomized controlled trial of a behavioral intervention. HIV and HCV antibody testing were performed, and subject data (e.g., demographics, drug and sexual risk behavior, and history of HIV and HCV testing) were collected via audio computer-administered self-interview. Risk behavior during the previous three months was compared to self-reported anti-HCV serostatus. Results. Anti-HCV prevalence in this sample of young IDUs was 34.1%. Seventy-two percent of anti-HCV-positive and 46% of anti-HCV-negative IDUs in this sample were not aware of their HCV serostatus. Drug treatment or needle exchange use was associated with increased awareness of HCV serostatus. Anti-HCV-negative IDUs who knew their serostatus were less likely than those unaware of their status to inject with a syringe used by another IDU or to share cottons to filter drug solutions. Knowledge of one's positive anti-HCV status was not associated with safer injection practices. Conclusions. Few anti-HCV-positive IDUs in this study were aware of their serostatus. Expanded availability of HCV screening with high quality counseling is clearly needed for this population to promote the health of chronically HCV-infected IDUs and to decrease risk among injectors susceptible to acquiring or transmitting HCV.Serosorting for hepatitis C status in the sharing of injection equipment among Seattle area injection drug users
AbstractBurt, R. D., Thiede, H., & Hagan, H. (n.d.).Publication year
2009Journal title
Drug and alcohol dependenceVolume
105Issue
3Page(s)
215-220AbstractBackground: Hepatitis C virus (HCV) is a major health problem among injection drug users (IDU). One potential means of reducing risk of HCV transmission among IDU is serosorting, whereby IDU preferentially share injection equipment with persons of like HCV status. Methods: We surveyed Seattle area IDU recruited by respondent-driven sampling as part of the National HIV/AIDS Behavioral Surveillance system in 2005. Results: Of 337 participants, 91% reported ever having been tested for HCV. Fifty-three percent of participants who shared any injection equipment in the last 12 months reported knowing the HCV status of the last person with whom they shared injection equipment. Thirty-seven percent of self-reported HCV-positive participants reported that their last injection equipment sharing partner was also HCV-positive and 7% reported a HCV-negative partner. Among self-reported HCV-negative participants, 11% reported a HCV-positive partner and 23% a negative partner. The disproportionate tendency to share injection equipment with a partner of like HCV status persisted after control for characteristics associated with HCV positivity in stratified and logistic regression analyses. Among participants sharing injection equipment, 39% reported that they had intentionally shared injection equipment with a partner based on knowledge of their concordant HCV status. Conclusions: We conclude that a measurable degree of serosorting by HCV status is occurring among Seattle area IDU. Promotion of serosorting among HCV-positive IDU may be a useful harm reduction strategy for IDU who continue to practice sharing injection equipment. If judged efficacious, serosorting would provide a further rationale to encourage and support HCV testing among IDU.Sex Practices by HIV Awareness and Engagement in the Continuum of Care Among MSM : A National HIV Behavioral Surveillance Analysis in 21 U.S. Cities
AbstractHagan, H. (n.d.).Publication year
2018Journal title
AIDS and BehaviorVolume
22Issue
3Page(s)
840-847AbstractUsing National HIV Behavioral Surveillance (NHBS) cross-sectional survey and HIV testing data in 21 U.S. metropolitan areas, we identify sex practices among sexually active men who have sex with men (MSM) associated with: (1) awareness of HIV status, and (2) engagement in the HIV care continuum. Data from 2008, 2011, and 2014 were aggregated, yielding a sample of 5079 sexually active MSM living with HIV (MLWH). Participants were classified into HIV status categories: (1) unaware; (2) aware and out of care; (3) aware and in care without antiretroviral therapy (ART); and (4) aware and on ART. Analyses were conducted examining sex practices (e.g. condomless sex, discordant condomless sex, and number of sex partners) by HIV status. Approximately 30, 5, 10 and 55% of the sample was classified as unaware, aware and out of care, aware and in care without ART, and aware and on ART, respectively. Unaware MLWH were more likely to report condomless anal sex with a last male partner of discordant or unknown HIV status (25.9%) than aware MLWH (18.0%, p value OpenSPiltSPi 0.0001). Unaware MLWH were 3 times as likely to report a female sex partner in the prior 12 months as aware MLWH (17.3 and 5.6%, p-value OpenSPiltSPi 0.0001). When examining trends across the continuum of care, reports of any condomless anal sex with a male partner in the past year (ranging from 65.0 to 70.0%), condomless anal sex with a male partner of discordant or unknown HIV status (ranging from 17.7 to 21.3%), and median number of both male and female sex partners were similar. In conclusion, awareness of HIV and engagement in care was not consistently associated with protective sex practices, highlighting the need for continued prevention efforts.Sexual and injection-related risks in Puerto Rican-born injection drug users living in New York City : A mixed-methods analysis
AbstractGelpí-Acosta, C., Hagan, H., Jenness, S. M., Wendel, T., & Neaigus, A. (n.d.).Publication year
2011Journal title
Harm Reduction JournalVolume
8AbstractBackground: These data were collected as part of the National HIV Behavioral Surveillance (NHBS) study. NHBS is a cross-sectional study to investigate HIV behavioral risks among core risk groups in 21 U.S. cities with the highest HIV/AIDS prevalence. This analysis examines data from the NHBS data collection cycle with IDU conducted in New York City in 2009. We explored how the recency of migration from Puerto Rico (PR) to New York City (NYC) impacts both syringe sharing and unprotected sex among injection drug users (IDU) currently living in NYC.Methods: We used a mixed-methods approach to examine differences in risk between US-born IDU, PR IDU who migrated to NYC more than three years ago (non-recent migrants), and PR IDU who migrated in the last three years (recent migrants). Respondent-driven sampling (RDS) was used to recruit the sample (n = 514). In addition, qualitative individual and group interviews with recent PR migrants (n = 12) and community experts (n = 2) allowed for an in-depth exploration of the IDU migration process and the material and cultural factors behind continued risk behaviors in NYC.Results: In multiple logistic regression controlling for confounding factors, recent migrants were significantly more likely to report unprotected sexual intercourse with casual or exchange partners (adjusted odds ratio [AOR]: 2.81; 95% confidence intervals [CI]: 1.37-5.76) and receptive syringe sharing (AOR = 2.44; 95% CI: 1.20-4.97) in the past year, compared to US-born IDU. HIV and HCV seroprevalence were highest among non-recent migrants. Qualitative results showed that risky injection practices are partly based on cultural norms acquired while injecting drugs in Puerto Rico. These same results also illustrate how homelessness influences risky sexual practices.Conclusions: Poor material conditions (especially homelessness) may be key in triggering risky sexual practices. Cultural norms (ingrained while using drugs in PR) around injection drug use are perpetuated in their new setting following an almost natural flow. These norms may have a particular stronghold over risky drug injection practices. These results indicate that culturally appropriate HIV and HCV prevention and education services are needed. In addition, homelessness should be addressed to reduce risky sexual practices.Sexual HIV/HSV-2 risk among drug users in new york city : An HIV testing and counseling intervention
AbstractPantin, M., Leonard, N. R., & Hagan, H. (n.d.).Publication year
2013Journal title
Substance Use and MisuseVolume
48Issue
6Page(s)
438-445AbstractUndiagnosed and untreated sexually transmitted infections are highly prevalent among users of heroin, crack, cocaine, and amphetamines. Between 2008 and 2009, 58 heroin, cocaine, and crack users in New York City who reported unprotected vaginal and anal sex with more than one partner in the past 30 days were enrolled in an HIV testing and counseling intervention. Four weeks post intervention, increases were found for condom use and STI knowledge. Reductions were noted for safe-sex risk fatigue, number of same-and opposite-sex partners, and days when drugs were injected. Brief but intense counseling interventions can reduce HIV risk among high-risk populations.Sexual risk and HIV infection among drug users in New York city : A pilot study
AbstractHagan, H., Perlman, D. C., & Des Jarlais, D. C. (n.d.).Publication year
2011Journal title
Substance Use and MisuseVolume
46Issue
2-3Page(s)
201-207AbstractMeasures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.Sharing of drug preparation equipment as a risk factor for hepatitis C
AbstractHagan, H., Hagan, H., Thiede, H., Weiss, N. S., Hopkins, S. G., Duchin, J. S., & Alexander, E. R. (n.d.).Publication year
2001Journal title
American journal of public healthVolume
91Issue
1Page(s)
42-46AbstractObjectives. This study investigated the sharing of drug preparation equipment as a possible route of hepatitis C virus (HCV) transmission. Methods. HCV seroconversion was measured in a cohort of 317 injection drug users who tested negative for HCV antibody at recruitment. Results. Cumulative HCV incidence was 16.7% per year. Among those who did not share syringes, HCV seroconversion was associated with sharing drug cookers and filtration cotton (adjusted risk ratio=5.9; 95% confidence interval=1.1, 31.7);54% of HCV infections in injection drug users who did not share syringes were attributable to cooker/cotton sharing. Conclusions. Among injection drug users who do not share syringes, an important proportion of HCV infections may be attributed to cooker/cotton sharing.Social structural and behavioral underpinnings of hyperendemic hepatitis C virus transmission in drug injectors
AbstractBrewer, D. D., Hagan, H., Sullivan, D. G., Muth, S. Q., Hough, E. S., Feuerborn, N. A., & Gretch, D. R. (n.d.).Publication year
2006Journal title
Journal of Infectious DiseasesVolume
194Issue
6Page(s)
764-772AbstractBackground. Hepatitis C virus (HCV) is hyperendemic in drug injectors, yet social structural and behavioral factors underlying transmission are not well established. Methods. We conducted a case-control study of HCV seroconversion in drug injectors, focusing on transmission within networks. Incident case subjects (n = 17) and seronegative control subjects (n = 42) reported injection and sex partners and referred as many as 5 for interviewing and blood testing. We performed nucleotide sequencing of HCV isolates from infected individuals. Results. Seventy-eight percent of recent injection partnerships involved behavior that could transmit HCV. Case subjects and control subjects were similar demographically and behaviorally. Case subjects, however, had more HCV-infected partners and consequently engaged in injection risk behavior with more infected partners. The injection network was mostly connected, dense, and cyclic, but the sexual network was highly fragmented. Although participants generally injected with partners of similar age, most HCV-uninfected participants recently had injected with infected partners. In at least 1 of 4 pairs of genetically linked infections, transmission appeared to be due to sharing of injection equipment other than syringes. Except for transmission pairs, network distance between incident case subjects and genetic distance between their HCV variants were uncorrelated. Conclusions. Without dramatic reductions in injection risk behaviors, shattering of cohesive injection networks, and/or broad coverage of an effective vaccine, HCV will likely remain hyperendemic in drug injectors.Spatial Recruitment Bias in Respondent-Driven Sampling : Implications for HIV Prevalence Estimation in Urban Heterosexuals
AbstractJenness, S. M., Neaigus, A., Wendel, T., Gelpi-Acosta, C., & Hagan, H. (n.d.).Publication year
2014Journal title
AIDS and BehaviorVolume
18Issue
12Page(s)
2366-2373AbstractRespondent-driven sampling (RDS) is a study design used to investigate populations for which a probabilistic sampling frame cannot be efficiently generated. Biases in parameter estimates may result from systematic non-random recruitment within social networks by geography. We investigate the spatial distribution of RDS recruits relative to an inferred social network among heterosexual adults in New York City in 2010. Mean distances between recruitment dyads are compared to those of network dyads to quantify bias. Spatial regression models are then used to assess the impact of spatial structure on risk and prevalence outcomes. In our primary distance metric, network dyads were an average of 1.34 (95 % CI 0.82–1.86) miles farther dispersed than recruitment dyads, suggesting spatial bias. However, there was no evidence that demographic associations with HIV risk or prevalence were spatially confounded. Therefore, while the spatial structure of recruitment may be biased in heterogeneous urban settings, the impact of this bias on estimates of outcome measures appears minimal.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
AbstractSmith, D. J., Jordan, A. E., Frank, M., & Hagan, H. (n.d.).Publication year
2016Journal title
BMC Infectious DiseasesVolume
16Issue
1AbstractBackground: 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).Staff perspectives on facilitating the implementation of hepatitis C services at drug treatment programs
AbstractMunoz-Plaza, C. E., Strauss, S. M., Astone-Twerwll, J. M., Des Jarlais, D. C., & Hagan, H. (n.d.).Publication year
2006Journal title
Journal of Psychoactive DrugsVolume
38Issue
3Page(s)
233-241AbstractDrug users are at risk of acquiring the hepatitis C virus (HCV). Although ancillary services available to clients at drug treatment programs are often limited, some of these programs are providing HCV services. Presenting qualitative data, the authors describe the HCV education and/or support services available at four drug treatment programs and examine staff and client perspectives on factors that facilitated the implementation of these services. Major findings include participants' perceptions that their programs had: (1) at least one change agent on staff who promoted the innovation and delivery ofHCV services; (2) at least one administrator or director who encouraged and supported the adoption of these services; and (3) a treatment team that tended to collectively “buy into” and value the HCV service. Ultimately, we found that some drug treatment programs are finding creative and nonresource-intensive ways of delivering HCV services despite the existence of significant barriers. While programs need more funding and resources to overcome these barriers, these findings may prove helpful to other drug treatment programs that would like to offer HCV services to at least some of their clients.Strategies to uncover undiagnosed HIV infection among heterosexuals at high risk and link them to HIV care with high retention : A "seek, test, treat, and retain" study
AbstractHagan, H. (n.d.).Publication year
2015Journal title
BMC public healthVolume
15Issue
1AbstractBackground: Over 50,000 individuals become infected with HIV annually in the U.S., and over a quarter of HIV infected individuals are heterosexuals. Undiagnosed HIV infection, as well as a lack of retention in care among those diagnosed, are both primary factors contributing to ongoing HIV incidence. Further, there are racial/ethnic disparities in undiagnosed HIV and engagement in care, with African Americans/Blacks and Latinos remaining undiagnosed longer and less engaged in care than Whites, signaling the need for culturally targeted intervention approaches to seek and test those with undiagnosed HIV infection, and link them to care with high retention. Methods/Design: The study has two components: one to seek out and test heterosexuals at high risk for HIV infection, and another to link those found infected to HIV care with high retention. We will recruit sexually active African American/Black and Latino adults who have opposite sex partners, negative or unknown HIV status, and reside in locations with high poverty and HIV prevalence. The "Seek and Test" component will compare the efficacy and cost effectiveness of two strategies to uncover undiagnosed HIV infection: venue-based sampling and respondent-driven sampling (RDS). Among those recruited by RDS and found to have HIV infection, a "Treat and Retain" component will assess the efficacy of a peer-driven intervention compared to a control arm with respect to time to an HIV care appointment and health indicators using a cluster randomized controlled trial design to minimize contamination. RDS initial seeds will be randomly assigned to the intervention or control arm at a 1:1 ratio and all recruits will be assigned to the same arm as the recruiter. Participants will be followed for 12 months with outcomes assessed using medical records and biomarkers, such as HIV viral load. Discussion: Heterosexuals do not test for HIV as frequently as and are diagnosed later than other risk groups. The study has the potential to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. Because the majority of heterosexuals at high risk are African American/Black or Latino, the study has great potential to reduce racial/ethnic disparities in HIV/AIDS. Trial registration: ClinicalTrials.gov, NCT01607541, Registered May 23, 2012.