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

Predictors of accidental fatal drug overdose among a cohort of injection drug users

O’Driscoll, P. T., McGough, J., Hagan, H., Thiede, H., Critchlow, C., & Alexander, E. R. (n.d.).

Publication year

2001

Journal title

American journal of public health

Volume

91

Issue

6

Page(s)

984-987

10.2105/AJPH.91.6.984

Abstract

Abstract

Objectives. 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.

Public health and changes in illicit drug prices

Hagan, H. (n.d.).

Publication year

2001

Journal title

American journal of public health

Volume

91

Issue

9

Page(s)

1350

10.2105/AJPH.91.9.1350

Sharing of drug preparation equipment as a risk factor for hepatitis C

Hagan, H., Thiede, H., Weiss, N. S., Hopkins, S. G., Duchin, J. S., & Alexander, E. R. (n.d.).

Publication year

2001

Journal title

American journal of public health

Volume

91

Issue

1

Page(s)

42-46

10.2105/AJPH.91.1.42

Abstract

Abstract

Objectives. 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.

Using a jail-based survey to monitor HIV and risk behaviors among Seattle area injection drug users

Thiede, H., Romero, M., Bordelon, K., Hagan, H., & Murrill, C. (n.d.).

Publication year

2001

Journal title

Journal of Urban Health

Volume

78

Issue

2

Page(s)

264-278

10.1093/jurban/78.2.264

Abstract

Abstract

Routine monitoring of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs) is difficult outside drug treatment settings. We developed and implemented a survey of recently arrested IDUs to describe the prevalence of HIV, drug use, and sexual behaviors among them. A probability sampling survey was instituted in the King County Correctional Facility in Seattle, Washington; to sample recently arrested IDUs at the time of booking and in the jail health clinic between 1998 and 1999. Following HIV risk assessment and blood draw, additional information on drug use practices was gathered using a standardized questionnaire. Potential participants who were released from jail early could complete the study at a nearby research storefront office. Of the 4,344 persons intercepted at booking, 503 (12%) reported injection drug use, and 201 of the IDUs (40%) participated in the study. An additional 161 IDUs were enrolled in the study from the jail health clinic. Among the 348 unduplicated subjects, HIV prevalence was 2%; in the past 6 months, 69% reported two or more shooting partners, 72% used a cooker after someone else, 60% shared a syringe to divide up drugs, and 62% injected with used needles. Only 37% reported being hepatitis C seropositive, and 8% reported hepatitis B vaccination. It was feasible to conduct a jail-based survey of recently arrested IDUs that yielded useful information. The high prevalence of reported risky drug use practices warrants ongoing monitoring and illustrates the need for improving prevention programs for HIV and hepatitis B and C in this population, including expansion of hepatitis C screening and provision of hepatitis B vaccination at the jail health clinic.

Changes in injection risk behavior associated with participation in the Seattle needle-exchange program

Hagan, H., & Thiede, H. (n.d.).

Publication year

2000

Journal title

Journal of Urban Health

Volume

77

Issue

3

Page(s)

369-382

10.1007/BF02386747

Abstract

Abstract

We studied the influence of the Seattle, Washington, needle-exchange program on sharing of drug injection equipment (syringes, drug cookers, filtration cotton) to identify potential gaps in risk reduction and to understand in greater detail the lack of an association between exchange use and risk of hepatitis B or C virus transmission. In a cohort of 2,208 injection drug users who completed a 1-year follow-up visit, we measured the association between needle-exchange use at study enrollment (ever vs. never) and injection risk behavior at the follow-up. Control for confounding was carried out using both logistic regression and propensity score analytic methods to estimate the adjusted odds ratio (AOR). In both univariate and multivariate analyses, needle-exchange use was associated with a lower likelihood of injection with a used syringe (AOR = 0.7, 95% confidence limit 0.5, 0.9). There was no association between exchange use and cooker or cotton sharing (AOR = 0.8, 95% confidence limit 0.6, 1.1) or between exchange use and use of a common syringe to divide drugs (AOR = 0.9). This analysis suggests that risk reduction measures adopted by users of the Seattle exchange may not be sufficient to prevent transmission of all blood-borne viruses, including hepatitis C virus. Greater awareness of the infection risk associated with these practices may help curb this type of equipment sharing and ultimately prevent disease transmission.

HIV and HCV infection among injecting drug users

Hagan, H., & Des Jarlais, D. C. (n.d.).

Publication year

2000

Journal title

Mount Sinai Journal of Medicine

Volume

67

Issue

5

Page(s)

423-428

Abstract

Abstract

Background: Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are the two blood-borne pathogens most commonly transmitted among injection drug users via multi-person use of syringes and other injection equipment. However, important differences exist in the epidemiology of HIV and HCV within different populations of intravenous drug users. Methods: A literature review was carried out to summarize publications describing the epidemiology and natural history of HIV and HCV in injection drug users. Results: Among injection drug users worldwide, HIV prevalence varies from < 5% to > 80%, with annual HIV incidence between < 1% and 50%. More consistency is shown in HCV prevalence (50-90%) and incidence (10-30% per year). Host, environmental and viral factors that favor rapid spread of HCV among IDUs suggest that HCV infection in a population of injection drug users may become endemic over a relatively short period of time. Lower transmission efficiency for HIV also indicates that its spread among injection drug users may be somewhat slower. Conclusions: Successful efforts to prevent transmission of blood-borne viruses among IDUs typically result in risk reduction; however, no intervention has resulted in elimination of risk behavior. To reduce HIV transmission, risk reduction may be sufficient, whereas control of HCV may necessitate the use of injection practices that guarantee elimination of exposure to equipment contaminated with even small amounts of blood.

Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area

Thiede, H., Hagan, H., & Murrill, C. S. (n.d.).

Publication year

2000

Journal title

Journal of Urban Health

Volume

77

Issue

3

Page(s)

331-345

10.1007/BF02386744

Abstract

Abstract

Drug treatment has the potential to reduce incidence of blood-borne infections by helping injection drug users (IDUs) achieve abstinence or by decreasing the frequency of injection and sharing practices. We studied the associations between retention in methadone treatment and drug use behaviors and incidence of hepatitis B and C in a cohort of IDUs in the Seattle, Washington, area. Data on IDUs entering methadone treatment at four centers in King County, Washington, were collected through face-to-face interviews using a standardized questionnaire at baseline and 12-month follow-up between October 1994 and January 1998. Blood specimens were obtained and tested for human immunodeficiency virus (HIV) and hepatitis B and C. Drug treatment status at follow-up was analyzed in relation to study enrollment characteristics and potential treatment outcomes, including injection risk behaviors, cessation or reduced frequency of injection, and incidence of hepatitis B and C. Of 716 IDUs, 292 (41%) left treatment, 198 (28%) disrupted (left and returned) treatment, and 226 (32%) continued treatment throughout the 1-year follow-up period. Compared to those who left treatment, subjects who disrupted or continued were less likely to inject at follow-up (odds ratio [OR] = 0.5, 95% CI 0.3-0.7; and OR = 0.1, 95% CI 0.1-0.2, respectively). Among the 468 (65%) subjects who continued injecting, those who continued treatment injected less frequently, were less likely to pool money to buy drugs (OR = 0.5, 95% CI 0.3-0.8) and inject with used needles (OR = 0.5, 95% CI 0.2-0.8) compared to those who left treatment. Cooker or cotton sharing was not associated with retention in treatment, but hepatitis B incidence was lowest among those who continued treatment. The results of this study suggest drug use risk reduction is more likely to be achieved by those who remain in drug treatment and by those who stop injecting, but that those who drop out and return and those who continue to inject while in treatment may also benefit. This supports the role of consistent drug treatment in an overall harm-reduction strategy.

Re: 'Syringe exchange and risk of infection with hepatitis B and C viruses' [2] (multiple letters)

Voth, E. A., Hagan, H., McGough, J. P., Thiede, H., Hopkins, S. G., & Alexander, E. R. (n.d.). In American Journal of Epidemiology (1–).

Publication year

2000

Volume

151

Issue

2

Page(s)

207-208

10.1093/oxfordjournals.aje.a010190

Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors

Hagan, H., McGough, J. P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E. R. (n.d.).

Publication year

2000

Journal title

Journal of Substance Abuse Treatment

Volume

19

Issue

3

Page(s)

247-252

10.1016/S0740-5472(00)00104-5

Abstract

Abstract

The 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.

Volunteer bias in nonrandomized evaluations of the efficacy of needle- exchange programs

Hagan, H., McGough, J. P., Thiede, H., Hopkins, S. G., Weiss, N. S., & Alexander, E. R. (n.d.).

Publication year

2000

Journal title

Journal of Urban Health

Volume

77

Issue

1

Page(s)

103-112

10.1007/BF02350966

Abstract

Abstract

Objective. Nonrandomized comparisons of the incidence of HIV and hepatitis B and C between injection drug users (IDUs) who do and do not attend voluntary needle-exchange programs may be subject to bias. To explore possible sources of bias, we examined characteristics associated with voluntarily beginning or ceasing to participate in the Seattle needle exchange. Methods. In a cohort of 2,879 IDUs, a standardized questionnaire measured characteristics present at enrollment. We examined the relation of these characteristics to the proportion of IDUs who began to use the program during the ensuing 12-month follow-up period and to the proportion of current exchangers who dropped out during that period of time. Results. Of the 494 never-exchangers at baseline, 32% attended the exchange program during follow-up; those who reported sharing syringes or who were homeless at enrollment were more likely to become new exchange users (adjusted risk ratio [ARR] for becoming an exchange user = 1.8 for those who shared syringes, and ARR = 2.2 for those who were homeless). Of 1,274 current exchangers, 16% stopped using the exchange during follow-up, with daily injectors (ARR = 0.6) and those who reported backloading (APR = 0.6) being relatively less likely to drop out of the exchange. Conclusions. The analysis suggests that IDUs participating in needle-exchange programs at a given point in time may include a particularly high proportion of those injectors whose pattern of drug use puts them at elevated risk of blood-borne vital infections.

Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: A quasi-randomised trial

Des Jarlais, D. C., Paone, D., Milliken, J., Turner, C. F., Miller, H., Gribble, J., Shi, Q., Hagan, H., & Friedman, S. R. (n.d.).

Publication year

1999

Journal title

Lancet

Volume

353

Issue

9165

Page(s)

1657-1661

10.1016/S0140-6736(98)07026-3

Abstract

Abstract

Background. We aimed to assess audio-computer-assisted self-interviewing (audio-CASI) as a method of reducing under-reporting of HIV risk behaviour among injecting drug users. Methods. Injecting drug users were interviewed at syringe-exchange programmes in four US cities. Potential respondents were randomly selected from participants in the syringe exchanges, with weekly alternate assignment to either traditional face-to-face interviews or audio-CASI. The questionnaire included items on sociodemographic characteristics, drug use, and HIV risk behaviours for 30 days preceding the interview. We calculated odds ratios for the difference in reporting of HIV risk behaviours between interview methods. Findings. 757 respondents were interviewed face-to-face, and 724 were interviewed by audio-CASI. More respondents reported HIV risk behaviours and other sensitive behaviours in audio-CASI than in face-to-face interviews (odds ratios for reporting of rented or bought used injection equipment in audio-CASI vs face-to-face interview 2.1 [95% CI 1.4-3.3] p = 0.001; for injection with borrowed used injection equipment 1.5 [1.1-2.2] p = 0.02; for renting or selling used equipment 2.3 [1.3-4.0] p = 0.003). Interpretation. Although validation of these self-reported behaviours was not possible, we propose that audio-CASI enables substantially more complete reporting of HIV risk behaviour. More complete reporting might increase understanding of the dynamics of HIV transmission and make the assessment of HIV-prevention efforts easier.

Syringe exchange and risk of infection with hepatitis B and C viruses

Hagan, H., McGough, J. P., Thiede, H., Weiss, N. S., Hopkins, S., & Alexander, E. R. (n.d.).

Publication year

1999

Journal title

American Journal of Epidemiology

Volume

149

Issue

3

Page(s)

203-213

10.1093/oxfordjournals.aje.a009792

Abstract

Abstract

The authors utilized a cohort study among Seattle injection drug users (IDUs) to assess whether participation in a syringe exchange program was associated with incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Susceptible IDU subjects (187 seronegative for antibody to HCV, and 460 seronegative for core antibody to HBV) were identified in drug treatment, corrections, and social service agencies from June 1994 to January 1996, and followed for seroconversion one year later. The subjects included in the analysis were Seattle-King County (Washington State) area IDUs enrolled in a larger multipurpose cohort study, the Risk Activity Variables, Epidemiology, and Network Study (RAVEN Study). There were 39 HCV infections (20.9/100/year) and 46 HBV infections (10.0/100/year). There was no apparent protective effect of syringe exchange against HBV (former exchange users, relative risk (RR) = 0.68, 95% confidence interval (CI) 0.2-2.5; sporadic exchange users, RR = 2.4, 95% CI 0.9-6.5; regular users, RR - 1.81, 95% CI 0.7-4.8; vs. RR = 1.0 for nonusers of the exchange; adjusted for daily drug injection). Neither did the exchange protect against HCV infection (sporadic users, RR = 2.6, 95% CI 0.8-8.5; regular users, RR = 1.3, 95% CI 0.8-2.2; vs. RR = 1.0 for nonusers; adjusted for recent onset of injection and syringe sharing prior to enrollment). While it is possible that uncontrolled confounding or other bias obscured a true beneficial impact of exchange use, these data suggest that no such benefit occurred during the period of the study.

Hepatitis C virus transmission dynamics in injection drug users

Hagan, H. (n.d.).

Publication year

1998

Journal title

Substance Use and Misuse

Volume

33

Issue

5

Page(s)

1197-1212

10.3109/10826089809062214

Abstract

Abstract

Hepatitis C virus (HCV) presents several challenges to the development of prevention programs. HCV infection is persistent in up to 80% of cases, and viremic individuals may transmit infection to others. With 65-90% of injection drug users anti-HCV positive, a large reservoir of infection exists in most drug-injector populations. Studying the genetic variability of HCV infections could permit researchers to reconstruct chains of viral transmission in IDUs. However, the relationship of HCV to HIV epidemiology remains unclear and may depend on whether the proportions of infectious persons in the population are similar for both viruses.

HIV among injecting drug users

Des Jarlais, D. C., Hagan, H., & Friedman, S. (n.d.). In . Merigan, . Bartlet, & . Bolognesi (Eds.), Textbook of AIDS medicine (2nd eds., 1–).

Publication year

1998

Drug use

Des Jarlais, D. C., Friedman, S. R., Hagan, H., Paone, D., & Vlahov, D. (n.d.).

Publication year

1997

Journal title

AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV

Volume

9

Issue

1

Page(s)

53-57

Emerging infectious diseases and the injection of illicit psychoactive substances

Des Jarlais, D. C., Stimson, G. V., Hagan, H., Perlman, D., Choopanya, K., Bastos, F., & Friedman, S. (n.d.).

Publication year

1996

Journal title

Current Issues in Public Health

Volume

2

Page(s)

130-137

HIV among injecting drug users

Des Jarlais, D. C., Hagan, H., & Friedman, S. (n.d.). In J. Lowinson, P. Ruiz, R. Millman, & J. Langrod (Eds.), Substance abuse: Epidemiology and emerging public health perspectives (3rd eds., 1–).

Publication year

1996

Injection drug use and emerging blood-borne diseases [2]

Des Jarlais, D. C., Stimson, G. V., Hagan, H., & Friedman, S. R. (n.d.). In JAMA (1–).

Publication year

1996

Volume

276

Issue

13

Page(s)

1034

10.1001/jama.1996.03540130032014

The protective effect of AIDS-related behavioral change among injection drug users: A cross-national study

Des Jarlais, D. C., Friedmann, P., Hagan, H., & Friedman E., S. R. (n.d.).

Publication year

1996

Journal title

American journal of public health

Volume

86

Issue

12

Page(s)

1780-1785

10.2105/ajph.86.12.1780

Abstract

Abstract

Objective. This study assessed the relationship between self-reported acquired immunodeficiency syndrome (AIDS) behavioral change and human immunodeficiency virus (HIV) serostatus among injection drug users. Methods. The study sample involved 4419 injection drug users recruited from drug abuse treatment and nontreatment settings in 11 cities in North America, South America, Europe, Asia, and Australia, The World Health Organization multisite risk behavior questionnaire was used, and either blood or saliva samples for HIV testing were obtained. Subjects were asked, "Since you first heard about AIDS, have you done anything to avoid getting AIM?" Results. The protective odds ratio for behavioral change against being infected with HIV was 0.50 (95% confidence interval = 0.42, 0.59). White there was important variation across sites, the relationship remained consistent across both demographic and drug use history subgroups. Conclusions. Injection drug users are capable of modifying their HIV risk behaviors and reporting accurately on behavioral changes. These behavioral changes are associated with their avoidance of HIV infection.

Maintaining low HIV seroprevalence in populations of injecting drug users

Des 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, M. E., & Myers, T. (n.d.).

Publication year

1995

Journal title

JAMA

Volume

274

Issue

15

Page(s)

1226-1231

10.1001/jama.274.15.1226

Abstract

Abstract

Objectives. - To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUs), but where seroprevalence has nevertheless remained low (<5%) during at least 5 years. Design and Setting. - A literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUs. Participants. - Injecting drug users recruited from both drug treatment and nontreatment settings in each city. Interventions. - A variety of HIV prevention activities for IDUs had been implemented in each of the five cities. Results. - There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low, (2) provision of sterile injection equipment, and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one third or more of the IDUs reporting recent unsafe injections. Conclusions. - In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUs, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUs are at risk for rapid spread of HIV.

Management of children with hypodermic needle injuries

Bell, T., & Hagan, H. (n.d.).

Publication year

1995

Journal title

The Pediatric Infectious Disease Journal

Volume

14

Issue

3

Page(s)

254-255

Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program

Hagan, H., Des Jarlais, D. C., Friedman, S. R., Purchase, D., & Alter, M. J. (n.d.).

Publication year

1995

Journal title

American journal of public health

Volume

85

Issue

11

Page(s)

1531-1537

10.2105/AJPH.85.11.1531

Abstract

Abstract

Objectives. 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.

An interview study of participants in the Tacoma, Washington, syringe exchange

HAGAN, H., JARLAIS, D. C., PURCHASE, D., FRIEDMAN, S. R., REID, T., & BELL, T. A. (n.d.).

Publication year

1993

Journal title

Addiction

Volume

88

Issue

12

Page(s)

1691-1697

10.1111/j.1360-0443.1993.tb02044.x

Abstract

Abstract

Although European and Australian studies of syringe exchange programs have reported safer injection among participants and no increase in drug use, the generalizability of these findings to the US is uncertain. We report on the operations and potential effectiveness of the longest‐operating syringe exchange in the US and compare our results to studies of exchange programs outside the US. The sample of 204 study subjects reported no change in the frequency of injection, from 155 to 152 injections per month, and a decline in the frequency of unsafe injections, from 56 to 30 times per month, while participating in the program. In all studies, participants report reduction in unsafe injections, and no increase in illicit drug use. However, the comparison also suggests that a high proportion of Tacoma exchangers have higher initial rates of drug injection, unsafe injection and homelessness, all of which were associated with unsafe injection while using the exchange. These indicate a need for additional services but that the Tacoma program is no less effective than European and Australian programs.

Studies of HIV/AIDS and injecting drug use

Des Jarlais, D. C., Friedman, S. R., & Hagan, H. (n.d.).

Publication year

1992

Journal title

AIDS Care

Volume

4

Issue

4

Page(s)

481-485

10.1080/09540129208253129

The Incidence of HBV Infection and Syringe Exchange Programs

Hagan, H., Reid, T., Des Jarlais, D. C., Purchase, D., Friedman, S. R., & Bell, T. A. (n.d.). In JAMA: The Journal of the American Medical Association (1–).

Publication year

1991

Volume

266

Issue

12

Page(s)

1646-1647

10.1001/jama.1991.03470120048019