Complete works of Dr. Don Des Jarlais [medline search: Author = "Des Jarlais" - 4/11/01]

2
UI - 3
AU - Des J
AU - Schuchat A
AD - Chemical Dependency Institute, Beth Israel Medical Center, First Ave at 16th St, New York, NY 10003, USA. dcdesjarla@aol.com
TI - Hepatitis C among drug users: deja vu all over again?
MH - Hepatitis C
MH - epidemiology
MH - prevention & control
MH - transmission
MH - Human
MH - Needle Sharing
MH - Substance Abuse,Intravenous
MH - virology
MH - United States
RP - NOT IN FILE
NT - UI - 21030003LA - engPT - Journal ArticleDA - 20010112IS - 0090-0036SB - AIMSB - IMCY - United StatesJC - 3XW
UR - PM:11189818
SO - Am J Public Health 2001 Jan ;91(1):21-22

3
UI - 2
AU - Diaz T
AU - Des J
AU - Vlahov D
AU - Perlis TE
AU - Edwards V
AU - Friedman SR
AU - Rockwell R
AU - Hoover D
AU - Williams IT
AU - Monterroso ER
AD - Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Prevention Research and Analytic Methods, Atlanta, Ga., USA
TI - Factors associated with prevalent hepatitis C: differences among young adult injection drug users in lower and upper Manhattan, New York City
AB - OBJECTIVES: This study examined correlates of prevalent hepatitis C virus (HCV) infection among young adult injection drug users in 2 neighborhoods in New York City. METHODS: Injection drug users aged 18 to 29 years were street recruited from the Lower East Side and Harlem. Participants were interviewed about drug use and sex practices; venipuncture was performed for hepatitis B virus (HBV), HCV, and HIV serologies. RESULTS: In both sites, testing positive for HCV antibody (anti-HCV) was associated with having injected for more than 3 years. Additionally, HCV infection was positively associated with injecting with someone known to have had hepatitis (but the association was significant only in the Lower East Side) and with sharing cotton (but the association was statistically significant only in Harlem). Being in drug treatment and older than 24 years were associated with HCV in the Lower East Side but not in Harlem. Receiving money for sex was associated with anti-HCV positivity in Harlem but not in the Lower East Side. CONCLUSIONS: Several differences in factors associated with prevalent HCV infection existed among 2 populations of young injection drug users from the same city. Indirect transmission of HCV may occur
MH - Adolescence
MH - Adult
MH - Age Factors
MH - Comparative Study
MH - Female
MH - Hepatitis C
MH - epidemiology
MH - prevention & control
MH - transmission
MH - Human
MH - Logistic Models
MH - Male
MH - Multivariate Analysis
MH - Needle Sharing
MH - New York City
MH - Odds Ratio
MH - Poverty Areas
MH - Prevalence
MH - Residence Characteristics
MH - Risk Factors
MH - Risk-Taking
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - virology
RP - NOT IN FILE
NT - UI - 21030004LA - engPT - Journal ArticlePT - Multicenter StudyDA - 20010112IS - 0090-0036SB - AIMSB - IMCY - United StatesJC - 3XW
UR - PM:11189819
SO - Am J Public Health 2001 Jan ;91(1):23-30

4
UI - 1
AU - Vanichseni S
AU - Kitayaporn D
AU - Mastro TD
AU - Mock PA
AU - Raktham S
AU - Des J
AU - Sujarita S
AU - Srisuwanvilai LO
AU - Young NL
AU - Wasi C
AU - Subbarao S
AU - Heyward WL
AU - Esparza L
AU - Choopanya K
AD - Bangkok Metropolitan Administration, Thailand
TI - Continued high HIV-1 incidence in a vaccine trial preparatory cohort of injection drug users in Bangkok, Thailand
AB - BACKGROUND: A large epidemic of HIV-1 subtype B began among injection drug users (IDUs) in Bangkok in 1988. Despite ongoing prevention efforts, HIV-1 prevalence among IDUs remained at 30-50% through the 1990s. OBJECTIVES: To measure the incidence of HIV-1 infection and related risk factors to guide prevention efforts and to evaluate the feasibility of conducting an HIV vaccine efficacy trial. DESIGN AND METHODS: A prospective cohort study in which IDUs attending methadone treatment programs in Bangkok were screened during 1995-1996 for enrollment into the study. IDUs found to be HIV-seronegative on two occasions were offered enrollment with follow-up visits every 4 months. On each visit participants were evaluated with a questionnaire and serologic testing. RESULTS: A total of 1209 HIV-negative IDUs were enrolled. Through the end of 1998, the overall HIV-1 incidence rate was 5.8 (95% confidence interval, 4.8-6.8) per 100 person-years of follow- up. HIV-1 subtypes E and B accounted for 79 and 21% of infections, respectively. On multivariate analysis, HIV-1 seroconversion was primarily associated with the frequency of heroin injection, the sharing of injection equipment, and incarceration, especially with drug injection. Sexual behavior was not associated with increased risk for HIV-1. Risk factors for infection with HIV-1 subtypes E and B were similar. CONCLUSION: HIV-1 transmission risk remains high among Bangkok IDUs despite methadone treatment and other current prevention strategies. There is an urgent need to address this ongoing epidemic, especially in jails and prisons. This study led to the initiation in 1999 of a phase III HIV-1 vaccine efficacy trial in this population
RP - NOT IN FILE
NT - UI - 21120061LA - engPT - Journal ArticleDA - 20010301IS - 0269-9370SB - IMCY - EnglandJC - AID
UR - PM:11273220
SO - AIDS 2001 Feb 16 ;15(3):397-405

5
UI - 12
AU - Des J
AU - Marmor M
AU - Friedmann P
AU - Titus S
AU - Aviles E
AU - Deren S
AU - Torian L
AU - Glebatis D
AU - Murrill C
AU - Monterroso E
AU - Friedman SR
AD - Beth Israel Medical Center, New York, NY 10003, USA
TI - HIV incidence among injection drug users in New York City, 1992-1997: evidence for a declining epidemic
AB - OBJECTIVES: We assessed recent (1992-1997) HIV incidence in the large HIV epidemic among injection drug users in New York City. METHODS: Data were compiled from 10 separate studies (N = 4979), including 6 cohort studies, 2 "repeat service user" studies, and 2 analyses of voluntary HIV testing and counseling services within drug treatment programs. RESULTS: In the 10 studies, 52 seroconversions were found in 6344 person-years at risk. The observed incidence rates among the 10 studies were all within a narrow range, from 0 per 100 person-years at risk to 2.96 per 100 person-years at risk. In 9 of the 10 studies, the observed incidence rate was less than 2 per 100 person-years at risk. The weighted average incidence rate was 0.7 per 100 person-years at risk. CONCLUSIONS: The recent incidence rate in New York City is quite low for a high-seroprevalence population of injection drug users. The very large HIV epidemic among injection drug users in New York City appears to have entered a "declining phase," characterized by low incidence and declining prevalence. The data suggest that very large high- seroprevalence HIV epidemics may be "reversed."
MH - Adult
MH - Female
MH - HIV Infections
MH - diagnosis
MH - epidemiology
MH - ethnology
MH - etiology
MH - prevention & control
MH - Human
MH - Incidence
MH - Male
MH - Mass Screening
MH - New York City
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 20170029LA - engPT - Journal ArticleID - R01 DA 03574/DA/NIDAID - R01 DA 06001/DA/NIDAID - U01 DA 07286/DA/NIDAID - etcDA - 20000315IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:10705851
SO - Am J Public Health 2000 Mar ;90(3):352-359

6
UI - 13
AU - Des J
TI - Prospects for a public health perspective on psychoactive drug use ?editorialE
MH - Human
MH - Morals
MH - New York City
MH - epidemiology
MH - Psychotropic Drugs
MH - administration & dosage
MH - adverse effects
MH - Public Health
MH - trends
MH - Substance-Related Disorders
MH - prevention & control
MH - United States
RP - NOT IN FILE
NT - UI - 20170025LA - engRN - 0 (Psychotropic Drugs)PT - EditorialDA - 20000315IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:10705847
SO - Am J Public Health 2000 Mar ;90(3):335-337

7
UI - 10
AU - Des J
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, New York 10003, USA
TI - Structural interventions to reduce HIV transmission among injecting drug users
AB - OBJECTIVE: To review current knowledge of 'structural' interventions to reduce HIV transmission among injecting drug users. Structural interventions are defined as programs or policies that change the environments in which risk behavior occurs, without attempting to change knowledge, attitudes or social interaction patterns of the persons at risk. Structural interventions may either facilitate enactment of existing motives to avoid HIV transmission or make enacting risk behavior more difficult. METHODS: Nonquantitative literature review. RESULTS AND CONCLUSIONS: Preventing HIV infection among injecting drug users must be considered within the context of the continuing global spread of psychoactive drug use, and injecting drug use in particular. Some policies that are designed to reduce drug use may tend to increase HIV transmission among persons who do inject drugs. Evaluation of structural interventions can be difficult, as populations of drug users are usually the relevant unit of analysis. Typically, pre versus post comparisons must be used, hopefully with multiple pre and post data points. Structural interventions are often associated with 'large effects', increasing confidence that the intervention is the cause of the reduction in HIV-risk behavior. Increasing the availability of sterile injection equipment, through pharmacy sales or syringe exchange or both, is the most common and best- studied structural intervention for injecting drug users. The studies to date indicate that this usually, but not always, leads to large reductions in HIV-risk behavior. Involving drug users in the design and implementation of HIV-prevention programs can be considered a 'meta- structural' intervention that should lead to programs with increased effectiveness
MH - Disease Transmission,Horizontal
MH - HIV Infections
MH - prevention & control
MH - Health Policy
MH - Health Promotion
MH - Human
MH - Needle-Exchange Programs
MH - Substance Abuse,Intravenous
MH - Syringes
MH - supply & distribution
RP - NOT IN FILE
NT - UI - 20434339LA - engPT - Journal ArticlePT - ReviewPT - Review, AcademicDA - 20010109IS - 0269-9370SB - IMCY - ENGLANDJC - AID
UR - PM:10981473
SO - AIDS 2000 Jun ;14 Suppl 1():S41-S46

8
UI - 9
AU - Des J
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA. dcdesjarla@aol.com
TI - Research, politics, and needle exchange
AB - We now have had 15 years of public discussion of and research on needle exchange programs. The data have shown these programs to be usually, but not always, effective in limiting HIV transmission among injection drug users. Needle exchange programs are conceptualized within a larger framework of providing ready availability of sterile injection equipment for injection drug users. Continuing research is clearly needed regarding how to maximize the availability of sterile injection equipment and how to integrate this with other needed health and social services for drug users. Many initial opponents of needle exchange programs have become supporters of the programs. The number of programs in the United States has been increasing by about 20% per year, and this can be considered substantial progress in reducing HIV infection among injection drug users. Important opposition remains, however, based primarily on the symbolic values expressed in government support for the programs. These value conflicts over needle exchange, which have existed since it was first considered in the United States, cannot be resolved with data. In the late 1980s, the value conflicts greatly hampered the collection of relevant data--there was no federal funding of research on needle exchange programs. Currently, there is considerable research on needle exchange, but many researchers are quite concerned about possible misuse of findings. This may be considered progress to an important but modest degree. Whether current and future research will be used to improve HIV prevention efforts remains to be seen
MH - Attitude to Health
MH - Evidence-Based Medicine
MH - HIV Infections
MH - epidemiology
MH - etiology
MH - prevention & control
MH - Human
MH - Needle-Exchange Programs
MH - organization & administration
MH - Politics
MH - Program Evaluation
MH - Research
MH - Research Support
MH - Substance Abuse,Intravenous
MH - complications
MH - United States
RP - NOT IN FILE
NT - UI - 20438926LA - engPT - CommentPT - Journal ArticleDA - 20000921IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:10983194
SO - Am J Public Health 2000 Sep ;90(9):1392-1394

9
UI - 5
AU - Friedman SR
AU - Kottiri BJ
AU - Neaigus A
AU - Curtis R
AU - Vermund SH
AU - Des J
AD - Institute for AIDS Research, National Development and Research Institutes, Inc., New York, NY 10048, USA. sam.friedman@ndri.org
TI - Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population- group saturation
AB - In many cities, human immunodeficiency virus (HIV)-1 seroprevalence among drug injectors stabilizes at 30-70% for many years without secondary outbreaks that increase seroprevalence by 15% or more. The authors considered how HIV-1 incidence can remain moderate at seroprevalence levels that would give maximum incidence. Previously suggested answers include behavioral risk reduction and network saturation within high-risk subgroups. Among 767 drug injectors studied in 1991-1993, during a period of stable high seroprevalence in New York City, risk behaviors remained common, and networks were far from saturated. The authors suggest a different network-based mechanism: in stable high-prevalence situations, the relatively small sizes of subnetworks of linked seronegatives (within larger networks containing both infected and uninfected persons) may limit infectious outbreaks. Any primary infection outbreak would probably be limited to members of connected subcomponents of seronegatives, and the largest such subcomponent in the study contained only 18 members (of 415 seronegatives). Research and mathematical modeling should study conditions that may affect the size and stability of subcomponents of seronegatives. Finally, if the existence of small, connected components of seronegatives prevents secondary outbreaks, this protection may weaken, and vulnerability to new outbreaks increase, if HIV-1 seroprevalence falls. Thus, in situations of declining prevalence, prevention programs should be maintained or strengthened
MH - Cross-Sectional Studies
MH - Disease Outbreaks
MH - statistics & numerical data
MH - Group Processes
MH - HIV Infections
MH - epidemiology
MH - HIV Seronegativity
MH - immunology
MH - HIV Seroprevalence
MH - trends
MH - Hiv-1
MH - Human
MH - Interpersonal Relations
MH - New York City
MH - Risk Assessment
MH - Risk-Taking
MH - Sociometric Techniques
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
MH - Urban Population
RP - NOT IN FILE
NT - UI - 20540980LA - engPT - Journal ArticleID - DA06723/DA/NIDADA - 20001227IS - 0002-9262SB - IMCY - UNITED STATESJC - 3H3
UR - PM:11092433
SO - Am J Epidemiol 2000 Nov 15 ;152(10):913-922

10
UI - 8
AU - Galynker II
AU - Watras-Ganz S
AU - Miner C
AU - Rosenthal RN
AU - Des J
AU - Richman BL
AU - London E
AD - Department of Psychiatry, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003, USA
TI - Cerebral metabolism in opiate-dependent subjects: effects of methadone maintenance
AB - BACKGROUND: The long-term effects of opiate use on human brain are not known. The goal of this preliminary study was to determine whether human subjects with histories of opiate dependence have persistent differences in brain function as compared with individuals without substance use disorders, and whether methadone maintenance reverses or ameliorates the potential abnormality. METHOD: Positron emission tomographic (PET) [18F]fluorodeoxyglucose (FDG) method was used to compare the regional cerebral metabolic rate for glucose(rCMRglc) in three groups: four opiate-dependent subjects currently receiving methadone maintenance therapy (MM), four opiate-dependent subjects not receiving methadone maintenance therapy (MW), and a comparison group of five subjects without substance use disorders. RESULTS: A significant difference in rCMRglc in the anterior cingulate gyrus was found between the MW and Control groups (Mann-Whitney U=2.0, p=0.05). Generally speaking, rCMRglc's in MM subjects were intermediate between those of MW and Control groups, although the difference did not reach statistical significance. CONCLUSIONS: The results of this study suggest that neurobiological abnormalities can persist in the brain of a chronic opiate user several years after detoxification from methadone. Future research is needed to replicate these results and to determine whether the observed rCMRglc differences are related to opiate use or to neurochemical abnormalities that play a role in developing addictive behavior
MH - Adult
MH - Analgesics,Opioid
MH - pharmacology
MH - therapeutic use
MH - Brain
MH - drug effects
MH - metabolism
MH - Case-Control Studies
MH - Female
MH - Gyrus Cinguli
MH - Human
MH - Male
MH - Methadone
MH - Opioid-Related Disorders
MH - physiopathology
MH - Statistics,Nonparametric
MH - Support,U.S.Gov't,P.H.S.
MH - Tomography,Emission-Computed
RP - NOT IN FILE
NT - UI - 20519855LA - engRN - 0 (Analgesics, Opioid)RN - 76-99-3 (Methadone)PT - Journal ArticleID - R01 DA09431/DA/NIDADA - 20001201IS - 0027-2507SB - IMCY - UNITED STATESJC - NJU
UR - PM:11064488
SO - Mt Sinai J Med 2000 Oct ;67(5-6):381-387

11
UI - 7
AU - Hagan H
AU - Des J
AD - Public Health--Seattle and King County, 106 Prefontaine Place South, Seattle, WA 98104, USA
TI - HIV and HCV infection among injecting drug users
AB - 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. METHOD: 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
MH - Comparative Study
MH - HIV Infections
MH - drug therapy
MH - epidemiology
MH - physiopathology
MH - prevention & control
MH - Hepatitis C,Chronic
MH - Human
MH - Incidence
MH - Prevalence
MH - Preventive Health Services
MH - methods
MH - Substance Abuse,Intravenous
MH - virology
RP - NOT IN FILE
NT - UI - 20519860LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 20001201IS - 0027-2507SB - IMCY - UNITED STATESJC - NJU
UR - PM:11064493
SO - Mt Sinai J Med 2000 Oct ;67(5-6):423-428

12
UI - 11
AU - Marmor M
AU - Shore RE
AU - Titus S
AU - Chen X
AU - Des J
AD - Department of Environmental Medicine, Center for AIDS Research, New York University School of Medicine, New York City, USA. michael.marmor@med.nyu.edu
TI - Drug injection rates and needle-exchange use in New York City, 1991- 1996
AB - Objectives included (1) to develop methods for identifying injection drug users with accelerating injection habits so they might be referred to counseling and treatment and (2) to investigate behavioral correlates of accelerating injection habits, including syringe-exchange program utilization. Data on drug use, enrollment in methadone maintenance, and demographic variables were obtained from 328 subjects who were seronegative for human immunodeficiency virus (HIV) who attended anywhere from 4 to 11 quarterly study visits for interview, HIV pretest counseling and risk reduction counseling, and blood donation for HIV antibody testing. Subjects were recalled 2 weeks after each study visit to receive their results and post-test counseling. We characterized subjects according to their patterns of drug injection as accelerating, decelerating, or stable, using intraindividual regression analyses and categorization rules, and by syringe-exchange use as consistent users, sporadic users, or nonusers. The present subjects included 52% with decelerating, 29% with stable, and 19% with accelerating rates of drug injection. There were 128 subjects (39%) who were categorized as consistent users of syringe-exchange programs, 84 (25%) were categorized as sporadic users, and 116 (35%) were categorized as nonusers. All syringe-exchange groups showed significantly decelerating drug injection. Rates of decline were significantly less, however, among consistent syringe-exchange users than sporadic or nonusers of syringe exchanges. Categorical analysis also showed significant differences among groups, with 30% of consistent syringe-exchange program users having accelerating rates of drug injection compared to 9% of nonusers and 17% of sporadic users. That consistent syringe-exchange users included a larger proportion of individuals whose drug habits were accelerating than did sporadic users or nonusers of syringe exchanges suggests a need for improved identification and counseling of such subjects by syringe-exchange program staff. The present statistical approaches may be of value in targeting such efforts. The ability of a syringe-exchange program to attract a disproportionate share of drug users with accelerating rates of drug injection underscores the importance of these programs to HIV prevention efforts
MH - Adult
MH - Aged
MH - Cohort Studies
MH - Female
MH - HIV Infections
MH - blood
MH - prevention & control
MH - Human
MH - Longitudinal Studies
MH - Male
MH - Methadone
MH - Middle Age
MH - Needle-Exchange Programs
MH - methods
MH - statistics & numerical data
MH - New York City
MH - epidemiology
MH - Questionnaires
MH - Risk-Taking
MH - Substance Abuse Treatment Centers
MH - Substance Abuse,Intravenous
MH - ethnology
MH - rehabilitation
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 20431122LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleID - 1P30AI27742/AI/NIAIDID - DA06001/DA/NIDAID - MO1 RR00096/RR/NCRRDA - 20001213IS - 1099-3460SB - IMCY - UNITED STATESJC - C5L
UR - PM:10976610
SO - J Urban Health 2000 Sep ;77(3):359-368

13
UI - 6
AU - Monterroso ER
AU - Hamburger ME
AU - Vlahov D
AU - Des J
AU - Ouellet LJ
AU - Altice FL
AU - Byers RH
AU - Kerndt PR
AU - Watters JK
AU - Bowser BP
AU - Fernando MD
AU - Holmberg SD
AD - The Division of HIV/AIDS Prevention--Surveillance and Epidemiology, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
TI - Prevention of HIV infection in street-recruited injection drug users. The Collaborative Injection Drug User Study (CIDUS)
AB - BACKGROUND: Injection drug users (IDUs) and their sex partners account for an increasing proportion of new AIDS and HIV cases in the United States, but public debate and policy regarding the effectiveness of various HIV prevention programs for them must cite data from other countries, from non-street-recruited IDUs already in treatment, or other programs, and from infection rates for pathogens other than HIV. METHODS: Participants were recruited from the street at six sites (Baltimore [Maryland], New York [two sites], Chicago [Illinois], San Jose [California], Los Angeles [California], and at a state women's correctional facility [Connecticut]), interviewed with a standard questionnaire, and located and reinterviewed at one or more follow-up visits (mean, 7.8 months later). HIV serostatus and participation in various programs and behaviors that could reduce HIV infection risk were determined at each visit. RESULTS: In all, 3773 participants were recruited from the street, and 2306 (61%) were located and interviewed subsequently. Of 3562 initial serum specimens, 520 (14.6%) were HIV- seropositive; at subsequent assessment, 19 people, all from the East Coast and Chicago, had acquired HIV. Not using previously used needles was substantially protective against HIV acquisition (relative risk [RR], 0.29; 95% confidence interval [CI], 0.11-0.80 ) and, in a multivariate model, was significantly associated with use of needle and syringe exchange programs (adjusted odds ratio [ORadj], 2.08; 95% CI, 1.15-3.85). Similarly, reduction of injection frequency was very protective against seroconversion (RR, 0.33; 95% CI, 0.14-0.80), and this behavior was strongly associated with participation in drug treatment programs (ORadj, 3.54; 95% CI, 2.50-5.00). In a separate analysis, only 37.5% of study-participants had sufficient new needles to meet their monthly demand. CONCLUSIONS: In this large multicity study of IDUs in the United States, several HIV prevention strategies appeared to be individually and partially effective; these results indicate the continued need for, and substantial gaps in, effective approaches to preventing HIV infection in drug users
MH - Adult
MH - Cohort Studies
MH - Female
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - virology
MH - HIV Seropositivity
MH - Human
MH - Incidence
MH - Male
MH - Needle-Exchange Programs
MH - Prevalence
MH - Questionnaires
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - United States
MH - Urban Population
RP - NOT IN FILE
NT - UI - 20520072LA - engPT - Journal ArticleDA - 20001213IS - 1525-4135SB - IMCY - UNITED STATESJC - DGE
UR - PM:11064506
SO - J Acquir Immune Defic Syndr 2000 Sep 1 ;25(1):63-70

14
UI - 14
AU - Salomon N
AU - Perlman DC
AU - Friedmann P
AU - Ziluck V
AU - Des J
AD - Department of Medicine, Beth Israel Medical Center, New York, New York 10003, USA. nsalomon@bethisraelny.org
TI - Prevalence and risk factors for positive tuberculin skin tests among active drug users at a syringe exchange program
AB - OBJECTIVES: To evaluate the prevalence and predictors of tuberculin skin test (TST) reactions > or =10 mm among active injection drug users (IDUs) at a syringe exchange program in New York City. METHODS: From August 1995 to January 1996, participants were offered TB screening, an interview, and received $15.00 upon returning for skin test interpretation. RESULTS: 610/650 (94%) consented to screening. Of the 566 (93%) who returned for skin test readings, skin test data were available for 564 (99.8%); 14% (95% CI 11.6-17.4) had TSTs > or =10 mm. When the > or =5 mm threshold for interpretation of TST among HIV- infected persons was used, the prevalence of TST positivity increased by only 1%. In univariate analysis, the prevalence of TST > or =10 mm increased with age and with increasing years of IDU (both P = 0.001). Because of a strong correlation between age and duration of IDU, two logistic regression models were examined. In the model with age alone, a history of self-reported TST positivity (OR 8.88; 95% CI 4.9-16.09; P = 0.0001) and increasing age (OR per 10 years increase in age, 1.69; 95% CI 1.24-2.29; P = 0.0008) were independent predictors of TSTs > or =10 mm. In the model with duration of IDU, a history of TST positivity (OR 8.82; 95% CI 4.74-16.41; P = 0.0001) and duration of IDU (OR per 10 years of IDU, 1.46; 95% CI 1.10-1.94; P = 0.0081) were independent predictors of TST > or =10 mm. CONCLUSIONS: Use of the reduced cutoff point for TST positivity from 10 mm to 5 mm did not significantly affect the prevalence of positive TSTs in this cohort of active drug users. Increased prevalence of TB infection with age suggests a high annual incidence of TB infection in this population, and the increased risk of TB infection with increasing duration of IDU suggests that the duration spent in IDU environments may increase infection risk
MH - Adult
MH - Cohort Studies
MH - Female
MH - Human
MH - Logistic Models
MH - Male
MH - Mass Screening
MH - Needle-Exchange Programs
MH - New York City
MH - epidemiology
MH - Prevalence
MH - Risk Factors
MH - Socioeconomic Factors
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
MH - Tuberculin Test
MH - Tuberculosis
MH - diagnosis
RP - NOT IN FILE
NT - UI - 20118805LA - engPT - Journal ArticleID - R01-DA-09005-01A1/DA/NIDADA - 20000224IS - 1027-3719SB - IMCY - FRANCEJC - CY6
UR - PM:10654644
SO - Int J Tuberc Lung Dis 2000 Jan ;4(1):47-54

15
UI - 24
AU - Des J
AD - Beth Israel Medical Center, New York City, New York 10003, USA
TI - Psychoactive drug use and progression of HIV infection
AB - Early in the history of the AIDS epidemic there was clear evidence of differences in the outcomes of HIV infection between injecting drug users and men who have sex with men. There were also some indications that high levels of nonsterile drug injection may increase the progression of HIV infection. Recent epidemiologic studies indicate no differences in rates of progression to AIDS among drug injectors, men who have sex with men, or persons infected through heterosexual contact. In vitro and animal studies suggest that the effects of different psychoactive drugs on HIV infection may be negative, positive, or mixed, and that the effects of a psychoactive drug on immune functioning may differ among acute administration, chronic administration, or cessation of chronic administration. Although the current epidemiologic data do not provide support for the hypothesis that psychoactive drug use will have any important effects on the course of HIV infection, possible interactions between psychoactive drugs and antiviral medications and medication adherence issues among drug users are important areas for AIDS research. Relations between psychoactive drug use, the nervous system, and the immune system are a promising area for basic research
MH - Animal
MH - Disease Progression
MH - HIV Infections
MH - physiopathology
MH - Human
MH - Male
MH - Psychotropic Drugs
MH - pharmacology
RP - NOT IN FILE
NT - UI - 99174794LA - engRN - 0 (Psychotropic Drugs)PT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19990401IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:10077176
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1999 Mar 1 ;20(3):272-274

16
UI - 27
AU - Des J
AU - Friedman SR
AU - Perlis T
AU - Chapman TF
AU - Sotheran JL
AU - Paone D
AU - Monterroso E
AU - Neaigus A
AD - Beth Israel Medical Center, New York, New York 10003, USA
TI - Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City
AB - OBJECTIVE: To examine HIV risk behavior and HIV infection among new initiates into illicit drug injection in New York City. DESIGN AND METHODS: Cross-sectional surveys of injecting drug users (IDUs) recruited from a large detoxification treatment program (n=2489) and a street store-front research site (n=2630) in New York City from 1990 through 1996. Interviews covering demographics, drug use history, and HIV risk behavior were administered; serum samples were collected for HIV testing. Subjects were categorized into two groups of newer injectors: very recent initiates (just began injecting through 3 years) and recent initiates (injecting 4-6 years); and long-term injectors (injecting > or = 7 years). RESULTS: 954 of 5119 (19%) of the study subjects were newer injectors, essentially all of whom had begun injecting after knowledge about AIDS was widespread among IDUs in the city. New injectors were more likely to be female and white than long- term injectors, and new injectors were more likely to have begun injecting at an older age (median age at first injection for very recent initiates, 27 years; median age at first injection for recent initiates, 25 years; compared with median age at first injection for long-term injectors, 17 years). The newer injectors generally matched the long-term injectors in frequencies of HIV risk behavior; no significant differences were found among these groups on four measures of injection risk behavior. HIV infection was substantial among the newer injectors: HIV prevalence was 11% among the very recent initiates and 18% among the recent initiates. Among the new injectors, African Americans, Hispanics, females, and men who engaged in male-male sex were more likely to be infected. CONCLUSIONS: The new injectors appear to have adopted the reduced risk injection practices of long-term injectors in the city. HIV infection among new injectors, however, must still be considered a considerable public health problem in New York City
MH - Adult
MH - Aged
MH - Cross-Sectional Studies
MH - Female
MH - HIV Infections
MH - etiology
MH - HIV Seroprevalence
MH - Human
MH - Male
MH - Middle Age
MH - New York City
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 99125812LA - engPT - Journal ArticleID - 464CCU209685/PHSID - RO1 DA 03574/DA/NIDADA - 19990209IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:9928732
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1999 Jan 1 ;20(1):67-72

17
UI - 23
AU - Des J
AU - Hubbard R
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA
TI - Treatment for drug dependence
AB - Drug abuse treatment is a major method for reducing the health and social problems associated with dependence on psychoactive drugs. Drug dependence is very well established in the United States, where cyclical rises and falls in the use of different drugs often occur. Heroin and cocaine use are spreading rapidly throughout the world as a whole, particularly in developing countries. The need for effective treatments for drug dependence is likely to increase in the foreseeable future. Currently three major forms of long-term drug abuse treatment exist: methadone maintenance, in which an agonist medication is used to normalize physiological functioning; residential therapeutic communities, which are based on "resocializing" the drug user; and outpatient drug-free programs, which utilize a wide variety of counseling and psychotherapy approaches. Multiple large treatment outcome studies have been conducted among persons receiving treatment for drug dependence and have shown consistent effects in reducing the use of psychoactive drugs, though complete elimination of drug use is an infrequent outcome. Length of time in drug treatment is the best single predictor of positive post-treatment outcomes. HIV infection has become an extremely important adverse consequence associated with the injection of psychoactive drugs. Multiple studies have shown that drug abuse treatment is an effective method for preventing HIV infection among injecting drug users
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Substance-Related Disorders
MH - epidemiology
MH - therapy
MH - Treatment Outcome
MH - United States
RP - NOT IN FILE
NT - UI - 99237156LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19990629IS - 1081-650XSB - IMCY - UNITED STATESJC - CDQ
UR - PM:10220807
SO - Proc Assoc Am Physicians 1999 Mar ;111(2):126-130

18
UI - 21
AU - Des J
AU - Paone D
AU - Milliken J
AU - Turner CF
AU - Miller H
AU - Gribble J
AU - Shi Q
AU - Hagan H
AU - Friedman SR
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA
TI - Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: a quasi-randomised trial
AB - 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
MH - Adult
MH - Condoms
MH - utilization
MH - Female
MH - HIV Infections
MH - Human
MH - Interviews
MH - methods
MH - Male
MH - Needle-Exchange Programs
MH - Risk-Taking
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 99266816LA - engPT - Journal ArticleID - R01 DA 09536/DA/NIDADA - 19990610IS - 0140-6736SB - AIMSB - IMCY - ENGLANDJC - L0S
UR - PM:10335785
SO - Lancet 1999 May 15 ;353(9165):1657-1661

19
UI - 15
AU - Friedman SR
AU - Chapman TF
AU - Perlis TE
AU - Rockwell R
AU - Paone D
AU - Sotheran JL
AU - Des J
AD - National Development and Research Institutes, Inc., New York, New York 10048, USA. sam.friedman@ndri.org
TI - Similarities and differences by race/ethnicity in changes of HIV seroprevalence and related behaviors among drug injectors in New York City, 1991-1996
AB - OBJECTIVE: To measure differences and similarities in the prevalence of HIV infection and of related risk and protective behaviors among New York City black, white, and Hispanic drug injectors during a period of decreasing HIV prevalence. METHODS: Drug injectors were interviewed at a drug detoxification clinic and a research storefront in New York City from 1990 to 1996. All subjects had injected drugs within the last six months. Phlebotomy for HIV testing was conducted after pretest counseling. Analysis compares the first half (period) of this recruitment interval with the second half. RESULTS: HIV seroprevalence declined among each racial/ethnic group. In each period, white drug injectors were significantly less likely to be infected than either blacks or Hispanics. Similar declines were found in separate analyses by gender, length of time since first injection, and by recruitment site. After adjustment for changes in sample composition over time, blacks and Hispanics remained significantly more likely to be infected than whites. Interactions indicate that the decline may be greatest among Hispanics and slowest among blacks. A wide variety of risk behaviors declined in each racial/ethnic group; and syringe exchange use increased in each group. Few respondents reported injecting with members of a different racial group at their last injection event. CONCLUSIONS: HIV prevalence and risk behaviors seem to be falling among each racial/ethnic group of drug injectors. Black and Hispanic injectors continue to be more likely to be infected. Declining prevalence among whites poses some risk of politically based decisions to reduce prevention efforts. Overall, these results show that risk reduction can be successful among all racial/ethnic groups of drug injectors and suggest that continued risk reduction programs may be able to attain further declines in infection rates in each group
MH - Adult
MH - Blacks
MH - Female
MH - HIV Infections
MH - ethnology
MH - HIV Seroprevalence
MH - trends
MH - Health Behavior
MH - Hispanic Americans
MH - Human
MH - Male
MH - Needle Sharing
MH - statistics & numerical data
MH - New York City
MH - epidemiology
MH - Risk-Taking
MH - Sex Distribution
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Whites
RP - NOT IN FILE
NT - UI - 20001718LA - engPT - Journal ArticleID - DA03574/DA/NIDAID - U64/CCU209685/PHSDA - 19991028IS - 1525-4135SB - IMCY - UNITED STATESJC - DGE
UR - PM:10534151
SO - J Acquir Immune Defic Syndr 1999 Sep 1 ;22(1):83-91

20
UI - 19
AU - Friedman SR
AU - Curtis R
AU - Jose B
AU - Flom PL
AU - Neaigus A
AU - Des J
TI - The message not heard: myth and reality in discussions about syringe exchange
MH - Adolescence
MH - Adult
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Knowledge,Attitudes,Practice
MH - Needle-Exchange Programs
MH - New York City
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 99323705LA - engPT - LetterID - DA06723/DA/NIDADA - 19990921IS - 0269-9370SB - IMCY - ENGLANDJC - AID
UR - PM:10397576
SO - AIDS 1999 Apr 16 ;13(6):738-739

21
UI - 18
AU - MacQueen KM
AU - Vanichseni S
AU - Kitayaporn D
AU - Lin LS
AU - Buavirat A
AU - Naiwatanakul T
AU - Raktham S
AU - Mock P
AU - Heyward WL
AU - Des J
AU - Choopanya K
AU - Mastro TD
AD - Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. kmm3@cdc.gov
TI - Willingness of injection drug users to participate in an HIV vaccine efficacy trial in Bangkok, Thailand
AB - We assessed willingness to participate in an HIV recombinant gp120 bivalent subtypes B/E candidate vaccine efficacy trial among 193 injection drug users (IDUs) attending drug treatment clinics in Bangkok, Thailand. IDUs previously enrolled in a prospective cohort study were invited to group sessions describing a potential trial, then completed questionnaires assessing comprehension and willingness to participate. A week later, they completed a follow-up questionnaire that again assessed comprehension and willingness to participate, as well as barriers to and positive motives for participation, with whom (if anyone) they talked about the information, and whether others thought participation was a good, bad, or neutral idea. At baseline, 51% were definitely willing to participate, and at follow-up 54%; only 3% were not willing to participate at either time. Comprehension was high at baseline and improved at follow-up. Participants who viewed altruism, regular HIV tests, and family support for participation as important were more willing to volunteer. Frequency of incarceration and concerns about the length of the trial, possible vaccine-induced accelerated disease progression, and lack of family support were negatively associated with willingness. Overall, IDUs comprehended the information needed to make a fully informed decision about participating in an rgp120 vaccine efficacy trial and expressed a high level of willingness to participate in such a trial
MH - AIDS Vaccines
MH - Adult
MH - Clinical Trials
MH - HIV Envelope Protein gp120
MH - Human
MH - Male
MH - Motivation
MH - Patient Acceptance of Health Care
MH - Prospective Studies
MH - Substance Abuse,Intravenous
MH - psychology
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
MH - Vaccines,Synthetic
RP - NOT IN FILE
NT - UI - 99347617LA - engRN - 0 (AIDS Vaccines)RN - 0 (AIDSVAX)RN - 0 (HIV Envelope Protein gp120)RN - 0 (Vaccines, Synthetic)PT - Journal ArticleDA - 19990819IS - 1525-4135SB - IMCY - UNITED STATESJC - DGE
UR - PM:10421249
SO - J Acquir Immune Defic Syndr 1999 Jul 1 ;21(3):243-251

22
UI - 22
AU - Novotna L
AU - Wilson TE
AU - Minkoff HL
AU - McNutt LA
AU - DeHovitz JA
AU - Ehrlich I
AU - Des J
AD - State University of New York, School of Public Health at Albany, USA
TI - Predictors and risk-taking consequences of drug use among HIV-infected women
AB - ObJECTIVE: To determine rates of drug use among women with HIV, and to examine associations between drug use, health, risk behavior, and sexually transmitted diseases (STD). DESIGN: A longitudinal cohort study of 260 women with confirmed HIV-positive serostatus. METHODS: Each participant contributed a self-report interview, a clinical examination, laboratory testing of cultures for Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and urinalysis for the presence of metabolites of cocaine and opiates. Data were examined on 140 women at 1-year follow-up. Women were defined as drug users if they reported crack, cocaine, or heroin use in the 6 months before the interview or if they had a positive toxicologic test result for cocaine or opiates. RESULTS: 34% of those in the sample were classified as positive for drug use. Drug use was associated with the number of sexual partners, age at first intercourse, prevalence of STDs, and lower quality of life. STDs were present at baseline in 33.7% and 15.5% of drug users and nonusers, respectively. Drug use among this population was also associated at both baseline and follow-up with the likelihood of having a Karnofsky score below 80, and with overall perceived general health. CONCLUSIONS: Drug users in this cohort were more likely to engage in behaviors that place them at risk for STDs, to have elevated STD prevalence, and to have lower perceived health across several indices. Identification of drug use and treatment for it need to be a central component of HIV care for women
MH - Adult
MH - Female
MH - HIV Infections
MH - immunology
MH - physiopathology
MH - psychology
MH - Human
MH - Longitudinal Studies
MH - Predictive Value of Tests
MH - Quality of Life
MH - Risk-Taking
MH - Sex Behavior
MH - Sexually Transmitted Diseases
MH - Substance-Related Disorders
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 99239740LA - engPT - Journal ArticleID - NO1-HD-8-2913/HD/NICHDID - RO1-AI-3134/AI/NIAIDID - TW00233/TW/FICDA - 19990528IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:10225234
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1999 Apr 15 ;20(5):502-507

23
UI - 17
AU - Paone D
AU - Cooper H
AU - Alperen J
AU - Shi Q
AU - Des J
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA
TI - HIV risk behaviours of current sex workers attending syringe exchange: the experiences of women in five US cities
AB - Existing research indicates that sex workers who inject drugs are vulnerable to HIV infection through both risky sexual and drug use practices. This study is the first attempt to learn whether this increased risk persists among current sex workers who participate in syringe exchange programmes (SEPs). With data from interviews with randomly selected participants in five US cities, we compared the demographic characteristics, sexual risk behaviours, drug use practices, emotional and physical health, and SEP utilization patterns of currently active female sex workers who attend SEPs with female SEP participants who do not engage in sex work. Data indicate that women enrolled in SEPs who were currently trading sex typically reported greater HIV risk than women non-sex workers. Current sex workers reported higher levels of risk for every drug risk variable examined in bivariate analysis. They were more likely than other women to inject with a syringe previously used by someone else, to inject daily and to attend shooting galleries; they were less likely to use a condom with their primary partners and to report higher levels of psychological distress than their counterparts. The relationship between sex work status and risky injection practices persisted when potential confounders were controlled for in multivariate analysis. SEPs can serve a pivotal role in providing sex workers with services and referrals which would help them reduce risk behaviours
MH - Acquired Immunodeficiency Syndrome
MH - psychology
MH - Adult
MH - Female
MH - HIV Infections
MH - Human
MH - Multivariate Analysis
MH - Needle Sharing
MH - Prostitution
MH - Risk-Taking
MH - Stress,Psychological
MH - etiology
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,Non-U.S.Gov't
MH - United States
RP - NOT IN FILE
NT - UI - 99403875LA - engPT - Journal ArticleDA - 19990930IS - 0954-0121SB - IMCY - ENGLANDJC - A1O
UR - PM:10474627
SO - AIDS Care 1999 Jun ;11(3):269-280

24
UI - 25
AU - Paone D
AU - Clark J
AU - Shi Q
AU - Purchase D
AU - Des J
AD - Beth Israel Medical Center, New York, NY 10003, USA. dpaone@ix.netcom.com
TI - Syringe exchange in the United States, 1996: a national profile
AB - OBJECTIVES: This paper provides 1996 information on the status of US syringe exchange programs and compares these findings with data from our 1994 survey. METHODS: In November 1996, questionnaires were mailed to 101 syringe exchange programs. Program directors were contacted to conduct telephone interviews based on the mailed questionnaires. Data collected included number of syringes exchanged, syringe exchange program operations, legal status, and services offered. RESULTS: Eighty- seven programs participated in the survey. A total of 46 (53%) were legal, 20 (23%) were illegal but tolerated, and 21 (24%) were illegal- underground. Since 1994, there has been a 54% increase in the number of cities and a 38% increase in the number of states with syringe exchange programs. Eighty-four programs reported exchanging approximately 14 million syringes, a 75% increase from 1994. Syringe exchange programs also provided a variety of other services and supplies, and legal programs were more likely than illegal ones to provide these services. CONCLUSION: Despite continued lack of federal funding, syringe exchange programs expanded in terms of the number of syringes exchanged, the geographic distribution of programs, and the range of services offered
MH - Health Care Surveys
MH - Human
MH - Needle-Exchange Programs
MH - legislation & jurisprudence
MH - organization & administration
MH - trends
MH - Organizational Objectives
MH - Program Evaluation
MH - Questionnaires
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 99141936LA - engPT - Journal ArticleID - 1 R01 DA09356-01A1/DA/NIDADA - 19990303IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:9987463
SO - Am J Public Health 1999 Jan ;89(1):43-46

25
UI - 20
AU - Perlman DC
AU - Henman AR
AU - Kochems L
AU - Paone D
AU - Salomon N
AU - Des J
AD - Beth Israel Medical Center, New York, NY 10003, USA. perlman@aecom.yu.edu
TI - Doing a shotgun: a drug use practice and its relationship to sexual behaviors and infection risk
AB - There has been a rise in the frequency with which inhalational routes such as smoking are used for illicit drug use. A growing population of new inhalational drug users augments the pool of individuals at risk for transition to injection drug use. Further, illicit drug smoking has been implicated in the transmission of a variety of pathogens by the respiratory route, and crack smoking has been associated with an increased risk of HIV infection, particularly through the exchange of high-risk sex for drugs. Shotguns are an illicit drug smoking practice in which smoked drugs are exhaled or blown by one user into the mouth of another user. We conducted a series of ethnographic observations to attempt to characterize more fully the practice of shotgunning, the range of associated behaviors, and the settings and contexts in which this practice occurs. Shotguns may be seen as a form of drug use which has close ties to sexual behaviors, and which has both pragmatic and interpersonal motivations, combining in a single phenomenon the potential direct and indirect risk of disease transmission by sexual, blood borne and respiratory routes. These data support the need to develop and evaluate comprehensive risk reduction interventions, which take into consideration the relationships between interpersonal and sexual behaviors and specific forms of drug use
MH - Administration,Inhalation
MH - Adolescence
MH - Adult
MH - Crack Cocaine
MH - administration & dosage
MH - Data Collection
MH - Disease Transmission,Horizontal
MH - Female
MH - HIV Infections
MH - epidemiology
MH - transmission
MH - Human
MH - Incidence
MH - Male
MH - Middle Age
MH - Risk Assessment
MH - Risk-Taking
MH - Sex Behavior
MH - drug effects
MH - Smoking
MH - Social Behavior
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - Tuberculosis
MH - United States
RP - NOT IN FILE
NT - UI - 99296134LA - engRN - 0 (Crack Cocaine)PT - Journal ArticleID - RO1-DA-09005/DA/NIDAID - RO1-DA9005-01A1/DA/NIDADA - 19990804IS - 0277-9536SB - IMCY - ENGLANDJC - UT9
UR - PM:10369443
SO - Soc Sci Med 1999 May ;48(10):1441-1448

26
UI - 16
AU - Rockwell R
AU - Des J
AU - Friedman SR
AU - Perlis TE
AU - Paone D
AD - National Development and Research Institutes, Inc., New York 10048, USA
TI - Geographic proximity, policy and utilization of syringe exchange programmes
AB - The objective of the research was to assess the effects of geographic proximity on the utilization of syringe exchange among injection drug users (IDUs) in New York City. Between 1994 and 1996, 805 IDUs were interviewed with a structured questionnaire. Geographic proximity was defined as living within a ten-minute walk. Eighty-one per cent of IDUs who lived close typically used a syringe exchange compared to 59% of those who lived further away. In multiple logistic regression analysis, those who lived close remained (adjusted odds ratio of 2.89; 95% CI 2.06 to 4.06, p = 0.001) more likely to use syringe exchange. Those who lived close were less likely to have engaged in receptive syringe sharing at last injection (adjusted odds ratio = 0.45, 95% CI 0.24 to 0.86, p = 0.015). In conclusion, locating exchange services in areas convenient to large numbers of IDUs may be critical for prevention of HIV infection
MH - Adult
MH - Female
MH - HIV Infections
MH - prevention & control
MH - Health Policy
MH - Human
MH - Male
MH - Needle Sharing
MH - statistics & numerical data
MH - Needle-Exchange Programs
MH - utilization
MH - New York City
MH - epidemiology
MH - Questionnaires
MH - Residence Characteristics
MH - Substance Abuse,Intravenous
MH - rehabilitation
RP - NOT IN FILE
NT - UI - 20003729LA - engPT - Journal ArticleDA - 19991108IS - 0954-0121SB - IMCY - ENGLANDJC - A1O
UR - PM:10533536
SO - AIDS Care 1999 Aug ;11(4):437-442

27
UI - 35
AU - Des J
AD - Beth Israel Medical Center, New York, New York, USA
TI - "Single-use" needles and syringes for the prevention of HIV infection among injection drug users
AB - Providing single-use injection equipment to persons who inject illicit drugs would appear to be an effective method for reducing HIV transmission. However, interviews with manufacturers, syringe exchange program staff, and drug users revealed numerous difficulties with such a technologic solution. All designs for such equipment can be defeated and should probably be called difficult-to-reuse equipment. There are problems with consumer acceptance of difficult-to-reuse equipment and with safe disposal of large amounts of biohazardous waste. Despite these problems, it would be useful to conduct additional research, particularly on the potential for placing difficult-to-reuse equipment into shooting galleries
MH - Australia
MH - Costs and Cost Analysis
MH - Disposable Equipment
MH - economics
MH - Equipment Design
MH - Equipment Reuse
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Needles
MH - Substance Abuse,Intravenous
MH - Syringes
MH - United States
RP - NOT IN FILE
NT - UI - 98326757LA - engPT - Journal ArticleDA - 19980728IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:9663624
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1998 ;18 Suppl 1():S52-S56

28
UI - 40
AU - Des J
AU - Vanischseni S
AU - Marmor M
AU - Kitayaporn D
TI - HIV vaccine trials
MH - AIDS Vaccines
MH - Clinical Trials
MH - standards
MH - Ethics,Medical
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Preventive Health Services
MH - Risk-Taking
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - United States
RP - NOT IN FILE
NT - UI - 98170741LA - engRN - 0 (AIDS Vaccines)PT - CommentPT - LetterDA - 19980318IS - 0036-8075SB - IMCY - UNITED STATESJC - UJ7
UR - PM:9508711
SO - Science 1998 Mar 6 ;279(5356):1433-1434

29
UI - 33
AU - Des J
AD - Beth Israel Medical Center, New York, NY 1003, USA
TI - Validity of self-reported data, scientific methods and drug policy
MH - Crime
MH - psychology
MH - statistics & numerical data
MH - Data Collection
MH - Drug and Narcotic Control
MH - legislation & jurisprudence
MH - Epidemiologic Research Design
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Israel
MH - Reproducibility of Results
MH - Substance Abuse,Intravenous
MH - epidemiology
MH - Truth Disclosure
RP - NOT IN FILE
NT - UI - 99004267LA - engPT - CommentPT - Journal ArticleDA - 19990126IS - 0376-8716SB - IMCY - IRELANDJC - EBS
UR - PM:9787999
SO - Drug Alcohol Depend 1998 Aug 1 ;51(3):265-266

30
UI - 38
AU - Des J
TI - Understanding the long-term course of HIV epidemics
MH - Disease Outbreaks
MH - HIV Infections
MH - epidemiology
MH - HIV Seroprevalence
MH - Human
MH - Netherlands
RP - NOT IN FILE
NT - UI - 98242910LA - engPT - CommentPT - EditorialDA - 19980608IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:9583608
SO - AIDS 1998 Apr 16 ;12(6):669-670

31
UI - 30
AU - Des J
AU - Perlis T
AU - Friedman SR
AU - Deren S
AU - Chapman T
AU - Sotheran JL
AU - Tortu S
AU - Beardsley M
AU - Paone D
AU - Torian LV
AU - Beatrice ST
AU - DeBernardo E
AU - Monterroso E
AU - Marmor M
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA. dcdesjarla@aol.com
TI - Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996
AB - OBJECTIVES: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. METHODS: We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested. RESULTS: From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend). CONCLUSIONS: The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV- seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence
MH - Adult
MH - Female
MH - HIV Seroprevalence
MH - trends
MH - Health Behavior
MH - Human
MH - Male
MH - New York City
MH - epidemiology
MH - Odds Ratio
MH - Population Surveillance
MH - Racial Stocks
MH - Risk Factors
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Urban Health
RP - NOT IN FILE
NT - UI - 99058517LA - engPT - Journal ArticleID - R01 DA 03574/DA/NIDAID - U01 DA 07286/DA/NIDAID - U64/CCU209685/PHSID - etcDA - 19981218IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:9842377
SO - Am J Public Health 1998 Dec ;88(12):1801-1806

32
UI - 29
AU - Des J
AU - Friedman SR
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA. dcdesjarla@aol.com
TI - Fifteen years of research on preventing HIV infection among injecting drug users: what we have learned, what we have not learned, what we have done, what we have not done
AB - OBJECTIVE: Acquired immunodeficiency syndrome (AIDS) was formally identified among injecting drug users (IDUs) in 1981, and research on preventing human immunodeficiency virus (HIV) infection among drug injectors began shortly thereafter. At the time this research was begun, there was a general assumption that drug user (who were called drug abusers at that time) were too self-destructive and their behavior too chaotic for them to change their behavior to avoid infection with HIV. This chapter reviews the history of research on implementation of programs for prevention of HIV infection among IDUs. METHODS: Reviews of both research and program implementation research were conducted. Consultative discussions of issues and findings were conducted with researcher in the United States and other countries. RESULTS: An extremely large amount of useful information has accumulated during the pat 15 years. We now know that the great majority of IDUs will change their injecting behavior in response to the threat of AIDS and that these behavior changes are effective in reducing HIV transmission among drug injectors. Additional insight is needed regarding the apparent insufficiency of some prevention programs to control HIV, the transmission dynamics of rapid HIV spread, and the persistence of moderate to high incidence of HIV infection in high seroprevalence populations. Despite the current research knowledge base, implementation of effective prevention programs in may countries is nonexistent to incomplete. CONCLUSIONS: The most important barrier to reducing HIV transmission among drug injectors is not a lack of knowledge but the failure to implement effective prevention programs in may parts of the world
MH - HIV Infections
MH - etiology
MH - prevention & control
MH - Health Services Accessibility
MH - Human
MH - Primary Prevention
MH - organization & administration
MH - Substance-Related Disorders
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - United States
MH - World Health
RP - NOT IN FILE
NT - UI - 98390047LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - R01 03574/PHSDA - 19980921IS - 0033-3549SB - AIMSB - IMCY - UNITED STATESJC - QJA
UR - PM:9722823
SO - Public Health Rep 1998 Jun ;113 Suppl 1():182-188

33
UI - 28
AU - Friedman SR
AU - Furst RT
AU - Jose B
AU - Curtis R
AU - Neaigus A
AU - Des J
AU - Goldstein MF
AU - Ildefonso G
AD - National Development and Research Institutes, Inc., New York 10048, USA. sam.friedman@NDRI.org
TI - Drug scene roles and HIV risk
AB - AIMS: Drug scenes (social and spatial drug-using and drug-selling environments) have complex role structures. Many drug injectors earn money or drugs as drug or syringe sellers, hit doctors (people who help others to inject) commercial sex workers, or in other roles. This paper aims to measure "role behaviors" of drug injectors; describe which drug injectors are more likely to engage in such role behaviors; and to determine whether roles are related to elements of HIV risk. DESIGN: Cross-sectional study of drug injectors. SETTING: Bushwick, a section of Brooklyn, New York, a major location for injection drug use and drug sales. PARTICIPANTS: Seven hundred and sixty-seven street-recruited drug injectors. MEASUREMENTS: Participants were interviewed about their roles, behaviors, socio-demographics and risk networks; sera were collected and assayed for HIV and hepatitis B core antibody. FINDINGS: Socio-demographic variables are related to role-holding in complex ways. Economic need is generally associated with engaging in drug-scene role behaviors. Holders of these roles are at greater behavioral and network risk for HIV and other blood-borne infections than are other drug injectors. They also engage in extensive communication with other drug users, including discussion of HIV risk reduction. CONCLUSION: Role behaviors can be measured in quantitative studies, and seem to be related to HIV risk. Role-holders may be strategic targets for risk- reduction campaigns. It seems feasible and advisable to measure drug scene role-holding in research on drug users
MH - Adult
MH - Female
MH - HIV Infections
MH - etiology
MH - Human
MH - Male
MH - New York
MH - epidemiology
MH - Risk-Taking
MH - Role
MH - Sex Behavior
MH - Street Drugs
MH - Substance Abuse,Intravenous
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
MH - supply & distribution
RP - NOT IN FILE
NT - UI - 99125462LA - engRN - 0 (Street Drugs)PT - Journal ArticleID - DA06723/DA/NIDADA - 19990209IS - 0965-2140SB - IMCY - ENGLANDJC - BM3
UR - PM:9926546
SO - Addiction 1998 Sep ;93(9):1403-1416

34
UI - 31
AU - Henman AR
AU - Paone D
AU - Des J
AU - Kochems LM
AU - Friedman SR
AD - Chemical Dependency Institute, New York, NY 10003, USA
TI - Injection drug users as social actors: a stigmatized community's participation in the syringe exchange programmes of New York City
AB - In 1992, New York State Department of Health regulations provided for fully legal syringe exchange programmes in the state. The policies and procedures mandated that: 'Each program must seek to recruit ... for inclusion on its advisory board ... program participants ... Programs are also urged to establish other advisory bodies, such as Users' Advisory Boards made up of program participants, to provide input and guidance on program policies and operations.' The inclusion of drug users as official advisors to the legal programmes was seen as a method for incorporating the views of the consumers of the service in operational decisions. The 1992 regulations implied a new public image for users of illicit psychoactive drugs: active drug users were seen to be capable not only of self-protective actions (such as avoiding HIV infection), but also of serving as competent collaborators in programmes to preserve the public health. This development has important implications with regard to the evolution of official drug policy, since it will be difficult in future to treat IDUs simply as the passive objects of state intervention. Whether as individuals or representatives of a wider population of illicit drug users, they have acquired a legitimacy and sense of personal worth which would have been unthinkable in previous periods
MH - Human
MH - Needle-Exchange Programs
MH - organization & administration
MH - New York City
MH - Patient Participation
MH - Public Health
MH - Stereotyping
MH - Substance Abuse,Intravenous
MH - psychology
MH - therapy
RP - NOT IN FILE
NT - UI - 99046400LA - engPT - Journal ArticleDA - 19981204IS - 0954-0121SB - IMCY - ENGLANDJC - A1O
UR - PM:9828960
SO - AIDS Care 1998 Aug ;10(4):397-408

35
UI - 37
AU - Henman AR
AU - Paone D
AU - Des J
AU - Kochems LM
AU - Friedman SR
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA
TI - From ideology to logistics: the organizational aspects of syringe exchange in a period of institutional consolidation
AB - The initial period in the establishment of syringe exchange projects is often characterized by overt conflict: between community AIDS activists, on the one hand, and public officials and political leaders who remain ideologically opposed to the introduction of measures perceived as condoning illicit drug use. In this context, professionals concerned with legitimating the new institutions of syringe exchange may sometimes neglect aspects of their everyday logistics and social organization, obscuring the important choices which have to be made to carry these initiatives forward. In particular, the contrast between formally-constituted institutions-the "storefront" or "community-based" syringe exchange programs (SEPs)-and the model of low-threshold syringe availability through pharmacies, vending machines, and user networks, is here presented not as an either/or choice but rather as a pair of complementary strategies which respond to diverse needs and target different populations. The advantages and disadvantages of each particular approach make it likely that maximum effectiveness will be achieved through a combination of every possible form of needle distribution, each tailored to specific and cultural circumstances. The case is here examined in the light of the experience of the SEPs in New York City, from their clandestine origins in 1990 through their first years of official functioning in 1992-1996
MH - Attitude of Health Personnel
MH - Community-Institutional Relations
MH - Human
MH - Interinstitutional Relations
MH - Models,Organizational
MH - Needle-Exchange Programs
MH - organization & administration
MH - New York City
MH - Politics
MH - Program Development
MH - Program Evaluation
MH - Support,Non-U.S.Gov't
MH - Urban Health Services
RP - NOT IN FILE
NT - UI - 98255823LA - engPT - Journal ArticleDA - 19980709IS - 1082-6084SB - IMCY - UNITED STATESJC - CGG
UR - PM:9596384
SO - Subst Use Misuse 1998 Apr ;33(5):1213-1230

36
UI - 32
AU - Kitayaporn D
AU - Vanichseni S
AU - Mastro TD
AU - Raktham S
AU - Vaniyapongs T
AU - Des J
AU - Wasi C
AU - Young NL
AU - Sujarita S
AU - Heyward WL
AU - Esparza J
AD - HIV/AIDS Collaboration, Nonthaburi, Thailand
TI - Infection with HIV-1 subtypes B and E in injecting drug users screened for enrollment into a prospective cohort in Bangkok, Thailand
AB - From May through August 1995, a cross-sectional survey was conducted among injecting drug users (IDUs) drawn from 15 drug treatment clinics in Bangkok and who were not known to be HIV-seropositive, to determine the prevalence of HIV-1 subtypes B and E and related risk behaviors, and to offer enrollment in a prospective cohort study. IDUs who voluntarily consented were interviewed, and blood specimens were tested for the presence of HIV antibodies. HIV-1-seropositive specimens were tested for subtypes B' (Thai B) and E by using V3 loop peptide enzyme immunoassays specific for these HIV-1 genetic subtypes. Of 1674 IDUs studied, the mean age was 31.2 years (interquartile range, 25-37 years), 94.8% were men, and 29.3% were HIV-1-seropositive. On multiple logistic regression analysis, HIV-1 seropositivity was associated with older age, not being married, less education, needle sharing, and incarceration. HIV-1 subtype B' accounted for 65% of prevalent infections and subtype E, 35%. Infection with subtype E was associated with younger age and did not seem to be associated with sexual risk behaviors, which were uncommon in general. Bangkok IDUs continue to be at high risk for HIV-1 infection related to needle sharing and incarceration. Although HIV-1 subtype B' accounts for most prevalent infections, subtype E seems to be more prevalent among younger IDUs, and most infections seem likely to result from parenteral transmission
MH - Adult
MH - Age Factors
MH - Cohort Studies
MH - Cross-Sectional Studies
MH - Female
MH - HIV Infections
MH - epidemiology
MH - virology
MH - HIV Seroprevalence
MH - Hiv-1
MH - classification
MH - Human
MH - Logistic Models
MH - Male
MH - Middle Age
MH - Needle Sharing
MH - Prospective Studies
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - complications
MH - Thailand
RP - NOT IN FILE
NT - UI - 99019117LA - engPT - Journal ArticleDA - 19981110IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:9803972
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1998 Nov 1 ;19(3):289-295

37
UI - 39
AU - Mezzelani P
AU - Quaglio GL
AU - Venturini L
AU - Lugoboni F
AU - Friedman SR
AU - Des J
AD - Institute of Clinica Medica, University of Verona, Italy. mezzelani@cmib.univr.it
TI - A multicentre study on the causes of death among Italian injecting drug users. AIDS has overtaken overdose as the principal cause of death
AB - The causes of death among injecting drug users. (IDUs) are still being discussed worldwide. We analysed the causes of death among IDUs attending 26 centres for drug users in North-Eastern Italy from 1985 to 1994. The study of a total number of 1,022 deaths reveals the following: (1) AIDS has become the primary cause of death among IDUs since 1991 and is rising even in an area with a moderate HIV seroprevalence; (2) the mean age of death in AIDS patients proved higher than among patients who died of other causes (which may be due to the long incubation period of AIDS); (3) our data do not reveal higher HIV seroprevalence among IDUs who died of overdose and suicide as opposed to IDUs who died of other causes; (4) the mortality rate in IDUs is significantly higher when compared to that of the general population in the same age group
MH - Acquired Immunodeficiency Syndrome
MH - mortality
MH - Adult
MH - Age Factors
MH - Cause of Death
MH - Female
MH - Human
MH - Italy
MH - epidemiology
MH - Male
MH - Overdose
MH - Retrospective Studies
MH - Substance Abuse,Intravenous
RP - NOT IN FILE
NT - UI - 98197264LA - engPT - Journal ArticlePT - Multicenter StudyDA - 19980427IS - 0954-0121SB - IMCY - ENGLANDJC - A1O
UR - PM:9536202
SO - AIDS Care 1998 Feb ;10(1):61-67

38
UI - 36
AU - Paone D
AU - Perlman DC
AU - Perkins MP
AU - Kochems LM
AU - Salomon N
AU - Des J
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA. dpaone@ix.netcom.com
TI - Organizational issues in conducting tuberculosis screening at a syringe exchange program
AB - There has been a rise in tuberculosis (TB) cases in the United States and there is a potent link between human immunodeficiency virus (HIV) and tuberculosis. In New City it is estimated that 40% of the 200,000 injecting drug users are infected with HIV. In addition, the tuberculosis case rate is approximately four times the national average, and one third of these cases occurred in those persons infected with HIV. Drug users have a high prevalence of latent tuberculous infection and are at high risk for progression to active tuberculosis. Drug users are at high risk for both HIV and TB. Although studies have shown the value of incorporating TB services into drug treatment programs, the majority of drug users in the United States are not in drug treatment. We have been evaluating the feasibility of conducting TB screening and directly observed TB preventive therapy for active injecting drug users at a syringe exchange program in New York City. This paper describes issues relating to the implementation of the TB screening program and discusses general and operational issues relevant to integrating medical and public health programs into existing programs serving drug using individuals
MH - AIDS-Related Opportunistic Infections
MH - prevention & control
MH - Confidentiality
MH - HIV Infections
MH - transmission
MH - HIV Seropositivity
MH - Human
MH - Mass Screening
MH - organization & administration
MH - Needle-Exchange Programs
MH - New York City
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
MH - Tuberculosis
RP - NOT IN FILE
NT - UI - 98296691LA - engPT - Journal ArticleID - R01-DA-09005/DA/NIDADA - 19980911IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:9633035
SO - J Subst Abuse Treat 1998 May ;15(3):229-234

39
UI - 41
AU - Paone D
AU - Des J
AU - Shi Q
TI - Syringe exchange use and HIV risk reduction over time
MH - Adult
MH - Female
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Male
MH - Middle Age
MH - Needle-Exchange Programs
MH - New York City
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - Time Factors
RP - NOT IN FILE
NT - UI - 98115804LA - engPT - LetterDA - 19980306IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:9456269
SO - AIDS 1998 Jan 1 ;12(1):121-123

40
UI - 26
AU - Vazquez-Levin MH
AU - Goldberg SI
AU - Friedmann P
AU - Des J
AU - Nagler HM
AD - Department of Urology, Beth Israel Medical Center, New York, NY 10003, USA
TI - Papanicolaou and Kruger assessment of sperm morphology: thresholds and agreement
AB - The current World Health Organization guidelines (1992) suggest that the presence of > or = 30% normal sperm forms (i.e. PAP criteria) is consistent with normal semen quality. Critical evaluation of sperm morphology (CE; Kruger classification) has shown an excellent correlation with human in vitro fertilization. Utilizing Kruger criteria, > 14% normal sperm forms has been proposed as indicative of normal semen quality. We have performed a retrospective analysis on 261 individuals to assess the agreement between PAP and Kruger criteria for normal sperm morphology (NSM). When the threshold for NSM by PAP was set at 30%, a significant agreement was found between the percentage normal forms of both criteria (Kappa coefficient = 0.37; p < 0.001). Sixty-seven (92%) of the 73 men found to have abnormal sperm morphology by PAP had abnormal semen by Kruger classification. When the threshold for NSM by PAP was established at 50%, the Kappa coefficient was 0.48 (p < 0.001). Sixty of the 72 samples (83%) classified as normal by PAP staining were normal by Kruger criteria. Interestingly, when NSM by PAP was between 30 and 50%, the specimen was just as likely to have normal or abnormal sperm morphology by Kruger (40 vs. 60%, respectively). These results strongly suggest that a high or low percentage of NSM by PAP is in agreement with the Kruger classification. The excellent agreement of Kruger and WHO criteria at the extremes (< 30% and > 50%) may obviate the need for Kruger assessment. However, when WHO morphology is between 30 and 50%, the addition of Kruger evaluation may provide meaningful information to help better diagnose a patient and plan his treatment
MH - Comparative Study
MH - Human
MH - Male
MH - Predictive Value of Tests
MH - Retrospective Studies
MH - Sensitivity and Specificity
MH - Spermatozoa
MH - ultrastructure
MH - Support,Non-U.S.Gov't
RP - NOT IN FILE
NT - UI - 99138437LA - engPT - Journal ArticleDA - 19990329IS - 0105-6263SB - IMCY - ENGLANDJC - GQK
UR - PM:9972490
SO - Int J Androl 1998 Dec ;21(6):327-331

41
UI - 34
AU - Vogt RL
AU - Breda MC
AU - Des J
AU - Gates S
AU - Whiticar P
AD - Hawaii Department of Health, Honolulu, USA
TI - Hawaii's statewide syringe exchange program
MH - HIV Infections
MH - prevention & control
MH - Hawaii
MH - Health Behavior
MH - Human
MH - Needle-Exchange Programs
MH - organization & administration
MH - statistics & numerical data
RP - NOT IN FILE
NT - UI - 98408095LA - engPT - Journal ArticleDA - 19981001IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:9736888
SO - Am J Public Health 1998 Sep ;88(9):1403-1404

42
UI - 43
AU - Des J
AU - Vanichseni S
AU - Marmor M
AU - Buavirat A
AU - Titus S
AU - Raktham S
AU - Friedmann P
AU - Kitayaporn D
AU - Wolfe H
AU - Friedman SR
AU - Mastro TD
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, New York 10013, USA
TI - "Why I am not infected with HIV": implications for long-term HIV risk reduction and HIV vaccine trials
AB - OBJECTIVE: To describe beliefs about remaining HIV-seronegative in injecting drug users in two high-seroprevalence cities, and to consider implications of these beliefs for ongoing risk reduction efforts and for HIV vaccine efficacy trials. DESIGN: Cross-sectional survey with open- and closed-ended questions. SUBJECTS: 58 HIV-seronegative injecting drug users participating in HIV vaccine preparation cohort studies in New York City, New York, U.S.A., and Bangkok, Thailand. MAJOR FINDINGS: Large majorities of subjects in Bangkok (90%) and in New York (89%) believed their "own efforts" to practice safer injection methods and safer sex were very important in avoiding HIV infection. More Bangkok subjects (30%) believed that they would "probably" become infected with HIV in the future than New York subjects (4%). Three percent of Bangkok subjects and 70% of New York subjects believed "having an immune system strong enough to avoid becoming infected with HIV despite exposure to the virus" was very important in avoiding HIV infection. This belief in New York subjects was associated with having previously engaged in high-risk behaviors (i.e., sharing injection equipment, unprotected sex, or both) with partners known to be HIV- seropositive. CONCLUSIONS: Risk reduction programming for high-HIV- seroprevalence populations and within HIV vaccine trials should address not only specific HIV risk behaviors, but also the complex belief systems about avoiding HIV infection that develop within such groups. The person's "own efforts/self-efficacy" appears to be central in the psychology of risk reduction. Members of some high-risk populations may overestimate greatly the frequency of any possible natural immunity to becoming infected with HIV. Prevention programs for these populations will need to address explicitly the probabilistic nature of HIV transmission
MH - AIDS Vaccines
MH - immunology
MH - Adult
MH - Cohort Studies
MH - Cross-Sectional Studies
MH - HIV Infections
MH - prevention & control
MH - HIV Seronegativity
MH - Human
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 98080508LA - engRN - 0 (AIDS Vaccines)PT - Journal ArticleID - 06001/PHSID - DA 03574/DA/NIDAID - NCRR 00096/RR/NCRRDA - 19980115IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:9420319
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1997 Dec 15 ;16(5):393-399

43
UI - 51
AU - Des J
AU - Friedman SR
AU - Hagan H
AU - Paone D
AU - Vlahov D
AD - Beth Israel Medical Center, New York, NY 10003, USA
TI - Drug use. Vancouver Conference Review
MH - Adult
MH - Developed Countries
MH - Developing Countries
MH - Female
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Male
MH - Preventive Health Services
MH - Prognosis
MH - Risk-Taking
MH - Substance Abuse,Intravenous
RP - NOT IN FILE
NT - UI - 97300896LA - engPT - CongressesDA - 19970602IS - 0954-0121SB - IMCY - ENGLANDJC - A1O
UR - PM:9155916
SO - AIDS Care 1997 Feb ;9(1):53-57

44
UI - 45
AU - Des J
AU - Padian N
AD - Beth Israel Medical Center, New York, New York 10003, U.S.A
TI - Strategies for universalistic and targeted HIV prevention
AB - The controversy over "targeted" versus "universalistic" programs for HIV prevention has persisted throughout the history of the HIV/AIDS epidemic in the United States and in some European countries. Building on previous analyses, we outline methods for integrating universalistic and targeted HIV prevention programming. The outline considers possible synergy between targeted and universalistic programs, rather than a forced choice between the two. Components within this framework include a continuum of the intensity of targeted programs, specification of local risk behavior populations, categories of risk behavior, and HIV seroprevalence within local risk-behavior populations. Given the scarce resources currently available, preventing all new HIV infections is not a realistic public health goal, but with better use of current scientific knowledge, it should be possible to greatly reduce the rate of new HIV infections
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - prevention & control
MH - transmission
MH - Communicable Disease Control
MH - methods
MH - Europe
MH - HIV Infections
MH - HIV Seropositivity
MH - Health Education
MH - Human
MH - Population Surveillance
MH - Prevalence
MH - Public Health Administration
MH - Research
MH - Risk-Taking
MH - Sex Behavior
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 98019140LA - engPT - Journal ArticleID - R01 DA 03574/DA/NIDADA - 19971128IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:9358108
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1997 Oct 1 ;16(2):127-136

45
UI - 48
AU - Des J
TI - Intoxications, intentions, and disease preventions
MH - Female
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Sex Behavior
MH - drug effects
MH - Substance-Related Disorders
MH - complications
RP - NOT IN FILE
NT - UI - 97387720LA - engPT - CommentPT - EditorialDA - 19970911IS - 0148-5717SB - IMCY - UNITED STATESJC - U9G
UR - PM:9243737
SO - Sex Transm Dis 1997 Jul ;24(6):320-321

46
UI - 47
AU - Friedman SR
AU - Curtis R
AU - Jose B
AU - Neaigus A
AU - Zenilman J
AU - Culpepper-Morgan J
AU - Borg L
AU - Kreek J
AU - Paone D
AU - Des J
AD - National Development and Research Institutes, New York, New York 10048, USA
TI - Sex, drugs, and infections among youth. Parenterally and sexually transmitted diseases in a high-risk neighborhood
AB - BACKGROUND AND OBJECTIVES: To determine the extent to which youth who reside in households in a neighborhood with large numbers of drug injectors 1) are infected with parenterally or sexually transmitted agents, and 2) engage in high-risk behaviors. STUDY DESIGN: A multistage probability household sample survey was conducted in Bushwick, Brooklyn from 1994 to 1995. All households in 12 randomly selected primary sampling units were screened for age-eligible youth. One hundred eleven English-speaking 18- to 21-year-olds were interviewed. One hundred three sera were tested for human immunodeficiency virus type 1 (HIV-1), Hepatitis B virus, hepatitis C virus (HCV), human T-cell lymphotrophic virus types I and II (HTLV- I/II), herpes simplex virus type 2 (HSV-2), or syphilis. Urines were tested for chlamydial infection, and for opiate and cocaine metabolites. RESULTS: Eighty-nine percent had sex in the past year, 45% with two or more partners. Only 19% of the sexually active always used condoms. Two (of 95) had had sex with a crack smoker. Thirty percent of women reported being coerced the first time they had sex, and 23% of women and 3% of men reported having been sexually abused. Only 3% reported ever using heroin, and 9% cocaine. Only one reported ever having injected drugs or smoked crack. Some underreporting of stigmatized behaviors occurred: two "nonreporters" had opiate-positive urines and two had cocaine-positive urines. Marijuana use was common, with 48% using it in the past year. No subjects tested positive for HIV- 1, HIV-II, or syphilis; 2% tested positive for HTLV-I and 3% for hepatitis C; 3% had hepatitis B markers, 12% had chlamydial infection, and 50% serologic HSV-2 markers. CONCLUSIONS: Population-representative samples of high-risk communities can provide important knowledge. Although heroin and cocaine use, during drug injection, and rates of infection with parenterally transmitted infectious agents appear to be lower among these youth, sexual risk behaviors and chlamydial and HSV-2 infection are widespread. Sexually transmitted disease screening and outreach strategies are needed both to prevent sexually transmitted disease sequelae (including potential increased susceptibility to HIV infection) and to prevent transmission to partners
MH - Adolescence
MH - Adult
MH - Female
MH - Human
MH - Male
MH - Sex Behavior
MH - Sexually Transmitted Diseases
MH - epidemiology
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 97387721LA - engPT - Journal ArticleID - P50 DA05130/DA/NIDAID - R01 A134723/PHSID - R01 DA10411/DA/NIDAID - etcDA - 19970911IS - 0148-5717SB - IMCY - UNITED STATESJC - U9G
UR - PM:9243738
SO - Sex Transm Dis 1997 Jul ;24(6):322-326

47
UI - 46
AU - Friedman SR
AU - Neaigus A
AU - Jose B
AU - Curtis R
AU - Goldstein M
AU - Ildefonso G
AU - Rothenberg RB
AU - Des J
AD - National Development and Research Institutes Inc, New York, NY 10048, USA
TI - Sociometric risk networks and risk for HIV infection
AB - OBJECTIVES: This study examined whether networks of drug-injecting and sexual relationships among drug injectors are associated with individual human immunodeficiency virus (HIV) serostatus and with behavioral likelihood of future infection. METHODS: A cross-sectional survey of 767 drug injectors in New York City was performed with chain- referral and linking procedures to measure large-scale (sociometric) risk networks. Graph-theoretic algebraic techniques were used to detect 92 connected components (drug injectors linked to each other directly or through others) and a 105-member 2-core within a large connected component of 230 members. RESULTS: Drug injectors in the 2-core of the large component were more likely than others to be infected with HIV. Seronegative 2-core members engaged in a wide range of high-risk behaviors, including engaging in risk behaviors with infected drug injectors. CONCLUSIONS: Sociometric risk networks seem to be pathways along which HIV travels in drug-injecting peer groups. The cores of large components can be centers of high-risk behaviors and can become pockets of HIV infection. Preventing HIV from reaching the cores of large components may be crucial in preventing widespread HIV epidemics
MH - Adult
MH - Community Networks
MH - statistics & numerical data
MH - Female
MH - HIV Infections
MH - epidemiology
MH - transmission
MH - HIV Seroprevalence
MH - Hiv-1
MH - Human
MH - Interviews
MH - methods
MH - Male
MH - New York City
MH - Risk Factors
MH - Risk-Taking
MH - Sex Behavior
MH - Social Environment
MH - Sociometric Techniques
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - Urban Population
RP - NOT IN FILE
NT - UI - 97425213LA - engPT - Journal ArticleID - DA06723/DA/NIDADA - 19970917IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:9279263
SO - Am J Public Health 1997 Aug ;87(8):1289-1296

48
UI - 42
AU - Paone D
AU - Des J
AU - Caloir S
AU - Jose B
AU - Shi Q
AU - Friedman SR
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA. dpaone@ix.netcom.com
TI - Continued risky injection subsequent to syringe exchange use among injection drug users in New York City
AB - Although the vast majority of injection drug users (IDUs) attending syringe exchange programs in New York City have stopped risky injection (injecting with syringes used by someone else), there remains a subgroup of IDUs who continue to engage in high-risk injecting behaviors despite access to sterile syringes. Subjects were randomly recruited from five legally authorized syringe exchange programs in New York City between October 1992 and August 1994. Participants were asked about drug and sexual risk behavior 30 days prior to their first use of the syringe exchange as well as during the 30-day period prior to the interview while using the exchange. Of the 2,465 participants, 77.4% reported no risky injection during the 30 days prior to using syringes exchange. For this analysis we included only those who reported risky injection for the 30-day period prior to using syringe exchange (N = 556). We compared sociodemographics and behavioral characteristics of a group who continued risky injection while using the syringe exchange, "continuers," N = 158 (28.8%) with a group who reported risky injection prior to using the exchange and then ceased risky injection while using the exchange, "stoppers," N = 391(71.2%). Continuers were significantly more likely to report passing on dirty syringes to social network members and to inject cocaine at least daily. We present other predictors of continued risk and discuss the implications for interventions and make recommendations for syringe exchange programs
MH - Adult
MH - Chi-Square Distribution
MH - Comparative Study
MH - Female
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Logistic Models
MH - Male
MH - Needle-Exchange Programs
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
RP - NOT IN FILE
NT - UI - 98113438LA - engPT - Journal ArticleDA - 19980325IS - 0899-9546SB - IMCY - UNITED STATESJC - AUY
UR - PM:9451478
SO - AIDS Educ Prev 1997 Dec ;9(6):505-510

49
UI - 49
AU - Perlman DC
AU - Perkins MP
AU - Solomon N
AU - Kochems L
AU - Des J
AU - Paone D
AD - Beth Israel Medical Center, New York, NY 10003, USA
TI - Tuberculosis screening at a syringe exchange program
MH - Human
MH - Mass Chest X-Ray
MH - Mass Screening
MH - methods
MH - Needle-Exchange Programs
MH - New York City
MH - Population Surveillance
MH - Support,U.S.Gov't,P.H.S.
MH - Tuberculin Test
MH - Tuberculosis
MH - prevention & control
RP - NOT IN FILE
NT - UI - 97327967LA - engPT - Journal ArticleID - RO1-DA09005-01A1/DA/NIDADA - 19970626IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:9184525
SO - Am J Public Health 1997 May ;87(5):862-863

50
UI - 44
AU - Perlman DC
AU - Des J
AU - Salomon N
AU - Masson CL
TI - Preventing opportunistic infections in HIV-infected injection drug users
MH - AIDS-Related Opportunistic Infections
MH - prevention & control
MH - HIV Infections
MH - therapy
MH - Human
MH - Practice Guidelines
MH - Substance Abuse,Intravenous
RP - NOT IN FILE
NT - UI - 98047341LA - engPT - LetterDA - 19971211IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:9388148
SO - JAMA 1997 Dec 3 ;278(21):1743-1744

51
UI - 52
AU - Perlman DC
AU - Perkins MP
AU - Paone D
AU - Kochems L
AU - Salomon N
AU - Friedmann P
AU - Des J
AD - Department of Medicine, Beth Israel Medical Center, New York, NY 1003, USA
TI - "Shotgunning" as an illicit drug smoking practice
AB - There has been a rise in illicit drug smoking in the United States. "Shotgunning" drugs (or "doing a shotgun") refers to the practice of inhaling smoke and then exhaling it into another individual's mouth, a practice with the potential for the efficient transmission of respiratory pathogens. Three hundred fifty-four drug users (239 from a syringe exchange and 115 from a drug detoxification program) were interviewed about shotgunning and screened for tuberculosis (TB). Fifty- nine (17%; 95% CI 12.9%-20.9%) reported shotgunning while smoking crack cocaine (68%), marijuana (41%), or heroin (2%). In multivariate analysis, age < or = 35 years (OR 2.0, 95% CI 1.05-3.9), white race (OR 1.2, 95% CI 1.2-4.8), drinking alcohol to intoxication (OR 2.2, 95% CI 1.1-4.3), having engaged in high-risk sex (OR 2.6, 95% CI 1.04-6.7), and crack use (OR 6.0, 95% CI 3.0-12) were independently associated with shotgunning. Shotgunning is a frequent drug smoking practice with the potential to transmit respiratory pathogens, underscoring the need for education of drug users about the risks of specific drug use practices, and the ongoing need for TB control among active drug users
MH - Adult
MH - Analysis of Variance
MH - Crack Cocaine
MH - Female
MH - Heroin
MH - Human
MH - Logistic Models
MH - Male
MH - Marijuana Smoking
MH - New York City
MH - Odds Ratio
MH - Risk-Taking
MH - Skin Tests
MH - Substance-Related Disorders
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Tuberculosis
MH - transmission
RP - NOT IN FILE
NT - UI - 97361336LA - engRN - 0 (Crack Cocaine)RN - 561-27-3 (Heroin)PT - Journal ArticleID - R01-DA9005-01A1/DA/NIDADA - 19970904IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:9218230
SO - J Subst Abuse Treat 1997 Jan ;14(1):3-9

52
UI - 50
AU - Rosenberg KD
AU - Bateman DM
AU - Des J
TI - Underestimating cocaine use during pregnancy
MH - Cocaine
MH - Female
MH - Human
MH - Pregnancy
MH - Pregnancy Complications
MH - epidemiology
MH - Substance-Related Disorders
MH - United States
RP - NOT IN FILE
NT - UI - 97291916LA - engRN - 50-36-2 (Cocaine)PT - CommentPT - LetterDA - 19970721IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:9146456
SO - Am J Public Health 1997 Apr ;87(4):687

53
UI - 64
AU - Des J
AU - Friedman SR
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA
TI - HIV epidemiology and interventions among injecting drug users
MH - HIV Infections
MH - epidemiology
MH - etiology
MH - prevention & control
MH - Human
MH - Needle Sharing
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
RP - NOT IN FILE
NT - UI - 96393009LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19961205IS - 0956-4624SB - IMCY - ENGLANDJC - A16
UR - PM:8799797
SO - Int J STD AIDS 1996 ;7 Suppl 2():57-61

54
UI - 54
AU - Des J
AU - Friedmann P
AU - Hagan H
AU - Friedman SR
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA
TI - The protective effect of AIDS-related behavioral change among injection drug users: a cross-national study. WHO Multi-Centre Study of AIDS and Injecting Drug Use
AB - 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 AIDS?" RESULTS: The protective odds ratio for behavioral change against being infected with HIV was 0.50 (95% confidence interval = 0.42, 0.59). While 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
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - Adult
MH - Female
MH - HIV Seronegativity
MH - HIV Seropositivity
MH - Health Behavior
MH - Human
MH - Male
MH - Odds Ratio
MH - Questionnaires
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - World Health Organization
RP - NOT IN FILE
NT - UI - 97156747LA - engPT - Journal ArticlePT - Multicenter StudyID - DA03574/DA/NIDADA - 19970212IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:9003137
SO - Am J Public Health 1996 Dec ;86(12):1780-1785

55
UI - 56
AU - Des J
AU - Stimson GV
AU - Hagan H
AU - Friedman SR
TI - Injection drug use and emerging blood-borne diseases
MH - Blood-Borne Pathogens
MH - Carrier State
MH - Disease Transmission
MH - Human
MH - Substance Abuse,Intravenous
MH - World Health
RP - NOT IN FILE
NT - UI - 96404318LA - engPT - LetterDA - 19961023IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:8847757
SO - JAMA 1996 Oct 2 ;276(13):1034

56
UI - 61
AU - Des J
AU - Friedman SR
AU - Paone D
TI - Drug legalization, harm reduction, and drug policy
MH - Crime
MH - economics
MH - Human
MH - Public Policy
MH - Street Drugs
MH - legislation & jurisprudence
MH - United States
RP - NOT IN FILE
NT - UI - 96213868LA - engRN - 0 (Street Drugs)PT - LetterDA - 19960628IS - 0003-4819SB - AIMSB - IMCY - UNITED STATESJC - 5A6
UR - PM:8633847
SO - Ann Intern Med 1996 Apr 15 ;124(8):777

57
UI - 55
AU - Des J
AU - Marmor M
AU - Paone D
AU - Titus S
AU - Shi Q
AU - Perlis T
AU - Jose B
AU - Friedman SR
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA
TI - HIV incidence among injecting drug users in New York City syringe- exchange programmes
AB - BACKGROUND: There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non- participants. METHODS: We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness initiative cohort (n = 133 continuing exchanges and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. FINDINGS: HIV incidence among continuing exchange- users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. INTERPRETATION: We observed an ind