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 individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs
MH - Adult
MH - Cohort Studies
MH - Comparative Study
MH - Female
MH - Follow-Up Studies
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - HIV Seropositivity
MH - virology
MH - Human
MH - Incidence
MH - Male
MH - Middle Age
MH - Multivariate Analysis
MH - Needle-Exchange Programs
MH - New York City
MH - Proportional Hazards Models
MH - Risk Factors
MH - Risk-Taking
MH - Saliva
MH - Sterilization
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
RP - NOT IN FILE
NT - UI - 97008738LA - engPT - Journal ArticlePT - Meta-AnalysisID - DA03574/DA/NIDAID - DA05283/DA/NIDAID - DA06001/DA/NIDAID - etcDA - 19961107IS - 0140-6736SB - AIMSB - IMCY - ENGLANDJC - L0S
UR - PM:8855855
SO - Lancet 1996 Oct 12 ;348(9033):987-991

58
UI - 63
AU - Grund JP
AU - Friedman SR
AU - Stern LS
AU - Jose B
AU - Neaigus A
AU - Curtis R
AU - Des J
AD - Lindesmith Center, New York, NY 10106, USA
TI - Syringe-mediated drug sharing among injecting drug users: patterns, social context and implications for transmission of blood-borne pathogens
AB - Drug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public discussion have focused primarily on the sharing of syringes and needles. While the focus on syringe sharing has sparked important interventions (bleach distribution, syringe exchange) it may have obscured the social relationship in which injecting equipment is used. Drug sharing plays a crucial role in the social organization of the drug using subculture. In this paper, various drug sharing practices and other distinguishable aspects of the injecting process-collectively termed Syringe-Mediated Drug Sharing (SMDS)-are described. All of these behaviors may put injecting drug users (IDUs) at risk for infection. The purpose of this paper is to stimulate scientific inquiry into SMDS behaviors and the social contexts which shape them. Descriptions are based primarily on field studies in Rotterdam and New York City. Recommendations for safer injecting training and education are proposed, as are directions for future research
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Anthropology,Cultural
MH - Blood-Borne Pathogens
MH - Contact Tracing
MH - Cross-Cultural Comparison
MH - Human
MH - Needle Sharing
MH - statistics & numerical data
MH - Netherlands
MH - epidemiology
MH - New York City
MH - Risk Factors
MH - Social Environment
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Syringes
MH - Urban Population
RP - NOT IN FILE
NT - UI - 96243481LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19960822IS - 0277-9536SB - IMCY - ENGLANDJC - UT9
UR - PM:8685737
SO - Soc Sci Med 1996 Mar ;42(5):691-703

59
UI - 58
AU - Hershow RC
AU - Galai N
AU - Fukuda K
AU - Graber J
AU - Vlahov D
AU - Rezza G
AU - Klein RS
AU - Des J
AU - Vitek C
AU - Khabbaz R
AU - Freels S
AU - Zuckerman R
AU - Pezzotti P
AU - Kaplan JE
AD - University of Illinois, Chicago College of Medicine and School of Public Health 60612, USA
TI - An international collaborative study of the effects of coinfection with human T-lymphotropic virus type II on human immunodeficiency virus type 1 disease progression in injection drug users
AB - To determine whether human T-lymphotropic virus (HTLV) type II coinfection affects progression of human immunodeficiency virus type 1 (HIV) infection, longitudinal data on 370 HIV-infected injection drug users (IDUs) with known HIV seroconversion dates from four cohort studies were pooled. HTLV infection was determined by EIA and confirmed and typed by Western blot. Proportional hazards models were used to determine whether HTLV-II infection was associated with AIDS or AIDS- related mortality. Regression analyses were used to compare declines in CD4 cell percents in singly and dually infected persons. Of 370 IDUs, 61 (16%) were HTLV-II-coinfected. During follow-up, 43 (12%) developed and 24 (6%) died of AIDS. HTLV-II coinfection was not associated with progression to AIDS (relative hazard [RH], .82; 95% confidence interval [CI], 0.34-1.94]) or AIDS mortality (RH, 1.69; 95% CI, 0.62-4.60). Rates of decline in CD4 cell percent were similar in singly and dually infected IDUs. These results suggest that HTLV-II does not affect the progression of HIV infection
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - mortality
MH - Adult
MH - CD4 Lymphocyte Count
MH - Comparative Study
MH - Disease Progression
MH - Follow-Up Studies
MH - HIV Seropositivity
MH - complications
MH - Hiv-1
MH - HTLV-II Infections
MH - Human
MH - Longitudinal Studies
MH - Multivariate Analysis
MH - Prevalence
MH - Regression Analysis
MH - Rome
MH - epidemiology
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
MH - United States
RP - NOT IN FILE
NT - UI - 96313007LA - engPT - Journal ArticlePT - Multicenter StudyID - DA-04334/DA/NIDAID - DA-06589/DA/NIDAID - U64/CCU506834-01/PHSID - etcDA - 19960905IS - 0022-1899SB - AIMSB - IMCY - UNITED STATESJC - IH3
UR - PM:8699060
SO - J Infect Dis 1996 Aug ;174(2):309-317

60
UI - 53
AU - Kochems LM
AU - Paone D
AU - Des J
AU - Ness I
AU - Clark J
AU - Friedman SR
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA
TI - The transition from underground to legal syringe exchange: the New York City experience
AB - The most common method of syringe exchange program (SEP) development in the United States has been for SEPs to be started by activists without funding and then to become a government-funded community-based organization. This developmental process, which has not been studied to date, involves major organizational change. We report our findings on three New York City syringe exchanges experiencing this type of transition. Our data illustrate that following legalization, increased legitimacy and funding allowed all three SEPs to expand the size and scope of their programs (e.g., adding hours, sites, referral services, and the ability to support user groups), resulting in a rapid growth in participation (over 15,000 in 18 months). Regulation accompanying legalization posed significant challenges to SEPs, including added record-keeping and reporting tasks, increased demand for referrals, and accommodating evaluation, which affected already overburdened staffs. The transition process poses significant challenges to these developing organizations as well as opportunities for improved services
MH - Attitude of Health Personnel
MH - Community Health Services
MH - organization & administration
MH - Facility Regulation and Control
MH - legislation & jurisprudence
MH - Financing,Government
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Needle-Exchange Programs
MH - New York City
MH - Organizational Innovation
MH - Program Development
MH - Questionnaires
MH - Referral and Consultation
MH - Support,Non-U.S.Gov't
MH - Total Quality Management
RP - NOT IN FILE
NT - UI - 97163701LA - engPT - Journal ArticleDA - 19970328IS - 0899-9546SB - IMCY - UNITED STATESJC - AUY
UR - PM:9010508
SO - AIDS Educ Prev 1996 Dec ;8(6):471-489

61
UI - 57
AU - Marmor M
AU - Titus S
AU - Harrison C
AU - Cord-Cruz EA
AU - Shore RE
AU - Vogler M
AU - Krasinski K
AU - Mildvan D
AU - Des J
AD - Department of Environmental Medicine, New York University School of Medicine, New York 10010-2598, USA
TI - Weight loss associated with HIV seroconversion among injection-drug users
AB - To describe symptoms associated with human immunodeficiency virus (HIV) seroconversion, we studied a cohort of 366 injection-drug users (IDUs) with a study design that included recall every 3 months to collect symptom histories using a structured questionnaire. Eleven HIV seroconversions were observed in 621.5 person years at risk (PYAR), equivalent to 1.8 seroconversions/100 PYAR. Cox regression analysis showed age < or = 35 years to be a significant risk factor for HIV seroconversion after controlling for gender, race, and the frequency of drug injection. An embedded case-control analysis then compared symptom histories of HIV seroconverters with those of age-(+/- 5 years) and visit number-matched controls who remained HIV seronegative for > or = 3 months longer than the HIV-seroconverters. Multivariate case-control analysis adjusted for injection frequency yielded significant associations of HIV seroconversion with histories of weight loss > or = 4.5 kg (seven of 11 cases; odds ratio [OR] = 11.6, 95% confidence interval [CI] 3.1, 43.1) and oral ulcers (three of 11 cases; OR = 7.6, 95% CI = 1.2, 48.2) in the 3 months before the subjects' first HIV- seropositive study visit. We conclude that histories of recent symptoms reported by HIV-seroconverting IDUs differ from those reported by non- HIV-seroconverting IDUs, and weight loss may be particularly common among IDUs experiencing primary HIV infection
MH - Adult
MH - Case-Control Studies
MH - Cohort Studies
MH - Confidence Intervals
MH - Female
MH - Follow-Up Studies
MH - HIV Seropositivity
MH - complications
MH - physiopathology
MH - Human
MH - Male
MH - Middle Age
MH - Odds Ratio
MH - Questionnaires
MH - Regression Analysis
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Weight Loss
RP - NOT IN FILE
NT - UI - 96335115LA - engPT - Journal ArticleID - 1P30AI27742/AI/NIAIDID - DA06001/DA/NIDAID - NO1-AI-35176/AI/NIAIDID - etcDA - 19960918IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:8757430
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1996 Aug 15 ;12(5):514-518

62
UI - 62
AU - Neaigus A
AU - Friedman SR
AU - Jose B
AU - Goldstein MF
AU - Curtis R
AU - Ildefonso G
AU - Des J
AD - National Development and Research Institutes, New York, NY 10013, USA
TI - High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug injectors
AB - In a cross-sectional study of 174 new injecting drug users (IDUs) in New York City who had injected for < or = 6 years, we examined whether those who both share syringes and have personal risk networks that include high-risk injectors are particularly likely to be infected with HIV. Subjects were street recruited between July 1991 and January 1993, were interviewed about their risk behaviors in the prior 2 years and their personal risk networks with other IDUs in the prior 30 days, and were tested for HIV; 20% were HIV seropositive. Among those who both shared syringes and had a personal risk network member who injected more than once a day, 40% were HIV seropositive (versus 14% for others, p < 0.001). In simultaneous multiple logistic regression, the interaction of both sharing syringes and having a personal risk network member who injected more than once a day remained independently and significantly associated with being HIV seropositive (OR, 3.57; 95% CI, 1.22, 10.43; p < 0.020), along with Latino race/ethnicity and exchanging sex for money or drugs. These findings suggest that the combination of sharing syringes with having a high-risk personal network is a risk factor for HIV infection among new IDUs. Studies of risk factors for HIV infection among new IDUs and interventions to reduce the spread of HIV among them should focus on their risk networks as well as their risk behaviors
MH - Adult
MH - Cross-Sectional Studies
MH - Female
MH - HIV Infections
MH - complications
MH - epidemiology
MH - HIV Seropositivity
MH - Health Behavior
MH - Hispanic Americans
MH - Human
MH - Interpersonal Relations
MH - Interviews
MH - Logistic Models
MH - Male
MH - Needle Sharing
MH - adverse effects
MH - New York City
MH - Prevalence
MH - Risk Factors
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
RP - NOT IN FILE
NT - UI - 96198889LA - engPT - Journal ArticleID - R01 DA06723/DA/NIDADA - 19960523IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:8605596
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1996 Apr 15 ;11(5):499-509

63
UI - 59
AU - Orr MF
AU - Glebatis D
AU - Friedmann P
AU - Des J
AU - Prevots DR
TI - Incidence of HIV infection in a New York City methadone maintenance treatment program
MH - HIV Infections
MH - epidemiology
MH - HIV Seroprevalence
MH - Human
MH - Incidence
MH - New York City
MH - Substance Abuse Treatment Centers
MH - statistics & numerical data
RP - NOT IN FILE
NT - UI - 96272939LA - engPT - LetterDA - 19960801IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:8656520
SO - JAMA 1996 Jul 10 ;276(2):99

64
UI - 60
AU - Shore RE
AU - Marmor M
AU - Titus S
AU - Des J
AD - Department of Environmental Medicine, New York University School of Medicine, NY, USA
TI - Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use
AB - The objective of this study was to determine what sociodemographic, lifestyle, or drug-related characteristics predict temporal changes in self reported drug injection frequencies among HIV-seronegative injection-drug users (IDUs) who were being given HIV testing and risk reduction counseling. The 277 subjects were given 4-11 quarterly interviews including detailed history of drug use and other HIV risk factors, HIV risk reduction counseling, and venipuncture for HIV antibody testing. A regression slope of change over time in drug injection frequency was calculated for each subject, and categories were created of decreasing temporal slope, increasing slope, relapse (decrease initially, then increase), or no substantial change. Only 44% of subjects decreased their drug injection frequencies despite repetitive HIV testing and counseling. In multivariate logistic analyses, decreasing temporal trends were associated with consistent enrollment in methadone maintenance (p < .1), whereas increasing trends conversely were associated with inconsistent enrollment (p < .01) and also with an absence of crack use (p < .01). Relapses were significantly associated with needle sharing with multiple partners and a low frequency of smoking. The data suggest that methadone maintenance facilitates a positive response to HIV risk reduction counseling. However, the fact that only a minority of subjects displayed a decreasing temporal trend in drug injection frequencies emphasizes the need for improved therapeutic and counseling techniques
MH - Adult
MH - Aged
MH - Cohort Studies
MH - Female
MH - HIV Infections
MH - transmission
MH - Human
MH - Life Style
MH - Male
MH - Methadone
MH - therapeutic use
MH - Middle Age
MH - New York City
MH - Risk Factors
MH - Socioeconomic Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - rehabilitation
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 97170024LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleID - DA06001/DA/NIDAID - IP30AI27742/AI/NIAIDID - NO1-A1-35176/PHSID - etcDA - 19970409IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:9017567
SO - J Subst Abuse Treat 1996 May ;13(3):241-248

65
UI - 73
AU - Des J
TI - Harm reduction--a framework for incorporating science into drug policy
MH - Drug and Narcotic Control
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Psychotropic Drugs
MH - Substance Abuse,Intravenous
MH - complications
MH - Substance-Related Disorders
MH - therapy
MH - United States
RP - NOT IN FILE
NT - UI - 95133638LA - engRN - 0 (Psychotropic Drugs)PT - EditorialDA - 19950223IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:7832242
SO - Am J Public Health 1995 Jan ;85(1):10-12

66
UI - 66
AU - Des J
AU - Paone D
AU - Friedman SR
AU - Peyser N
AU - Newman RG
AD - Beth Israel Medical Center, New York City, USA
TI - Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs
AB - One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Drug and Narcotic Control
MH - history
MH - History of Medicine,20th Cent.
MH - Human
MH - Methadone
MH - therapeutic use
MH - Needle-Exchange Programs
MH - legislation & jurisprudence
MH - Public Health
MH - trends
MH - Substance Abuse Treatment Centers
MH - Substance Abuse,Intravenous
MH - rehabilitation
MH - Support,Non-U.S.Gov't
MH - United States
RP - NOT IN FILE
NT - UI - 96036593LA - engRN - 76-99-3 (Methadone)PT - Historical ArticlePT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19951205IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:7485676
SO - Am J Public Health 1995 Nov ;85(11):1577-1584

67
UI - 67
AU - Des J
AU - Hagan H
AU - Friedman SR
AU - Friedmann P
AU - Goldberg D
AU - Frischer M
AU - Green S
AU - Tunving K
AU - Ljungberg B
AU - Wodak A
AU - .
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY, USA
TI - Maintaining low HIV seroprevalence in populations of injecting drug users
AB - OBJECTIVES--To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUs), but where seroprevalence has nevertheless remained low (< 5%) during at least 5 years. DESIGN AND SETTING--A literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUs. PARTICIPANTS--Injecting drug users recruited from both drug treatment and non-treatment settings in each city. INTERVENTIONS--A variety of HIV prevention activities for IDUs had been implemented in each of the five cities. RESULTS--There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low, (2) provision of sterile injection equipment, and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one third or more of the IDUs reporting recent unsafe injections. CONCLUSIONS--In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUs, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUs are at risk for rapid spread of HIV
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - HIV Seroprevalence
MH - Human
MH - Risk-Taking
MH - Seroepidemiologic Studies
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Urban Population
RP - NOT IN FILE
NT - UI - 96017572LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19951107IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:7563513
SO - JAMA 1995 Oct 18 ;274(15):1226-1231

68
UI - 69
AU - Des J
AU - Friedman SR
AU - Friedmann P
AU - Wenston J
AU - Sotheran JL
AU - Choopanya K
AU - Vanichseni S
AU - Raktham S
AU - Goldberg D
AU - Frischer M
AU - .
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA
TI - HIV/AIDS-related behavior change among injecting drug users in different national settings
AB - OBJECTIVES: To identify factors associated with effective AIDS behavior change among injecting drug users (IDU) in different national settings. DESIGN: Cross-sectional surveys of IDU, with determination of HIV status. Trends in city HIV seroprevalence among IDU also used to validate effectiveness of behavior change. SETTING AND PARTICIPANTS: Subjects recruited from drug-use treatment programs and outreach efforts in Bangkok, Thailand (n = 601), Glasgow, Scotland (n = 919), New York City, USA (n = 2539), and Rio de Janeiro, Brazil (n = 466). RESULTS: Evidence for the effectiveness of self-reported risk reduction was available for all cities. Univariate followed by multiple logistic regression analyses were used to identify factors associated with self- reported AIDS behavior change. Separate analyses were conducted for each city. Talking about AIDS with drug-using friends was significantly associated with behavior change in all four cities. Talking with sex partners about AIDS, educational level, knowing that someone can be HIV- infected and still look healthy, and having been tested previously for HIV were each significantly associated with behavior change in three of the four cities. CONCLUSIONS: Despite the substantial differences in these national settings, there were common factors associated with effective risk reduction. In particular, risk reduction appears to occur through social processes rather than through individual attitude change. HIV prevention programs need to explicitly incorporate social processes into their work
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - prevention & control
MH - psychology
MH - Adult
MH - Behavior
MH - Brazil
MH - Cross-Sectional Studies
MH - Female
MH - HIV Infections
MH - Human
MH - Male
MH - New York City
MH - Regression Analysis
MH - Scotland
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
RP - NOT IN FILE
NT - UI - 95391171LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19951006IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:7662201
SO - AIDS 1995 Jun ;9(6):611-617

69
UI - 68
AU - Friedman SR
AU - Jose B
AU - Deren S
AU - Des J
AU - Neaigus A
AD - National Development and Research Institutes, Inc., New York, NY 10013, USA
TI - Risk factors for human immunodeficiency virus seroconversion among out- of-treatment drug injectors in high and low seroprevalence cities. The National AIDS Research Consortium
AB - From 1988 to 1991, 6,882 drug injectors in 15 US cities were interviewed and had serum samples collected. The interviews and samples were analyzed for determination of significant predictors of human immunodeficiency virus (HIV) seroconversion in the 10 low seroprevalence cities and the five high seroprevalence cities. The unit of analysis was the period of observation between consecutive paired interviews/blood samples. In Cox proportional hazards regression, significant predictors of seroconversion in the low seroprevalence cities were: not being in drug treatment, injecting in outdoor settings or abandoned buildings, using crack cocaine weekly or more frequently, engaging in woman-to-woman sex, being of non-Latino race/ethnicity, and city seroprevalence. Predictors in high seroprevalence cities were: injecting with potentially infected syringes, not being in drug treatment, and having a sex partner who injected drugs. These findings suggest that HIV may be concentrated in sociobehavioral pockets of infection in low seroprevalence cities. For reducing HIV transmission, these results suggest: 1) in low seroprevalence cities, localized monitoring to detect specific emerging sociobehavioral pockets of infection, and quick implementation of appropriate targeted interventions if necessary; 2) in high seroprevalence cities, relatively more emphasis on locality-wide outreach and syringe-exchange projects to reduce risky behavior; and 3) in both types of cities, considerable expansion of drug treatment programs
MH - Adult
MH - Comparative Study
MH - Female
MH - HIV Seropositivity
MH - blood
MH - epidemiology
MH - transmission
MH - HIV Seroprevalence
MH - Health Behavior
MH - Human
MH - Male
MH - Predictive Value of Tests
MH - Proportional Hazards Models
MH - Questionnaires
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - prevention & control
MH - Support,U.S.Gov't,P.H.S.
MH - United States
MH - Urban Health
RP - NOT IN FILE
NT - UI - 96017410LA - engPT - Journal ArticlePT - Multicenter StudyID - DA05283/DA/NIDAID - DA06723/DA/NIDADA - 19951114IS - 0002-9262SB - IMCY - UNITED STATESJC - 3H3
UR - PM:7572963
SO - Am J Epidemiol 1995 Oct 15 ;142(8):864-874

70
UI - 70
AU - Paone D
AU - Caloir S
AU - Shi Q
AU - Des J
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York City
TI - Sex, drugs, and syringe exchange in New York City: women's experiences
AB - The sex and drug human immunodeficiency virus (HIV) risk factors of drug-injecting women participating in New York City syringe exchange programs were studied and racial/ethnic differences examined. African- American women reported injecting least frequently and had lower rates of injecting with borrowed or used syringes. Women attending syringe exchange reported high levels of sexual risk behavior, and syringe exchange provides an opportunity for a sexual risk reduction intervention. Women were more likely to "always" use condoms with causal partners than with primary partners. About 60% of the women engaging in commercial sex work reported "always" using condoms. Three independent predictors for consistent condom use with primary partners were: knowing one's HIV status, any risky injection during the past 30 days, and being African-American, compared with white or Latina. The profile of African-American women attending syringe exchange in New York City suggests a higher level of stabilization than is found in the other groups of women. White women appear to be more socially isolated and to engage in higher risk behaviors. Although women attending New York City syringe exchange programs have significantly reduced risky drug injection, consistent with other studies, sexual risk behavior has remained at a high level. Syringe exchange and drug treatment programs have a great opportunity to target drug-injecting women for sexual risk reduction interventions
MH - Adult
MH - Female
MH - HIV Infections
MH - ethnology
MH - prevention & control
MH - transmission
MH - Human
MH - Needle-Exchange Programs
MH - New York City
MH - Odds Ratio
MH - Program Evaluation
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,Non-U.S.Gov't
MH - Women's Health
RP - NOT IN FILE
NT - UI - 95386838LA - engPT - Journal ArticleDA - 19951004IS - 0098-8421SB - IMCY - UNITED STATESJC - H7R
UR - PM:7657943
SO - J Am Med Womens Assoc 1995 May ;50(3-4):109-114

71
UI - 71
AU - Paone D
AU - Des J
AU - Caloir S
AU - Clark J
AU - Jose B
AD - Chemical Dependency Institute, Beth Israel Medical Center, N.Y., NY 10003, USA
TI - Operational issues in syringe exchanges: the New York City tagging alternative study
AB - It is estimated that 50% of the approximate 200,000 intravenous drug users (IDUs) in New York City (NYC) are infected with HIV. Syringe exchange, a common method of HIV prevention in many countries was legalized in NYC in 1992. As syringe exchange has gained public support and the number of functioning exchangers has grown in the country, more attention has been given to the study of operational characteristics of syringe exchanges. Syringe exchanges may be considered health service delivery organizations, and the specific methods of service delivery may greatly influence their effectiveness in reducing HIV risk behavior among injecting drug users. Improving operational characteristics of syringe exchanges requires both careful data collection, in order to reduce ambiguity in interpretation, and methods for cumulating knowledge, so that previous learning experiences need not be repeated with each new exchange. We report here on the practice of marking ("tagging") syringes distributed by exchanges in NYC during the period from 1990 through 1994. During this period the NYC exchanges operated illegally as underground exchanges, and then received legal status and expanded greatly. Developing regulations that reflect the reality of the program operations while allowing for monitoring and oversight is a complicated process, especially when implemented in states that maintain paraphernalia and prescription laws and where "unauthorized" possession of injection equipment remains a criminal activity under existing legal statutes. The particular situation in NYC which required the revision of existing regulations during a period of rapid program expansion and implementation of a large system of syringe exchange further illustrates the multiple pressures which accompany such a process. In order to implement meaningful regulations which maximize the public health benefits of syringe exchange programs on an individual and community level, recommendations are made
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Interinstitutional Relations
MH - Needle-Exchange Programs
MH - economics
MH - legislation & jurisprudence
MH - organization & administration
MH - New York
MH - Police
MH - Program Development
MH - methods
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
RP - NOT IN FILE
NT - UI - 95370451LA - engPT - Journal ArticleDA - 19950920IS - 0094-5145SB - IMCY - UNITED STATESJC - HUT
UR - PM:7642778
SO - J Community Health 1995 Apr ;20(2):111-123

72
UI - 72
AU - Paone D
AU - Des J
AU - Gangloff R
AU - Milliken J
AU - Friedman SR
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA
TI - Syringe exchange: HIV prevention, key findings, and future directions
AB - HIV among injecting drug users (IDUs) has now been documented in over 60 countries in the world, and there are an additional 40 countries where injecting drug use has been reported including widespread epidemics in Southeast and southern Asia and in Latin America. At present HIV infection is almost always fatal, and there is no promise that a preventive vaccine will become available soon. Given the enormity of the HIV epidemic among IDUs and the critical need to reduce the spread of HIV transmission to and from IDUs, prevention efforts are essential. Syringe-exchange programs have become a major component of HIV prevention strategies in most developed countries and work within the philosophy of harm reduction. Increasing access to sterile syringes has been met with considerable controversy. Opponents of syringe exchange have generally argued that increasing access to sterile syringes would simultaneously increase the number of injecting drug users, increase the frequency of injection for already active IDUs, and appear to "condone" an illegal behavior. To date many research studies and four major reviews of syringe exchange literature have been conducted. All studies thus far have shown no increase in illicit drug injection associated with syringe exchanges, and significant decrease in drug risk behaviors
MH - Cross-Sectional Studies
MH - Forecasting
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Health Services Accessibility
MH - trends
MH - Human
MH - Incidence
MH - Needle-Exchange Programs
MH - Program Evaluation
MH - Substance Abuse,Intravenous
MH - epidemiology
MH - rehabilitation
RP - NOT IN FILE
NT - UI - 96122207LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19960227IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:8557411
SO - Int J Addict 1995 ;30(12):1647-1683

73
UI - 65
AU - Perlman DC
AU - Salomon N
AU - Perkins MP
AU - Yancovitz S
AU - Paone D
AU - Des J
AD - Department of Medicine, Beth Israel Medical Center, New York, New York 10003, USA
TI - Tuberculosis in drug users
AB - The rise in tuberculosis (TB) has disproportionately affected specific populations. Historically, many patients with TB became iatrogenic opiate addicts through therapeutic use of these drugs for symptom control. Demographic trends reshaped the relationship between drug use and TB into one in which drug use became a risk factor for tuberculosis as a result of the overlap of epidemiological and social factors associated with both drug use and TB. The spread of human immunodeficiency virus infection has amplified the spread of TB among drug users. We review the epidemiology of TB in drug users as well as the factors relevant to screening and compliance in drug-using populations. Drug users constitute a high-risk group for whom screening, prevention of infection, diagnosis, and treatment pose particular challenges. The development of TB services capable of engaging drug users (those both in and out of drug treatment programs) has potential for disrupting a significant chain of rapid TB transmission
MH - AIDS-Related Opportunistic Infections
MH - complications
MH - epidemiology
MH - Epidemiologic Factors
MH - Female
MH - Human
MH - Male
MH - Mass Screening
MH - Risk Factors
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - Tuberculosis,Multidrug-Resistant
MH - Tuberculosis,Pulmonary
MH - prevention & control
MH - United States
RP - NOT IN FILE
NT - UI - 96126012LA - engPT - Journal ArticlePT - ReviewPT - Review, AcademicID - RO1-DA09005-01A1/DA/NIDADA - 19960327IS - 1058-4838SB - IMCY - UNITED STATESJC - A4J
UR - PM:8589151
SO - Clin Infect Dis 1995 Nov ;21(5):1253-1264

74
UI - 77
AU - Curtis R
AU - Friedman SR
AU - Neaigus A
AU - Jose B
AU - Goldstein M
AU - Des J
AD - NDRI, Inc., New York, NY 10013
TI - Implications of directly observed therapy in tuberculosis control measures among IDUs
AB - Tuberculosis (TB) is a rapidly growing problem among injecting drug users (IDU), especially those infected with human immunodeficiency virus. The authors review IDUs' responses to current TB control strategies and discuss the implications of their findings for the proposed implementation of directly observed therapy (DOT), a method for ensuring that patients take prescribed medication. Field workers carried out 210 ethnographic interviews with 68 IDUs in a Brooklyn, NY, community during 1990-93. Case studies suggested that many IDUs are uninformed about TB and often misinformed about their personal TB status. Ethnographic interviews and observations indicated that the threat of TB-related involuntary detainment may lead IDUs to avoid TB diagnostic procedures, treatment for TB, or drug abuse treatment, and to avoid AIDS outreach workers and other health-related services. IDUs who tested positive for the purified protein derivative (PPD) of TB sometimes have left hospitals before definitive diagnoses were made, because of a perceived lack of respectful treatment, fear of detention, or lack of adequate methadone therapy to relieve the symptoms of withdrawal from drugs. Current TB diagnosis and treatment systems are, at best, inadequate. The threat of TB-related detention discourages some IDUs from seeking any type of health care. There is an urgent need to educate IDUs about TB and to educate and sensitize health care providers about the lifestyles of IDUs. DOT may help in servicing this difficult-to-serve population, particularly if techniques are incorporated that have been developed for other successful public health interventions for IDUs
MH - Adult
MH - Case Report
MH - Female
MH - HIV Seropositivity
MH - complications
MH - Human
MH - Male
MH - New York
MH - Patient Compliance
MH - Prisons
MH - Professional-Patient Relations
MH - Public Health Administration
MH - methods
MH - Substance Abuse,Intravenous
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
MH - Tuberculosis
MH - prevention & control
RP - NOT IN FILE
NT - UI - 94248282LA - engPT - Journal ArticleID - DA 06723/DA/NIDADA - 19940623IS - 0033-3549SB - AIMSB - IMCY - UNITED STATESJC - QJA
UR - PM:8190855
SO - Public Health Rep 1994 May ;109(3):319-327

75
UI - 75
AU - Des J
AU - Paone D
AU - Friedman SR
AU - Peyser N
AU - Newman RG
TI - Regulating syringe exchange programs: a cautionary note
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Needles
MH - supply & distribution
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - Syringes
RP - NOT IN FILE
NT - UI - 94315712LA - engPT - LetterDA - 19940819IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:8040972
SO - JAMA 1994 Aug 10 ;272(6):431-432

76
UI - 83
AU - Des J
AU - Friedman SR
AU - Sotheran JL
AU - Wenston J
AU - Marmor M
AU - Yancovitz SR
AU - Frank B
AU - Beatrice S
AU - Mildvan D
AD - Beth Israel Medical Center, National Development and Research Institutes Inc, New York, NY 10013
TI - Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992
AB - OBJECTIVES--To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. DESIGN AND SETTING--Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. PARTICIPANTS--Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. INTERVENTIONS--Community-based AIDS prevention programs, including underground syringe exchanges. MAIN OUTCOME MEASURES--Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. RESULTS--The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. CONCLUSIONS--The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission
MH - Adult
MH - Community Health Services
MH - statistics & numerical data
MH - trends
MH - Drug Administration Routes
MH - Female
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - psychology
MH - HIV Seroprevalence
MH - Human
MH - Male
MH - New York City
MH - Risk-Taking
MH - Substance Abuse Treatment Centers
MH - Substance Abuse,Intravenous
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - Urban Health
RP - NOT IN FILE
NT - UI - 94087890LA - engPT - Journal ArticleID - DA03574/DA/NIDAID - DA06001/DA/NIDADA - 19940127IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:8264066
SO - JAMA 1994 Jan 12 ;271(2):121-127

77
UI - 74
AU - Des J
AU - Padian NS
AU - Winkelstein W
AD - Beth Israel Medical Center, New York, NY 10013
TI - Targeted HIV-prevention programs
AB - An effective program to prevent HIV infection must have both universal and targeted components. The universal component includes reducing HIV- related discrimination, removing commercial restrictions on the materials necessary for safer behavior, and providing information about the risk of HIV. The targeted component involves focusing the limited resources for intensive programs of behavioral change on situations in which the risk of HIV transmission is highest. Such a strategy would follow the dictum "Warn widely and spend wisely."
MH - Communicable Disease Control
MH - methods
MH - HIV Infections
MH - prevention & control
MH - Health Education
MH - Human
MH - Politics
MH - Public Policy
MH - Risk-Taking
MH - United States
RP - NOT IN FILE
NT - UI - 95059237LA - engPT - Journal ArticleDA - 19941128IS - 0028-4793SB - AIMSB - IMCY - UNITED STATESJC - NOW
UR - PM:7969287
SO - N Engl J Med 1994 Nov 24 ;331(21):1451-1453

78
UI - 80
AU - Des J
AU - Choopanya K
AU - Vanichseni S
AU - Plangsringarm K
AU - Sonchai W
AU - Carballo M
AU - Friedmann P
AU - Friedman SR
AD - Beth Israel Medical Center, New York, NY
TI - AIDS risk reduction and reduced HIV seroconversion among injection drug users in Bangkok
AB - Human immunodeficiency virus (HIV) seroconversion was studied in a group of 173 injection drug users in Bangkok, Thailand, who had been previously tested for HIV and were interviewed and retested in the fall of 1989. Ten percent of the group had seroconverted. Two factors protected against HIV seroconversion: having stopped sharing injection equipment in response to the acquired immunodeficiency syndrome (AIDS) and having a regular sexual partner. The association between self- reported deliberate risk reduction and reduced HIV seroconversion among persons continuing to inject illicit drugs indicates that injection drug users can change their behavior in response to AIDS and will accurately report on the behavior change, and that the changes can protect against HIV infection
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - psychology
MH - Female
MH - HIV Seropositivity
MH - Health Education
MH - Human
MH - Logistic Models
MH - Male
MH - Needle Sharing
MH - Risk-Taking
MH - Sex Behavior
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
RP - NOT IN FILE
NT - UI - 94175192LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19940412IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:8129064
SO - Am J Public Health 1994 Mar ;84(3):452-455

79
UI - 78
AU - Des J
AD - Beth Israel Medical Center, New York, NY 10003
TI - The 1993 Okey Memorial Lecture. Cross-national studies of AIDS among injecting drug users
AB - HIV infection among injecting drug users has become a world-wide public health problem. This raises fundamental questions about the modifiability of drug-using behavior and of the influence of different national settings upon the modification of drug use behavior. Data from the World Health Organization Multi-site Study of HIV and Injecting Drug Use and studies of HIV among drug injectors in New York City (the US component of the WHO study) are used to address these questions. There is no clear relationship between HIV seroprevalence and current levels of risk behavior in the WHO cities, and the range in seroprevalence is much greater than the range in current risk behavior. Nonetheless, historical trend data enable us to discern at least two broad patterns in different cities. HIV epidemics appear to have been successfully prevented among IDUs in some cities, in that seroprevalence has remained low and stable over several years. These cities are characterized by community outreach programs and good access to sterile injection equipment. On the other hand, high seroprevalence epidemics have also occurred in many different cities. Stabilization of seroprevalence has eventually also occurred in these cities, but this still includes moderate rates of new HIV infections. How to reverse high-seroprevalence situations remains one of the more difficult questions in HIV epidemiology. The epidemiology of HIV infection among injecting drug users also needs to include analyses of the impacts of decisions by political and public health leaders. A three-category scheme for classifying political decisions is offered: data-free decisions, data-based decisions, and data-proof decisions
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - epidemiology
MH - prevention & control
MH - Comorbidity
MH - Cross-Cultural Comparison
MH - HIV Seropositivity
MH - Health Promotion
MH - Human
MH - Needle Sharing
MH - Public Health
MH - Risk-Taking
MH - Sex Behavior
MH - Social Problems
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - World Health
MH - World Health Organization
RP - NOT IN FILE
NT - UI - 94297490LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA 03574/DA/NIDADA - 19940809IS - 0965-2140SB - IMCY - ENGLANDJC - BM3
UR - PM:8025490
SO - Addiction 1994 Apr ;89(4):383-392

80
UI - 81
AU - Des J
AD - Beth Israel Medical Center, New York, New York
TI - Self-help and science in the treatment of addiction
MH - Alcoholics Anonymous
MH - Alcoholism
MH - psychology
MH - rehabilitation
MH - Follow-Up Studies
MH - Human
MH - Outcome and Process Assessment (Health Care)
MH - Patient Care Team
MH - Recurrence
MH - Self Care
MH - Substance-Related Disorders
MH - Temperance
RP - NOT IN FILE
NT - UI - 94315648LA - engPT - CommentPT - Journal ArticleDA - 19940824IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:8040911
SO - J Subst Abuse Treat 1994 Mar ;11(2):109-110

81
UI - 79
AU - Friedman P
AU - Des J
AU - Peyser NP
AU - Nichols SE
AU - Drew E
AU - Newman RG
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, New York 10003
TI - Retention of patients who entered methadone maintenance via an interim methadone clinic
AB - Time in treatment is considered an important predictor of good outcomes for drug abuse treatment. Patient retention would be of particular concern for low-service types of treatment. Interim methadone maintenance was developed as an alternative to waiting lists and as a method of providing HIV risk-reduction services to heroin addicts waiting for treatment, and does not include the regular counseling required in comprehensive methadone treatment. This analysis compares the retention of patients first admitted to an interim methadone clinic versus that of patients admitted directly to a comprehensive methadone clinic. The two groups did not differ with regard to demographic characteristics and drug of abuse at the time of admission. The two groups did not differ with respect to demographics. The three-, six-, and 12-month retention rates of patients first admitted to the interim clinic were 78%, 69%, and 62%, respectively. The three-, six-, and 12- month retention rates for patients admitted directly to a traditional methadone clinic were 84%, 76%, and 68%, respectively. Life-table analysis revealed that the two groups did not differ significantly with regard to retention (p = 0.17). Interim treatment does not appear to adversely affect overall retention in treatment. Three- and six-month retention rates of interim clinic patients fall within the range of six- month nationwide retention rates reported by the GAO. Factors associated with discharge from treatment are examined for both groups
MH - Adolescence
MH - Adult
MH - Female
MH - Human
MH - Male
MH - Methadone
MH - therapeutic use
MH - Opioid-Related Disorders
MH - economics
MH - rehabilitation
MH - Patient Admission
MH - Pennsylvania
MH - Substance Abuse Treatment Centers
MH - organization & administration
MH - Time Factors
MH - Waiting Lists
RP - NOT IN FILE
NT - UI - 95017323LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleDA - 19941123IS - 0279-1072SB - IMCY - UNITED STATESJC - JLP
UR - PM:7931866
SO - J Psychoactive Drugs 1994 Apr ;26(2):217-221

82
UI - 82
AU - Friedman SR
AU - Jose B
AU - Neaigus A
AU - Goldstein M
AU - Curtis R
AU - Ildefonso G
AU - Mota P
AU - Des J
AD - National Development and Research Institutes (NDRI), Inc., New York, NY 10013
TI - Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs
AB - OBJECTIVES: To study how condom use in injecting drug users' (IDU) relationships differs according to whether they are HIV-infected, and to whether their sex partner is an IDU. DESIGN AND METHODS: A total of 317 street-recruited IDU were HIV-antibody tested and interviewed about 421 relationships with particular sex partners. RESULTS: Condoms were consistently (100%) used in sex between partners (during the previous 30 days) in 33% of these relationships, and their use was significantly more frequent in relationships of seropositive IDU and in relationships with non-IDU partners. In relationships between seropositive IDU and non-IDU, consistent condom use was reported to be high (68%); this remained unchanged under multivariate controls. CONCLUSIONS: Self- reported condom use by IDU in New York, with its relatively mature epidemic, appears to be concentrated where it may most reduce the spread of HIV to non-IDU heterosexuals, i.e., in relationships between infected IDU and non-IDU partners. Differential condom use by serostatus and by partners' drug injection should be incorporated into mathematical models of the HIV epidemic. Causes of the high level of condom use in this subset of relationships may include drug injector altruism and pressure by sex partners; prevention programs should develop ways to use both of these factors to motivate increased condom use
MH - Adult
MH - Condoms
MH - utilization
MH - Female
MH - HIV Infections
MH - transmission
MH - HIV Seropositivity
MH - complications
MH - epidemiology
MH - psychology
MH - Human
MH - Male
MH - New York City
MH - Questionnaires
MH - Sex Behavior
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 94304557LA - engPT - Journal ArticleID - RO1 DA06723/DA/NIDADA - 19940816IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:8031514
SO - AIDS 1994 Mar ;8(3):357-361

83
UI - 76
AU - Lima ES
AU - Friedman SR
AU - Bastos FI
AU - Telles PR
AU - Friedmann P
AU - Ward TP
AU - Des J
AD - Nucleo de Estudos e Pesquisas em Atencao ao Uso de Drogas (NEPAD), Rio de Janeiro, Brazil
TI - Risk factors for HIV-1 seroprevalence among drug injectors in the cocaine-using environment of Rio de Janeiro
AB - To determine risk factors for HIV-1 among drug injectors in Rio de Janeiro, where cocaine is the dominant drug of injection, subjects were recruited using the criteria and interview instrument of the World Health Organization's Cross-National Study of HIV infection and risk behaviour in injecting drug users. HIV antibody test results were derived both from serum tests and from self-reports of previous tests (documented evidence of self-reported seropositivity was required). The analytical sample consists of 123 subjects, recruited both at drug abuse treatment sites and at street locations. Of 27 subjects with both serological and self-reported antibody status data, 20 reported previous negative tests; of these three had positive sera and may have seroconverted. Seven subjects reporting prior positive serostatus all tested positive. For the 123 subjects, seroprevalence was 34%. Independent significant risk factors in multivariate logistic regression with backwards elimination are: years of injection greater than 5; being a male who has had sex with men in the previous 5 years; and not having taken deliberate steps to protect oneself against AIDS. These findings indicate that homosexual/bisexual male drug injectors may be a bridge group through which HIV is entering drug-injecting networks in Rio de Janeiro. Efforts by drug injectors to reduce their risk of infection seem to have protective effects. This underscores the importance of HIV prevention efforts aimed at drug injectors
MH - Brazil
MH - epidemiology
MH - Cocaine
MH - Comorbidity
MH - HIV Seropositivity
MH - complications
MH - diagnosis
MH - Hiv-1
MH - Human
MH - Male
MH - Risk Factors
MH - Self Assessment (Psychology)
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 94348362LA - engRN - 50-36-2 (Cocaine)PT - Journal ArticleID - RO1 DA03574/DA/NIDADA - 19940923IS - 0965-2140SB - IMCY - ENGLANDJC - BM3
UR - PM:8069170
SO - Addiction 1994 Jun ;89(6):689-698

84
UI - 85
AU - Marmor M
AU - Titus S
AU - Wolfe H
AU - Krasinski K
AU - Maslansky R
AU - Simberkoff M
AU - Beatrice S
AU - Nichols S
AU - Des J
AD - Department of Environmental Medicine, New York University School of Medicine, NY 10010
TI - Preparations for AIDS vaccine trials. Retention, behavior change, and HIV-seroconversion among injecting drug users (IDUs) and sexual partners of IDUs
AB - The likelihood that subjects in human immunodeficiency virus (HIV) vaccine efficacy trials will alter their behavioral risks for HIV infection over time must be considered in evaluating the feasibility of such trials and in estimating the necessary sample sizes to be enrolled. Potential subjects for future vaccine efficacy trials include injecting drug users (IDUs) and others who may be difficult to retain in studies and who may alter HIV-risk-related behaviors substantially over time. We have investigated behavior change, retention, and HIV seroconversion among 577 New York City resident IDUs and sexual partners of IDUs enlisted between July 1 and December 31, 1992. We attempted to see all subjects every 3 months for interviews, blood donation and HIV testing. We were able to retain 68% of subjects in the study through the third scheduled recall at 7.5-10.5 months after enlistment. HIV seroconversion through March 1, 1994, was 1.33/100 person-years at risk. There was a significant inverse relationship between HIV seroconversion and retention at the 9-month recall after adjusting for age, gender, and the amount of locator information provided by subjects at enlistment. Among subjects seen at each of the scheduled visits at 3, 6, and 9 months after enrollment, modest but statistically significant behavior changes that reduced risk were observed in self-reported drug injection frequency, heroin injection frequency, sexual contact with IDUs, and sharing of needles/syringes. The magnitude of these changes in risk, however, was small and may be transient. The behavior changes observed to date do not appear to be large enough to substantially alter calculations of sample sizes needed in future HIV vaccine efficacy trials
MH - AIDS Vaccines
MH - pharmacology
MH - Adolescence
MH - Adult
MH - Aged
MH - Clinical Trials
MH - methods
MH - psychology
MH - Cohort Studies
MH - Female
MH - HIV Seropositivity
MH - complications
MH - epidemiology
MH - Human
MH - Male
MH - Middle Age
MH - New York City
MH - Odds Ratio
MH - Patient Compliance
MH - Patient Selection
MH - Risk-Taking
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
RP - NOT IN FILE
NT - UI - 95169483LA - engRN - 0 (AIDS Vaccines)PT - Journal ArticleID - AI25702/AI/NIAIDID - AI29184/AI/NIAIDID - DA06001/DA/NIDAID - etcDA - 19950330IS - 0889-2229SB - IMCY - UNITED STATESJC - ART
UR - PM:7865302
SO - AIDS Res Hum Retroviruses 1994 ;10 Suppl 2():S207-S213

85
UI - 84
AU - Neaigus A
AU - Friedman SR
AU - Curtis R
AU - Des J
AU - Furst RT
AU - Jose B
AU - Mota P
AU - Stepherson B
AU - Sufian M
AU - Ward T
AU - .
AD - National Development and Research Institutes, Inc., New York City 10013
TI - The relevance of drug injectors' social and risk networks for understanding and preventing HIV infection
AB - Focusing on the social environment as well as the individual should both enhance our understanding of HIV transmission and assist in the development of more effective prevention programs. Networks are an important aspect of drug injectors' social environment. We distinguish between (1) risk networks (the people among whom HIV risk behaviors occur) as vectors of disease transmission, and (2) social networks (the people among whom there are social interactions with a mutual orientation to one another) as generators and disseminators of social influence. These concepts are applied to analyses of data from interviews with drug injectors in two studies. In the first study drug injectors' risk networks converge with their social networks: 70% inject or share syringes with a spouse or sex partner, a running partner, or with friends or others whom they know. Qualitative data from interviews with injectors in the second study also show that the social relationships between drug injectors and members of their risk network are often based on long-standing and multiplex relationships, such as those based on kinship, friendship, marital and sexual ties, and economic activity. In the first study the vast majority of injectors, over 90%, have social ties with non-injectors. Injectors with more frequent social contacts with non-injectors engage in lower levels of injecting risk behavior. Risk settings may function as risk networks: injectors in this study who inject at shooting galleries are more likely than those who do not to rent used syringes, borrow used syringes and inject with strangers. Since the adoption of a network approach is relatively new, a number of issues require further attention. These include: how to utilize social networks among drug injectors to reduce risk through peer pressure; how to promote risk reduction by encouraging ties between injectors and non-injectors; and how to integrate biographical and historical change into understanding network processes. Appropriate methodologies to study drug injectors' networks should be developed, including techniques to reach hidden populations, computer software for managing and analyzing network data bases, and statistical methods for drawing inferences from data gathered through dependent sampling designs
MH - Adult
MH - Female
MH - HIV Infections
MH - etiology
MH - prevention & control
MH - psychology
MH - Human
MH - Male
MH - Peer Group
MH - Risk-Taking
MH - Social Environment
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 - 94196423LA - engPT - Journal ArticleID - DA05283/DA/NIDAID - DA06723/DA/NIDADA - 19940504IS - 0277-9536SB - IMCY - ENGLANDJC - UT9
UR - PM:8146717
SO - Soc Sci Med 1994 Jan ;38(1):67-78

86
UI - 93
AU - Des J
AU - Friedman SR
AU - Ward TP
AD - Beth Israel Medical Center, New York, NY 10013
TI - Harm reduction: a public health response to the AIDS epidemic among injecting drug users
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - prevention & control
MH - transmission
MH - Adult
MH - Child
MH - Female
MH - Human
MH - Infant,Newborn
MH - Male
MH - Philosophy,Medical
MH - Preventive Health Services
MH - organization & administration
MH - Program Evaluation
MH - Public Health
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
MH - supply & distribution
RP - NOT IN FILE
NT - UI - 93312384LA - engPT - Journal ArticlePT - ReviewPT - Review LiteratureID - DA03574/DA/NIDADA - 19930812IS - 0163-7525SB - IMCY - UNITED STATESJC - ABA
UR - PM:8323596
SO - Annu Rev Public Health 1993 ;14():413-450

87
UI - 90
AU - Des J
AU - Friedman SR
AU - Marmor M
AU - Mildvan D
AU - Yancovitz S
AU - Sotheran JL
AU - Wenston J
AU - Beatrice S
AD - Beth Israel Medical Center, New York, New York
TI - CD4 lymphocytopenia among injecting drug users in New York City
AB - Recent cases of "AIDS-like" CD4 lymphocytopenia in the absence of HIV infection have generated considerable scientific and public interest. We studied CD4 cell counts and percentages from 1984 to 1992 among 1,246 HIV-seronegative injecting drug users in New York City, a population at very high risk for exposure to bloodborne pathogens. Severe CD4 lymphocytopenia was rare, and there was no evidence of an increase over time. Of 229 subjects with longitudinal data, only four met the surveillance definition for "idiopathic CD4 lymphocytopenia" (ICL). CD4 cell counts of < 500 cells/microliters were, however, associated with subsequent HIV seroconversion (12.7/100 person-years at risk, relative risk (RR) = 4.53, 95% exact binomial confidence interval (CI) 1.7-10.7, p = 0.002)
MH - Adult
MH - Binomial Distribution
MH - CD4-Positive T-Lymphocytes
MH - Female
MH - Human
MH - Leukocyte Count
MH - Longitudinal Studies
MH - Lymphopenia
MH - epidemiology
MH - etiology
MH - Male
MH - Middle Age
MH - New York City
MH - Substance Abuse,Intravenous
MH - blood
MH - complications
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 93286879LA - engPT - Journal ArticleID - DA03574/DA/NIDAID - DA06001/DA/NIDADA - 19930713IS - 0894-9255SB - IMCY - UNITED STATESJC - JOF
UR - PM:8099613
SO - J Acquir Immune Defic Syndr 1993 Jul ;6(7):820-822

88
UI - 89
AU - Des J
AU - Widdus R
TI - The missing AIDS science
MH - Acquired Immunodeficiency Syndrome
MH - Behavioral Sciences
MH - Human
MH - Risk-Taking
MH - Sex Behavior
MH - Street Drugs
MH - Substance-Related Disorders
RP - NOT IN FILE
NT - UI - 93342497LA - engRN - 0 (Street Drugs)PT - CommentPT - LetterDA - 19930831IS - 0036-8075SB - IMCY - UNITED STATESJC - UJ7
UR - PM:8342031
SO - Science 1993 Aug 6 ;261(5122):665

89
UI - 94
AU - Des J
AU - Friedman SR
AD - Beth Israel Medical Center, New York, N.Y
TI - Critical issues regarding AIDS among injecting drug users
AB - The paper identifies and reviews some critical issues in the field of human immunodeficiency virus (HIV) transmission among intravenous drug users. First, it discusses political denial and compartmentalization of the problem, giving an example from the United States that illustrates the lack of a coherent national strategy. It then reviews the role that stereotypes play in policy-making and points out that behaviour change can be considerable, giving details of successful safer injection programmes. The conditions that foster injection as a mode of ingesting drugs are reviewed, as in the role of drug trans-shipment patterns, particularly as a possible conduit of HIV. Finally, the role of prisons as places for the spread of HIV, and therefore for its prevention, is discussed
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - prevention & control
MH - transmission
MH - Denial (Psychology)
MH - Health Behavior
MH - Health Policy
MH - Human
MH - Politics
MH - Primary Prevention
MH - methods
MH - Prisons
MH - Risk Factors
MH - Stereotyping
MH - Substance Abuse,Intravenous
MH - complications
MH - psychology
MH - United States
RP - NOT IN FILE
NT - UI - 94138317LA - engPT - Journal ArticlePT - ReviewPT - Review LiteratureDA - 19940317IS - 0007-523XSB - IMCY - UNITED STATESJC - BQ7
UR - PM:8305907
SO - Bull Narc 1993 ;45(1):61-75

90
UI - 92
AU - Friedman SR
AU - Des J
AD - National Development and Research Institutes, Inc, New York
TI - Controlling the HIV epidemic among drug injectors
MH - Disease Outbreaks
MH - prevention & control
MH - HIV Infections
MH - transmission
MH - Hiv-1
MH - Human
MH - Spain
MH - Substance Abuse,Intravenous
MH - Urban Population
RP - NOT IN FILE
NT - UI - 93224263LA - engPT - Journal ArticleDA - 19930510IS - 0213-9111SB - IMCY - SPAINJC - GSZ
UR - PM:8468147
SO - Gac Sanit 1993 Jan ;7(34):41-44

91
UI - 88
AU - Friedman SR
AU - Des J
TI - Re: "The harm reduction approach and risk factors for human immunodeficiency virus (HIV) seroconversion in injecting drug users, Amsterdam"
MH - Cohort Studies
MH - HIV Seropositivity
MH - epidemiology
MH - Human
MH - Logistic Models
MH - Methadone
MH - therapeutic use
MH - Needle Sharing
MH - Netherlands
MH - Preventive Health Services
MH - Regression Analysis
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - psychology
MH - Syringes
RP - NOT IN FILE
NT - UI - 94056378LA - engRN - 76-99-3 (Methadone)PT - CommentPT - LetterDA - 19931214IS - 0002-9262SB - IMCY - UNITED STATESJC - 3H3
UR - PM:8292200
SO - Am J Epidemiol 1993 Nov 1 ;138(9):768-771

92
UI - 87
AU - Hagan H
AU - Des J
AU - Purchase D
AU - Friedman SR
AU - Reid T
AU - Bell TA
AD - Tacoma-Pierce County Health Department, Washington
TI - An interview study of participants in the Tacoma, Washington, syringe exchange
AB - Although European and Australian studies of syringe exchange programs have reported safer injection among participants and no increase in drug use, the generalizability of these findings to the US is uncertain. We report on the operations and potential effectiveness of the longest-operating syringe exchange in the US and compare our results to studies of exchange programs outside the US. The sample of 204 study subjects reported no change in the frequency of injection, from 155 to 152 injections per month, and a decline in the frequency of unsafe injections, from 56 to 30 times per month, while participating in the program. In all studies, participants report reduction in unsafe injections, and no increase in illicit drug use. However, the comparison also suggests that a high proportion of Tacoma exchangers have higher initial rates of drug injection, unsafe injection and homelessness, all of which were associated with unsafe injection while using the exchange. These indicate a need for additional services but that the Tacoma program is no less effective than European and Australian programs
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Adult
MH - Female
MH - Health Promotion
MH - Health Surveys
MH - Human
MH - Male
MH - Questionnaires
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Syringes
MH - utilization
MH - United States
MH - Washington
RP - NOT IN FILE
NT - UI - 94177074LA - engPT - Journal ArticleDA - 19940418IS - 0965-2140SB - IMCY - ENGLANDJC - BM3
UR - PM:8130708
SO - Addiction 1993 Dec ;88(12):1691-1697

93
UI - 86
AU - Jose B
AU - Friedman SR
AU - Neaigus A
AU - Curtis R
AU - Grund JP
AU - Goldstein MF
AU - Ward TP
AU - Des J
AD - National Development and Research Institutes, Inc., New York, New York 10013
TI - Syringe-mediated drug-sharing (backloading): a new risk factor for HIV among injecting drug users
AB - BACKGROUND: In syringe-mediated drug-sharing (backloading), injecting drug users (IDU) use their syringes to mix drugs and to give measured shares to other IDU by squirting drug solution into the syringes of other IDU. Backloading has been discussed as a potential HIV risk factor, but its role as an HIV transmission route has not been established empirically. METHODS: Six hundred and sixty IDU who had injected drugs in the previous 2 years were street-recruited from Bushwick, New York City through chain referral, tested for HIV antibody and interviewed about sexual and drug-risk behaviors. RESULTS: Receiving drugs via backloading in the previous 2 years was reported by 24.5% of the subjects. These subjects had significantly higher HIV seroprevalence than those who did not receive drugs by backloading (odds ratio, 2.2; 95% confidence interval, 1.5-3.1). Backloading remained positively and significantly associated with HIV seropositivity in stepwise logistic regression, and in a series of simultaneous logistic models controlling for sociodemographic variables and for sexual and drug risk variables. CONCLUSIONS: Backloading can be a route of HIV transmission among IDU and should be incorporated into risk-factor studies and HIV transmission modeling. Many IDU who avoid other high-risk drug-injection practices may overlook the risk of backloading. HIV prevention programs should warn IDU against syringe- mediated drug-sharing and work together to develop ways to avoid it
MH - Adult
MH - Confidence Intervals
MH - Female
MH - HIV Infections
MH - epidemiology
MH - transmission
MH - HIV Seropositivity
MH - Human
MH - Male
MH - Needle Sharing
MH - Odds Ratio
MH - Risk Factors
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
RP - NOT IN FILE
NT - UI - 94114142LA - engPT - Journal ArticleID - DA06723/DA/NIDADA - 19940223IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:8286076
SO - AIDS 1993 Dec ;7(12):1653-1660

94
UI - 91
AU - Vanichseni S
AU - Des J
AU - Choopanya K
AU - Friedmann P
AU - Wenston J
AU - Sonchai W
AU - Sotheran JL
AU - Raktham S
AU - Carballo M
AU - Friedman SR
AD - Bangkok Metropolitan Administration, Thailand
TI - Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States
AB - OBJECTIVE: To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities. DESIGN AND METHODS: Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990- 1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer. RESULTS: A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities. CONCLUSIONS: Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV
MH - Adult
MH - Communication
MH - Comorbidity
MH - Comparative Study
MH - Condoms
MH - utilization
MH - Dangerous Behavior
MH - Ethnic Groups
MH - Female
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - psychology
MH - Human
MH - Interpersonal Relations
MH - Logistic Models
MH - Male
MH - Multivariate Analysis
MH - New York City
MH - Risk Factors
MH - Sex Behavior
MH - statistics & numerical data
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
RP - NOT IN FILE
NT - UI - 93371720LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19931004IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:8363764
SO - AIDS 1993 Jun ;7(6):887-891

95
UI - 95
AU - Wodak A
AU - Des J
AD - Alcohol and Drug Service, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
TI - Strategies for the prevention of HIV infection among and from injecting drug users
AB - Despite a substantial reduction in the level of high-risk behaviours among injecting drug users (IDUs) documented in an impressive number of studies from many countries, human immunodeficiency virus (HIV) infection continues to spread among and from this population, reflecting the high baseline levels of these risk behaviours before the epidemic. In many countries, the control of HIV spread among IDUs is critical to efforts to control the epidemic in the population as a whole. Although the evaluation of individual or multiple strategies is problematic, there is accumulating evidence and increasing confidence that the course of the epidemic can be altered by implementing some or all of a range of strategies. Authorities mindful of their public health responsibilities should estimate the risk of spread of HIV among and from IDU populations in their jurisdiction and plan their response accordingly by selecting prevention measures that are appropriate for local conditions and by vigilantly monitoring developments
MH - AIDS Serodiagnosis
MH - Condoms
MH - utilization
MH - Disinfection
MH - HIV Infections
MH - diagnosis
MH - etiology
MH - prevention & control
MH - transmission
MH - Health Behavior
MH - Human
MH - Needle Sharing
MH - Needles
MH - Patient Education
MH - Primary Prevention
MH - methods
MH - Prisons
MH - Research
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
RP - NOT IN FILE
NT - UI - 94138316LA - engPT - Journal ArticlePT - ReviewPT - Review LiteratureDA - 19940317IS - 0007-523XSB - IMCY - UNITED STATESJC - BQ7
UR - PM:8305906
SO - Bull Narc 1993 ;45(1):47-60

96
UI - 98
AU - Abdul-Quader AS
AU - Des J
AU - Tross S
AU - McCoy E
AU - Morales G
AU - Velez I
AD - Narcotic and Drug Research, Inc., New York, NY 10013
TI - Outreach to injecting drug users and female sexual partners of drug users on the lower east side of New York City
AB - In 1984, outreach to injecting drug users and their female sexual partners was initiated as part of HIV behavioral research projects. HIV, health, drug treatment and family planning information and services were provided in addition to recruiting subjects to the research program. Such outreach also poses certain problems--especially potential disruption of neighborhood day-to-day life and clashes with police. This paper discusses an outreach program to injecting drug users and their female sexual partners that was initiated in New York City to provide HIV-related information and services. We examine the successes of the program and problems that were involved in conducting outreach to persons who are typically not accessible through formal institutional channels
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - prevention & control
MH - Behavior Therapy
MH - Cocaine
MH - Communication
MH - Community Health Services
MH - organization & administration
MH - Ethnic Groups
MH - Female
MH - Health Education
MH - Human
MH - Interpersonal Relations
MH - Male
MH - New York City
MH - Sex Behavior
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - rehabilitation
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - United States
MH - Verbal Behavior
RP - NOT IN FILE
NT - UI - 92274068LA - engRN - 50-36-2 (Cocaine)PT - Journal ArticleID - U62/CCU201085/PHSDA - 19920626IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1591518
SO - Br J Addict 1992 May ;87(5):681-688

97
UI - 107
AU - Des J
AU - Wenston J
AU - Friedman SR
AU - Sotheran JL
AU - Maslansky R
AU - Marmor M
AD - Beth Israel Medical Center, New York, New York 10013
TI - Crack cocaine use in a cohort of methadone maintenance patients
AB - We examined crack use in a cohort of methadone patients originally enrolled in 1984-86. Crack use questions were added to the study in 1987. Of the 494 methadone patients originally enrolled, 228 subjects remained in methadone and were re-interviewed in 1987-88, and 234 remained in methadone and were re-interviewed in 1988-89. Approximately one-quarter of the subjects were using crack at each of the 1987-88 and 1988-89 data collection points, and only 3% of the subjects were using crack at daily or greater frequencies at each of the 1987-88 and 1988- 89 interviews. Concurrent crack use was associated with (a) the number of noninjected drugs being used; (b) the number of IV drug-using sexual partners; (c) drug injection; and (d) the use of nonheroin opiates. Persistent crack use, defined as use in both 1987-88 and 1988-89, was associated with previous noninjected drug use and previous suicide attempts. While the potential problem of crack use among methadone patients should not be minimized, it appears that, compared to illicit drug injectors not in treatment, being in methadone maintenance may offer a protective effect against crack use
MH - Adult
MH - Cohort Studies
MH - Comorbidity
MH - Crack Cocaine
MH - Female
MH - Follow-Up Studies
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Longitudinal Studies
MH - Male
MH - Methadone
MH - therapeutic use
MH - Needle Sharing
MH - adverse effects
MH - statistics & numerical data
MH - New York City
MH - epidemiology
MH - Opioid-Related Disorders
MH - complications
MH - rehabilitation
MH - Risk Factors
MH - Sex Behavior
MH - Substance Abuse Detection
MH - Substance Abuse,Intravenous
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 93124523LA - engRN - 0 (Crack Cocaine)RN - 76-99-3 (Methadone)PT - Journal ArticleID - DA03574/DA/NIDADA - 19930211IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:1479629
SO - J Subst Abuse Treat 1992 ;9(4):319-325

98
UI - 96
AU - Des J
AU - Wenston J
AU - Friedman SR
AU - Sotheran JL
AU - Maslansky R
AU - Marmor M
AU - Yancovitz S
AU - Beatrice S
AD - Beth Israel Medical Center, National Development and Research Institutes, Inc., New York City, NY 10013
TI - Implications of the revised surveillance definition: AIDS among New York City drug users
AB - The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase in the number of persons recognized as living with AIDS. Among 440 HIV-seropositive research subjects recruited from drug treatment programs and through street outreach in New York City, 59 met this definition, yet only 25% of those had been reported to the New York City AIDS registry. The new definition, if combined with HIV and T-cell testing at drug treatment and street outreach programs, could thus yield very large increases in the number of injecting drug users meeting the new surveillance definition of AIDS
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - CD4-Positive T-Lymphocytes
MH - Centers for Disease Control and Prevention (U.S.)
MH - Female
MH - HIV Seropositivity
MH - immunology
MH - HIV Seroprevalence
MH - Human
MH - Leukocyte Count
MH - Male
MH - New York City
MH - Population Surveillance
MH - Prevalence
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 93072565LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19921211IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:1359800
SO - Am J Public Health 1992 Nov ;82(11):1531-1533

99
UI - 99
AU - Des J
AU - Casriel C
AU - Friedman SR
AU - Rosenblum A
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, New York 10003
TI - AIDS and the transition to illicit drug injection--results of a randomized trial prevention program
AB - Illicit drug injection is a major component of the AIDS epidemic in the United States, Europe and some developing countries. Prevention of illicit drug injection would not only reduce HIV transmission but would also reduce the other health, psychological and social problems associated with illicit drug injection. One hundred and four subjects who were using heroin intranasally ('sniffing') were recruited for a study of the transition to drug injection. Eligibility criteria included sniffing as the most frequent route of administration and no more than 60 injections in the past 2 years. All subjects received thorough basic information about AIDS, including HIV antibody test counseling. Subjects were then randomly assigned to a four-session social learning based AIDS/drug injection prevention program or a control condition. Eighty-three subjects were successfully followed at a mean time of 8.9 months. Twenty (24%) of the followed subjects reported injecting illicit drugs during the follow-up period. Drug injection during follow-up was associated with being in the control group, intensity of non-injected drug use, prior injection, and having close personal relationships with current intravenous (IV) drug users
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Administration,Intranasal
MH - Adolescence
MH - Adult
MH - Female
MH - Follow-Up Studies
MH - HIV Seroprevalence
MH - trends
MH - Heroin Dependence
MH - complications
MH - rehabilitation
MH - Human
MH - Male
MH - Middle Age
MH - New York City
MH - Risk Factors
MH - Street Drugs
MH - Substance Abuse,Intravenous
RP - NOT IN FILE
NT - UI - 92216643LA - engRN - 0 (Street Drugs)PT - Clinical TrialPT - Journal ArticlePT - Randomized Controlled TrialDA - 19920514IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1559048
SO - Br J Addict 1992 Mar ;87(3):493-498

100
UI - 97
AU - Des J
AU - Friedman SR
AU - Choopanya K
AU - Vanichseni S
AU - Ward TP
TI - International epidemiology of HIV and AIDS among injecting drug users
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - transmission
MH - HIV Infections
MH - HIV Seropositivity
MH - Hiv-1
MH - Human
MH - Preventive Medicine
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
MH - Virulence
MH - World Health
RP - NOT IN FILE
NT - UI - 93103613LA - engPT - EditorialID - DA03574/DA/NIDADA - 19930128IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:1466837
SO - AIDS 1992 Oct ;6(10):1053-1068

101
UI - 102
AU - Des J
AD - Beth Israel Medical Center, New York, NY 10013
TI - The first and second decades of AIDS among injecting drug users
AB - This paper examines findings and trends from the first decade of research on AIDS among injecting drug users as a basis for projecting into the next decade. One of the most disturbing aspects of AIDS and HIV infection among injecting drug users which emerged in the first decade is the globalization of the problem. Further geographic spread can be expected, particularly in developing countries. Rapid spread of HIV among drug injectors has occurred in many different cities, with a lack of AIDS awareness and mechanisms for efficient mixing of the at- risk population appearing to be important contributing factors. Drug injectors have modified their behavior in response to a wide variety of AIDS prevention programs. No single type of prevention program should be viewed as a panacea, and a comprehensive system of programs will undoubtedly be needed. Changing sexual risk behavior has proven to be considerably more difficult than changing drug injection risk behavior, and is an area in need of much more research
MH - Comparative Study
MH - Cross-Cultural Comparison
MH - Forecasting
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - HIV Seroprevalence
MH - trends
MH - Human
MH - Risk Factors
MH - Street Drugs
MH - Substance Abuse,Intravenous
MH - complications
MH - epidemiology
MH - rehabilitation
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 92216628LA - engRN - 0 (Street Drugs)PT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA03574/DA/NIDADA - 19920514IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1559033
SO - Br J Addict 1992 Mar ;87(3):347-353

102
UI - 101
AU - Friedman SR
AU - Neaigus A
AU - Des J
AU - Sotheran JL
AU - Woods J
AU - Sufian M
AU - Stepherson B
AU - Sterk C
AD - Narcotic and Drug Research, Inc., New York, NY 10013
TI - Social intervention against AIDS among injecting drug users
AB - Many drug injectors continue to engage in behaviors that lead them to become infected with HIV in spite of a wide variety of public health programs. In addition, many persons have begun to inject drugs in spite of knowing the risks of AIDS. The inadequacy of current efforts to prevent these behaviors suggests that additional forms of intervention should be attempted. We suggest that social interventions be tried to complement current programs (almost all of which have an individual focus). Evidence that social factors such as peer pressure and the social relations of race affect risk behavior is presented. Social interventions that are discussed include organizing drug injectors against AIDS in ways analogous to those in which gays organized against the epidemic, and finding ways to change large-scale social relationships that predispose people to inject drugs
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - psychology
MH - transmission
MH - Health Behavior
MH - Human
MH - Peer Group
MH - Risk Factors
MH - Social Environment
MH - Street Drugs
MH - Substance Abuse,Intravenous
MH - complications
MH - rehabilitation
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 92216633LA - engRN - 0 (Street Drugs)PT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA03574/DA/NIDAID - DA05283/DA/NIDAID - DA05360/DA/NIDADA - 19920514IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1559038
SO - Br J Addict 1992 Mar ;87(3):393-404

103
UI - 104
AU - Friedman SR
AU - Kleinman PH
AU - Des J
TI - History, biography, and HIV infection
MH - Cross-Sectional Studies
MH - HIV Infections
MH - epidemiology
MH - Hiv-1
MH - Health Behavior
MH - Human
MH - New York City
MH - Substance Abuse,Intravenous
MH - complications
RP - NOT IN FILE
NT - UI - 92161028LA - engPT - CommentPT - LetterDA - 19920320IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:1580918
SO - Am J Public Health 1992 Jan ;82(1):125

104
UI - 109
AU - Friedman SR
AU - Stepherson B
AU - Woods J
AU - Des J
AU - Ward TP
AD - International Working Group on AIDS and IV Drug Use, Narcotic and Drug Research, Inc., New York, NY 10013
TI - Society, drug injectors, and AIDS
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - therapy
MH - transmission
MH - Adolescence
MH - Female
MH - Human
MH - Male
MH - Public Health
MH - economics
MH - Risk Factors
MH - Social Environment
MH - Socioeconomic Factors
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 93004002LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA06723/DA/NIDADA - 19921112IS - 1049-2089SB - IMCY - UNITED STATESJC - A4D
UR - PM:1391390
SO - J Health Care Poor Underserved 1992 ;3(1):73-89

105
UI - 106
AU - Newman RG
AU - Des J
TI - Methadone dosage, program policies, and heroin use among methadone patients
MH - Dose-Response Relationship,Drug
MH - Heroin
MH - adverse effects
MH - pharmacokinetics
MH - Heroin Dependence
MH - rehabilitation
MH - urine
MH - Human
MH - Methadone
MH - administration & dosage
MH - Patient Compliance
MH - Substance Withdrawal Syndrome
MH - prevention & control
RP - NOT IN FILE
NT - UI - 92381762LA - engRN - 561-27-3 (Heroin)RN - 76-99-3 (Methadone)PT - CommentPT - LetterDA - 19921001IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:1512805
SO - J Subst Abuse Treat 1992 ;9(2):183-184

106
UI - 105
AU - Oliver KJ
AU - Friedman SR
AU - Maynard H
AU - Magnuson L
AU - Des J
TI - Impact of a needle exchange program on potentially infectious syringes in public places
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Comparative Study
MH - Human
MH - Needles
MH - Support,Non-U.S.Gov't
MH - United States
RP - NOT IN FILE
NT - UI - 92219104LA - engPT - LetterDA - 19920513IS - 0894-9255SB - IMCY - UNITED STATESJC - JOF
UR - PM:1560355
SO - J Acquir Immune Defic Syndr 1992 ;5(5):534-535

107
UI - 100
AU - Strang J
AU - Des J
AU - Griffiths P
AU - Gossop M
AD - National Addiction Centre, Bethlem Royal and Maudsley Hospital, London, UK
TI - The study of transitions in the route of drug use: the route from one route to another
AB - Route of administration of various drugs is an area of study to which specific attention must be paid in study of different HIV risks of drug use by various routes. If changes in route are seen in individuals or within populations, then study of these transitions in route may identify new approaches which could be developed in HIV prevention. The consideration in this paper is based around ten questions: (i) What is a transition? (ii) Do routes of administration vary by time and place? (iii) Is choice of route influenced by availability of drug paraphernalia? (iv) How does the context influence initial choice of administration, and possible subsequent transitions? (v) Are lapse and relapse meaningful concepts? (vi) Transitions: how much of it is going on? (vii) How much does change of route (with the same drug) signify a change of drug effect, its significance, or its relationship with other risk behaviour? (viii) Is change of route of use of one drug always accompanied by the same change of route of other drugs? (ix) Injectors/non-injectors and sharers/non-sharers: do these behavioural characteristics exist as categories or are they distributed along a continuum? (x) Are transitions reversible? This paper is accompanied by two research reports which describe explorations into the extent and nature of transitions amongst heroin users
MH - Cocaine
MH - Drug Administration Routes
MH - HIV Seroprevalence
MH - trends
MH - Heroin Dependence
MH - complications
MH - rehabilitation
MH - Human
MH - Needle Sharing
MH - adverse effects
MH - Street Drugs
MH - Substance Abuse,Intravenous
RP - NOT IN FILE
NT - UI - 92216641LA - engRN - 0 (Street Drugs)RN - 50-36-2 (Cocaine)PT - Journal ArticleDA - 19920514IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1559046
SO - Br J Addict 1992 Mar ;87(3):473-483

108
UI - 103
AU - Strang J
AU - Stimson GV
AU - Des J
TI - What is AIDS doing to the drug research agenda?
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Human
MH - Risk Factors
MH - Sex Behavior
MH - drug effects
MH - Street Drugs
MH - Substance Abuse,Intravenous
MH - complications
MH - rehabilitation
MH - Substance-Related Disorders
RP - NOT IN FILE
NT - UI - 92216627LA - engRN - 0 (Street Drugs)PT - EditorialDA - 19920514IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1559032
SO - Br J Addict 1992 Mar ;87(3):343-346

109
UI - 108
AU - Vanichseni S
AU - Choopanya K
AU - Des J
AU - Plangsringarm K
AU - Sonchai W
AU - Carballo M
AU - Friedmann P
AU - Friedman SR
AD - Health Department, Bangkok Metropolitan Administration, Thailand
TI - HIV testing and sexual behavior among intravenous drug users in Bangkok, Thailand
AB - The relationships between previous HIV counseling and testing and sexual behavior were examined among injecting drug users in Bangkok. Six hundred one i.v. drug users (IVDUs) were recruited from drug treatment programs in November of 1989. A standardized interview on AIDS risk behavior was administered and a blood sample was collected for HIV testing of the 601 people. Fifty-six percent reported that they had not been previously tested (NPT), 15% had previously tested positive (PT+), and 29% had previously tested negative (PT-). Previous testing was associated with higher levels of safer sex and contraception with primary partners: 56% of the PT+ people with regular partners reported using condoms at least some of the time with that partner, compared with 28% of the PT- and only 20% of the NPT people. Similarly, 89% of the PT+ and 72% of the PT- people, compared with 59% of the NPT people, reported practicing some form of contraception with regular partners. The results strongly support the utility of HIV counseling and testing as a method of reducing heterosexual and perinatal HIV transmission among IVDUs in Bangkok
MH - AIDS Serodiagnosis
MH - Adult
MH - Condoms
MH - Contraception
MH - Counseling
MH - Female
MH - HIV Infections
MH - complications
MH - prevention & control
MH - Human
MH - Male
MH - Risk Factors
MH - Sex Behavior
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - psychology
MH - Thailand
RP - NOT IN FILE
NT - UI - 93020183LA - engPT - Journal ArticleDA - 19921110IS - 0894-9255SB - IMCY - UNITED STATESJC - JOF
UR - PM:1403642
SO - J Acquir Immune Defic Syndr 1992 ;5(11):1119-1123

110
UI - 110
AU - Choopanya K
AU - Vanichseni S
AU - Des J
AU - Plangsringarm K
AU - Sonchai W
AU - Carballo M
AU - Friedmann P
AU - Friedman SR
AD - Health Department Bangkok Metropolitan Administration (BMA), Thailand
TI - Risk factors and HIV seropositivity among injecting drug users in Bangkok
AB - Bangkok experienced an extremely rapid spread of HIV infection among drug injectors in 1987 and 1988. This study examines risk factors for HIV infection and deliberate risk-reduction efforts by drug injectors. Two subsamples of injecting drug users were recruited in November 1989, a group in drug-use treatment (n = 342) and a group new to the treatment system (n = 259). Subjects were interviewed about AIDS risk behavior, and a blood sample was collected for HIV testing. Seroprevalence was 39 and 27% in the in-treatment sample and the new-to- treatment sample, respectively. The in-treatment sample seroprevalence rate is similar to rates observed 6 and 12 months earlier. Three factors were independently associated with HIV infection: subsample, having been in prison, and sharing injection equipment with two or more individuals in the previous 6 months. Deliberate risk reduction was reported by 92% of individuals, with 59% reporting that they had stopped sharing injection equipment. It appears that large-scale risk reduction has greatly slowed HIV transmission among drug injectors in Bangkok
MH - Adult
MH - Cross-Sectional Studies
MH - Female
MH - HIV Seropositivity
MH - complications
MH - epidemiology
MH - HIV Seroprevalence
MH - Human
MH - Male
MH - Multivariate Analysis
MH - Needle Sharing
MH - Prisoners
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
RP - NOT IN FILE
NT - UI - 92265235LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19920624IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:1814333
SO - AIDS 1991 Dec ;5(12):1509-1513

111
UI - 123
AU - Des J
AD - Beth Israel Medical Center, New York, New York
TI - Potential cofactors in the outcomes of HIV infection in intravenous drug users
MH - Female
MH - HIV Infections
MH - complications
MH - epidemiology
MH - transmission
MH - Human
MH - Male
MH - Psychotropic Drugs
MH - adverse effects
MH - Risk Factors
MH - Sarcoma,Kaposi
MH - Sex Factors
MH - Substance Abuse,Intravenous
RP - NOT IN FILE
NT - UI - 92093057LA - engRN - 0 (Psychotropic Drugs)PT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19920127IS - 1046-9516SB - IMCY - UNITED STATESJC - NRM
UR - PM:1753988
SO - NIDA Res Monogr 1991 ;109():115-123

112
UI - 120
AU - Des J
AU - Abdul-Quader A
AU - Minkoff H
AU - Hoegsberg B
AU - Landesman S
AU - Tross S
TI - Crack use and multiple AIDS risk behaviors
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - Cocaine
MH - Female
MH - Health Behavior
MH - Human
MH - Risk Factors
MH - Smoking
MH - Substance-Related Disorders
MH - complications
RP - NOT IN FILE
NT - UI - 91178683LA - engRN - 50-36-2 (Cocaine)PT - LetterDA - 19910502IS - 0894-9255SB - IMCY - UNITED STATESJC - JOF
UR - PM:2007982
SO - J Acquir Immune Defic Syndr 1991 ;4(4):446-447

113
UI - 112
AU - Des J
AU - Stepherson B
TI - History, ethics, and politics in AIDS prevention research
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Blacks
MH - Ethics,Medical
MH - History of Medicine,20th Cent.
MH - Human
MH - Needles
MH - New York City
MH - Public Health
MH - history
MH - United States
RP - NOT IN FILE
NT - UI - 92059592LA - engPT - CommentPT - EditorialPT - Historical ArticleDA - 19911204IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:1951792
SO - Am J Public Health 1991 Nov ;81(11):1393-1394

114
UI - 119
AU - Des J
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
TI - Drug abuse
MH - Cocaine
MH - Disease Outbreaks
MH - HIV Infections
MH - epidemiology
MH - transmission
MH - Heroin Dependence
MH - Human
MH - Models,Theoretical
MH - New York City
MH - Social Problems
MH - Substance-Related Disorders
MH - complications
MH - Urban Health
MH - statistics & numerical data
RP - NOT IN FILE
NT - UI - 91183266LA - engRN - 50-36-2 (Cocaine)PT - Journal ArticleDA - 19910508IS - 0028-7091SB - IMCY - UNITED STATESJC - BQO
UR - PM:2009418
SO - Bull N Y Acad Med 1991 Jan ;67(1):43-48

115
UI - 111
AU - Des J
AU - Abdul-Quader A
AU - Tross S
AD - Beth Israel Medical Center, New York, New York
TI - The next problem: maintenance of AIDS risk reduction among intravenous drug users
AB - Intravenous drug users have surprised many policymakers and researchers by exhibiting large-scale AIDS risk reduction. Relapse from desired behavior change has been a traditional problem in treatment for drug misuse/dependence. Failure to maintain AIDS risk reduction was examined in a study of 399 intravenous drug users from New York City. Over 80% of the subjects reported initiating risk reduction, but 36% of those also reported that they did not fully maintain the risk reduction. Factors associated with initiating risk reduction were not necessarily associated with maintenance, indicating that different types of change processes may be occurring. At the policy level, one needs to think of long-term efforts to reduce the spread of HIV among drug users; "quick fix" programs are not likely to be effective
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Adult
MH - Female
MH - Health Behavior
MH - Health Policy
MH - Human
MH - Male
MH - Models,Psychological
MH - Recurrence
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 92155851LA - engPT - Journal ArticleID - U62/CCU201085/PHSDA - 19920326IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:1787021
SO - Int J Addict 1991 Dec ;26(12):1279-1292

116
UI - 113
AU - Frank B
AU - Des J
AU - Marel R
AU - Schmeidler J
AU - Maranda M
AD - New York State Division of Substance Abuse Services, New York 10027
TI - The epidemiology of cocaine use in New York State
MH - Adolescence
MH - Adult
MH - Cocaine
MH - Cross-Sectional Studies
MH - HIV Seroprevalence
MH - trends
MH - Human
MH - Incidence
MH - New York
MH - epidemiology
MH - Substance-Related Disorders
RP - NOT IN FILE
NT - UI - 92093019LA - engRN - 50-36-2 (Cocaine)PT - Journal ArticleDA - 19920130IS - 0027-2507SB - IMCY - UNITED STATESJC - NJU
UR - PM:1753977
SO - Mt Sinai J Med 1991 Oct ;58(5):406-411

117
UI - 121
AU - Friedman SR
AU - Des J
AD - Narcotic and Drug Research, Inc., New York, NY 10013
TI - HIV among drug injectors: the epidemic and the response
MH - Europe
MH - epidemiology
MH - HIV Infections
MH - etiology
MH - prevention & control
MH - HIV Seroprevalence
MH - trends
MH - Hiv-1
MH - Human
MH - Politics
MH - Preventive Health Services
MH - organization & administration
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 92031812LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA03574/DA/NIDAID - DA05283/DA/NIDAID - DA06723/DA/NIDADA - 19911226IS - 0954-0121SB - IMCY - ENGLANDJC - A1O
UR - PM:1932186
SO - AIDS Care 1991 ;3(3):239-250

118
UI - 122
AU - Hagan H
AU - Des J
AU - Purchase D
AU - Reid T
AU - Friedman SR
AD - Tacoma-Pierce County Health Department, WA 98408
TI - The Tacoma Syringe Exchange
AB - For over a year, the Tacoma Syringe Exchange has been operating in spite of existing drug paraphernalia laws. One hundred fifty-four subjects have been interviewed regarding drug injection practices for the month prior to first use of the exchange and for the most recent month since using the exchange. Statistically significant reductions in mean frequency of obtaining used syringes, and in mean rate of passing on used syringes, have been reported. Mean number of times bleach was used to disinfect contaminated syringes has risen. The exchange continues to attract mainly men, median age 35, with a long history of injection. No differences have been observed in mean number of injections per month. In order to increase utilization, new sites are planned, but expansion has been hampered by a series of legal problems. Since the exchange draws many difficult to reach individuals, it is an important location for STD screening and drug treatment recruitment. Documentation of participation patterns and barriers to exchange use, and effects upon HIV serological status are recommended
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Animal
MH - Counseling
MH - Female
MH - Hamsters
MH - Human
MH - Male
MH - Needle Sharing
MH - adverse effects
MH - Program Evaluation
MH - Substance Abuse,Intravenous
MH - psychology
MH - Support,Non-U.S.Gov't
MH - Syringes
MH - United States
RP - NOT IN FILE
NT - UI - 92135227LA - engPT - Journal ArticleDA - 19920312IS - 1055-0887SB - IMCY - UNITED STATESJC - A0Y
UR - PM:1777501
SO - J Addict Dis 1991 ;10(4):81-88

119
UI - 114
AU - Hagan H
AU - Reid T
AU - Des J
AU - Purchase D
AU - Friedman SR
AU - Bell TA
TI - The incidence of HBV infection and syringe exchange programs
MH - Community Health Services
MH - Hepatitis B
MH - epidemiology
MH - etiology
MH - Human
MH - Incidence
MH - Syringes
MH - Washington
RP - NOT IN FILE
NT - UI - 91359389LA - engPT - LetterDA - 19911008IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:1886182
SO - JAMA 1991 Sep 25 ;266(12):1646-1647

120
UI - 117
AU - Mezzelani P
AU - Venturini L
AU - Turrina G
AU - Lugoboni F
AU - Des J
TI - High compliance with a hepatitis B virus vaccination program among intravenous drug users
MH - Hepatitis B
MH - prevention & control
MH - Hepatitis B Vaccines
MH - Human
MH - Patient Compliance
MH - Substance Abuse,Intravenous
MH - complications
MH - psychology
MH - Support,Non-U.S.Gov't
MH - Vaccination
MH - Viral Hepatitis Vaccines
MH - administration & dosage
RP - NOT IN FILE
NT - UI - 91185908LA - engRN - 0 (Hepatitis B Vaccines)RN - 0 (Viral Hepatitis Vaccines)PT - LetterDA - 19910506IS - 0022-1899SB - AIMSB - IMCY - UNITED STATESJC - IH3
UR - PM:1826302
SO - J Infect Dis 1991 Apr ;163(4):923

121
UI - 116
AU - Newman RG
AU - Des J
TI - Criteria for judging methadone maintenance programs
MH - Human
MH - Methadone
MH - administration & dosage
MH - Outcome and Process Assessment (Health Care)
MH - Patient Acceptance of Health Care
MH - Substance-Related Disorders
MH - rehabilitation
RP - NOT IN FILE
NT - UI - 91194112LA - engRN - 76-99-3 (Methadone)PT - LetterDA - 19910516IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:2013946
SO - JAMA 1991 May 1 ;265(17):2190-2191

122
UI - 118
AU - Rosenberg PS
AU - Gail MH
AU - Schrager LK
AU - Vermund SH
AU - Creagh-Kirk T
AU - Andrews EB
AU - Winkelstein W
AU - Marmor M
AU - Des J
AU - Biggar RJ
AU - .
AD - Epidemiologic Methods Section, National Cancer Institute, Rockville, MD 20892
TI - National AIDS incidence trends and the extent of zidovudine therapy in selected demographic and transmission groups
AB - After mid-1987 fewer than the expected number of cases of AIDS were reported in the United States in some demographic and transmission groups but not in others. Gay men (regardless of intravenous drug use), adults with hemophilia, and transfusion recipients exhibited fewer cases than expected based on previously reliable models. These favorable trends could not be explained by assuming earlier cessation of human immunodeficiency virus (HIV) infection. Favorable AIDS incidence trends were not found in heterosexual intravenous drug users or in persons infected through heterosexual contact. White gay men from New York City, Los Angeles, and San Francisco experienced markedly favorable trends, whereas little changes was observed for nonwhite gay men from nonurban areas. AIDS incidence trends were quantitatively consistent with the fraction of AIDS-free persons with severe immunodeficiency who received zidovudine in three cohorts. Gay men in San Francisco used zidovudine more frequently than did adults with hemophilia, while little was used by intravenous drug users in New York City. Data describing the initial national distribution of zidovudine (March 31-September 18, 1987) indicated relatively high use by patients with severe immunodeficiency in those groups, such as urban white gay men, that subsequently experienced fewer cases of AIDS than expected. Available data suggest that zidovudine, perhaps in combination with other therapies, has been one factor contributing to favorable AIDS incidence trends in some groups. Broader application of therapy might further retard the incidence of AIDS, especially in intravenous drug users, persons infected through heterosexual contact, minorities, women, and persons diagnosed outside major metropolitan areas
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - drug therapy
MH - epidemiology
MH - ethnology
MH - Blacks
MH - Blood Transfusion
MH - Cohort Studies
MH - Female
MH - Hemophilia A
MH - Hispanic Americans
MH - Homosexuality
MH - Human
MH - Incidence
MH - Los Angeles
MH - Male
MH - New York
MH - San Francisco
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - United States
MH - Urban Population
MH - Whites
MH - Zidovudine
MH - therapeutic use
RP - NOT IN FILE
NT - UI - 91178673LA - engRN - 30516-87-1 (Zidovudine)PT - Journal ArticleID - N01-CP7-1011/CP/NCIDA - 19910502IS - 0894-9255SB - IMCY - UNITED STATESJC - JOF
UR - PM:2007974
SO - J Acquir Immune Defic Syndr 1991 ;4(4):392-401

123
UI - 115
AU - Yancovitz SR
AU - Des J
AU - Peyser NP
AU - Drew E
AU - Friedmann P
AU - Trigg HL
AU - Robinson JW
AD - Beth Israel Medical Center, New York, NY 10003
TI - A randomized trial of an interim methadone maintenance clinic
AB - BACKGROUND. Interim methadone maintenance has been proposed as a method of providing clinically effective services to heroin addicts waiting for treatment in standard comprehensive methadone maintenance programs. METHODS. A clinic that provided initial medical evaluation, methadone medication, and AIDS education, but did not include formal drug abuse counseling or other social support services was established in New York City. A sample of 301 volunteer subjects recruited from the waiting list for treatment in the Beth Israel methadone program were randomly assigned to immediate entry into the interim clinic or a control group. RESULTS. There were no differences in initial levels of illicit drug use across the experimental and control groups. One-month urinalysis follow-up data showed a significant reduction in heroin use in the experimental group (from 63% positive at intake to 29% positive) with no change in the control group (62% to 60% positive). No significant change was observed in cocaine urinalyses (approximately 70% positive for both groups at intake and follow-up). A higher percentage of the experimental group were in treatment at 16-month follow-up (72% vs 56%). CONCLUSIONS. Limited services interim methadone maintenance can reduce heroin use among persons awaiting entry into comprehensive treatment and increase the percentage entering treatment
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Adult
MH - Female
MH - Heroin
MH - Heroin Dependence
MH - rehabilitation
MH - Human
MH - Male
MH - Methadone
MH - therapeutic use
MH - New York City
MH - Regression Analysis
MH - methods
MH - Substance Abuse Treatment Centers
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 92059634LA - engRN - 561-27-3 (Heroin)RN - 76-99-3 (Methadone)PT - Clinical TrialPT - Journal ArticlePT - Randomized Controlled TrialID - U62/CCU201072-012/PHSDA - 19911202IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:1659236
SO - Am J Public Health 1991 Sep ;81(9):1185-1191

124
UI - 124
AU - Abdul-Quader AS
AU - Tross S
AU - Friedman SR
AU - Kouzi AC
AU - Des J
AD - Narcotic and Drug Research, Inc., New York, NY 10013
TI - Street-recruited intravenous drug users and sexual risk reduction in New York City
AB - Previous studies have reported that intravenous drug users (IVDUs) have made considerable drug-use risk reduction, but less sexual risk reduction. This paper presents findings about sexual risk reduction by street-recruited IVDUs in New York City, and examines the predictors of sexual risk reduction. Sixty-one per cent of these street-recruited IVDUs have initiated deliberate sexual risk reduction in order to avoid AIDS. For the total sample (n = 568), as well as for the male IVDUs, specific health belief and social influence factors were significant predictors of sexual risk reduction. For female IVDUs, drug-risk reduction, having a friend or acquaintance who practices sexual risk reduction, and wanting to have a(nother) child were significant predictors of sexual risk reduction. These findings suggest the importance of social support and community organization to promote risk reduction
MH - Adult
MH - Female
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - Human
MH - Male
MH - New York City
MH - Regression Analysis
MH - Risk Factors
MH - Sex Behavior
MH - Social Support
MH - Socioeconomic Factors
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 91128658LA - engPT - Journal ArticleID - U62/CCU201085/PHSDA - 19910321IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:2282179
SO - AIDS 1990 Nov ;4(11):1075-1079

125
UI - 127
AU - Casadonte PP
AU - Des J
AU - Friedman SR
AU - Rotrosen JP
AD - New York University Medical School, New York
TI - Psychological and behavioral impact among intravenous drug users of learning HIV test results
AB - In 1984 as part of a New York City study to examine the prevalence of HIV infection in a substance-abusing population and to test the validity of HIV screening kits, 94 patients at the New York VAMC were tested. Results were made available to 50 (35 seronegative, 15 seropositive) patients in January 1986. Psychological and behavioral impact of learning test results was assessed using standardized psychiatric rating scales. A comparison group of 31 nontested subjects were also evaluated. Ratings were done preresults, approximately 1-2 weeks after results, and 8-10 weeks after informing patients of their HIV status. No major stress reactions were observed. Seropositives experienced a higher level of anxiety 1-2 weeks after learning results but anxiety generally diminished; they made significant behavior changes which were maintained. Seronegatives experienced relief and maintained IV drug risk reduction behavior. Anxiety about contracting AIDS increased in nontested subjects as the study progressed
MH - AIDS Serodiagnosis
MH - psychology
MH - Adaptation,Psychological
MH - Adult
MH - HIV Seropositivity
MH - transmission
MH - Health Behavior
MH - Homosexuality
MH - Human
MH - Male
MH - Middle Age
MH - New York City
MH - Risk Factors
MH - Sick Role
MH - Substance Abuse,Intravenous
MH - Urban Population
RP - NOT IN FILE
NT - UI - 91060309LA - engPT - Journal ArticleDA - 19910109IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:2246090
SO - Int J Addict 1990 Apr ;25(4):409-426

126
UI - 132
AU - Casriel C
AU - Des J
AU - Rodriguez R
AU - Friedman SR
AU - Stepherson B
AU - Khuri E
AD - Narcotic and Drug Research, Inc., New York City
TI - Working with heroin sniffers: clinical issues in preventing drug injection
AB - Preventing illicit drug injection would be the ideal point for preventing HIV infection and AIDS among illicit drug injectors. This paper reports on clinical issues that arose in a program for intranasal ("sniffer") heroin users who were at high risk of injecting drugs. Extensive field notes were kept by the staff of the project. A generalized mistrust of authorities, denial of problems associated with non-injected drug use, and ambivalence about injecting were the major issues that arose during subject recruitment and the group sessions. The staff underwent trial and error learning, both becoming more confident in working with heroin sniffers, and finding better results for later participants in the study
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Administration,Inhalation
MH - Adolescence
MH - Adult
MH - Attitude to Health
MH - Curriculum
MH - Female
MH - Heroin
MH - administration & dosage
MH - Heroin Dependence
MH - psychology
MH - rehabilitation
MH - Human
MH - Male
MH - Patient Education
MH - methods
MH - Pilot Projects
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 90189272LA - engRN - 561-27-3 (Heroin)PT - Journal ArticleID - U62/CCU201064-02-02/PHSDA - 19900426IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:2313766
SO - J Subst Abuse Treat 1990 ;7(1):1-10

127
UI - 130
AU - Des J
AU - Friedman SR
AU - Casriel C
AD - Beth Israel Medical Center, New York, New York
TI - Target groups for preventing AIDS among intravenous drug users: 2. The "hard" data studies
AB - Studies were reviewed with respect to three different target groups for preventing AIDS among intravenous (IV) drug users by (a) providing drug abuse treatment for those who want to stop injecting drugs, (b) providing "safer" injection for those who are likely to continue injecting, and (c) preventing drug injection among those who are at high risk for beginning to inject. The studies reviewed were limited to those that include "hard" data: validated self-reports, seroprevalence outcomes, or self-reports of behavior that is the opposed to any of the demand characteristics generated by the research setting. For two groups of current IV drug users--those entering drug treatment and those continuing to inject--these hard data studies show rapidly induced AIDS risk reduction but suggest a need for large-scale change maintained over long time periods. In terms of preventing initial injection, alternative forms of intense drug use have emerged but have not supplanted drug injection, and basic knowledge of AIDS does not appear to deter initial drug injection
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - prevention & control
MH - Human
MH - Substance Abuse,Intravenous
MH - complications
MH - therapy
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 90203393LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA05360/DA/NIDAID - UC2ICCU200I064/PHSDA - 19900502IS - 0022-006XSB - IMCY - UNITED STATESJC - HW3
UR - PM:2181005
SO - J Consult Clin Psychol 1990 Feb ;58(1):50-56

128
UI - 129
AU - Des J
AU - Friedman SR
TI - Shooting galleries and AIDS: infection probabilities and 'tough' policies
MH - Acquired Immunodeficiency Syndrome
MH - transmission
MH - HIV Antibodies
MH - isolation & purification
MH - Human
MH - Needles
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,Non-U.S.Gov't
MH - Syringes
RP - NOT IN FILE
NT - UI - 90119865LA - engRN - 0 (HIV Antibodies)PT - EditorialDA - 19900215IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:2297054
SO - Am J Public Health 1990 Feb ;80(2):142-144

129
UI - 131
AU - Friedman SR
AU - Des J
AU - Sterk CE
AU - Sotheran JL
AU - Tross S
AU - Woods J
AU - Sufian M
AU - Abdul-Quader A
AD - Narcotic and Drug Research, Inc., New York
TI - AIDS and the social relations of intravenous drug users
AB - Gauging the impact of AIDS on intravenous drug users requires analysis of the cultural, political, and racial contexts of American society in which drug use is embedded. Considerable variation in behavior among drug injectors and noninjectors in different cities over time further complicates an understanding of the dynamics of drug use. AIDS has prompted many IV drug users to change their behavior, though not all users have reduced the risks of transmitting HIV infection. While expanded harm-reduction strategies and drug abuse treatment systems may help limit the epidemic's spread, weak federal support, constrained hospital resources, and racial stigma inhibit more direct action needed to stem the negative social and personal consequences of drug use
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - transmission
MH - Cultural Characteristics
MH - Ethnic Groups
MH - Group Structure
MH - Health Policy
MH - Human
MH - Interpersonal Relations
MH - Knowledge,Attitudes,Practice
MH - Racial Stocks
MH - Risk Factors
MH - Social Change
MH - Substance Abuse,Intravenous
MH - complications
MH - psychology
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 - 90340236LA - engPT - Journal ArticleID - DA03574/DA/NIDAID - DA05283/DA/NIDAID - DA05360/DA/NIDAID - etcDA - 19900907IS - 0887-378XSB - IMCY - UNITED STATESJC - M9Q
UR - PM:2381380
SO - Milbank Q 1990 ;68 Suppl 1():85-110

130
UI - 128
AU - Kleinman PH
AU - Goldsmith DS
AU - Friedman SR
AU - Hopkins W
AU - Des J
AD - Narcotic and Drug Research, Inc., New York, New York 10013
TI - Knowledge about and behaviors affecting the spread of AIDS: a street survey of intravenous drug users and their associates in New York City
AB - An informal survey of knowledge about and behaviors relevant to the spread of AIDS was conducted on the street in New York City during October 1986. The sample (n = 204) includes IV drug users (60%) and others (40%). The informal nature of the interview suggests that respondents gave "salient" answers rather than the complete answers that would be expected in a formal interview situation. A smaller proportion of respondents reported salient knowledge about drug-related transmission of AIDS than had been found in other populations, using formal interview methods. A close association was found between any accurate knowledge about spread of AIDS and likelihood of practicing one or more risk reduction behaviors. New users (persons who had been using drugs for only 1 or 2 years) were significantly less likely than others to have salient knowledge about AIDS transmission and also less likely to practice risk reduction measures
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - psychology
MH - transmission
MH - Adolescence
MH - Adult
MH - Attitude to Health
MH - Female
MH - Human
MH - Male
MH - New York City
MH - Risk Factors
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Urban Population
RP - NOT IN FILE
NT - UI - 91060305LA - engPT - Journal ArticleDA - 19910109IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:2246086
SO - Int J Addict 1990 Apr ;25(4):345-361

131
UI - 125
AU - Kreek MJ
AU - Des J
AU - Trepo CL
AU - Novick DM
AU - Abdul-Quader A
AU - Raghunath J
AD - Rockefeller University, New York, NY 10021
TI - Contrasting prevalence of delta hepatitis markers in parenteral drug abusers with and without AIDS
AB - Parenteral drug abusers are the second largest group at risk for developing AIDS (25% of US cases) and a major risk group for infection with both hepatitis B virus (HBV) and the HBV-dependent RNA hepatitis delta virus (HDV). This study was conducted to determine the prevalence in 1984-1985 and relationships of HDV and HBV infections in 372 unselected parenteral drug abusers without AIDS or symptoms related to human immunodeficiency virus type 1 (HIV-1) infection (but 49% of whom were positive for HIV-1 antibodies) and in 53 drug abusers hospitalized with AIDS. The prevalence of HDV markers in the combined study groups was 20%; 81% of study subjects with hepatitis B surface antigenemia (HBsAg) had one marker for HDV infection. Significant differences were found between patients with and without AIDS with respect to the prevalence of hepatitis delta antigen (5.7% vs. 0.8%, P less than .05) and antibody (0 vs. 21.4%, P less than .01) and HBsAg (15.1% vs. 5.1%, P less than .05). The significantly higher prevalence of hepatitis delta antigen and HBsAg in subjects with AIDS suggests that persistence or reactivation of these viruses is significantly greater among parenteral drug abusers with AIDS than among those without AIDS. These findings, along with the absence of hepatitis delta antibodies in the drug abusers with AIDS, are probably related to the profound general immunosuppression that occurs in AIDS
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - Antigens,Viral
MH - blood
MH - HIV Seropositivity
MH - Hiv-1
MH - immunology
MH - Hepatitis Antibodies
MH - Hepatitis B
MH - Hepatitis B Surface Antigens
MH - Hepatitis D
MH - Hepatitis Delta Virus
MH - Human
MH - Interviews
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 90324675LA - engRN - 0 (Antigens, Viral)RN - 0 (Hepatitis Antibodies)RN - 0 (Hepatitis B Surface Antigens)RN - 0 (Hepatitis Delta Virus)RN - 0 (delta antigen)PT - Journal ArticleID - DA-00049/DA/NIDAID - DA-03574/DA/NIDAID - DA-05130/DA/NIDADA - 19900827IS - 0022-1899SB - AIMSB - IMCY - UNITED STATESJC - IH3
UR - PM:2373877
SO - J Infect Dis 1990 Aug ;162(2):538-541

132
UI - 126
AU - Lee HH
AU - Weiss SH
AU - Brown LS
AU - Mildvan D
AU - Shorty V
AU - Saravolatz L
AU - Chu A
AU - Ginzburg HM
AU - Markowitz N
AU - Des J
AU - .
AD - Abbott Laboratories, North Chicago, IL 60064
TI - Patterns of HIV-1 and HTLV-I/II in intravenous drug abusers from the middle atlantic and central regions of the USA
AB - Seroprevalence of human immunodeficiency virus type 1 (HIV-1) and human T lymphotropic virus types I and II (HTLV-I/II) was determined among 1160 intravenous (iv) drug abusers from five drug treatment or medical centers (Manhattan, Brooklyn, New Jersey, Detroit, and New Orleans). HIV-1 infection ranged from 5% in New Orleans to 48% in New York City. Hispanics and blacks had a significantly higher rate of HIV-1 infection than whites (P less than .01), but within each group rates were similar between males and females and by age stratum. HTLV-I/II seroprevalence increased with age from 3% in the 20-29 year age group to 37% in the group greater than 50 years. New Orleans and Manhattan (24%) had the highest rate, and blacks (19%) had a higher rate than either Hispanics (6.3%) or whites (7.3%). No association between HIV-1 and HTLV-I/II infection was observed except in Manhattan. When compared with iv drug abusers infected only with HIV-1, dually infected subjects had more clinical symptoms related to immune deficiency but a lower prevalence of HIV antigenemia. These data document the frequent occurrence of retroviral infections in iv drug abusers. The contrast between the two classes of virus suggests that HIV-1 is more efficiently transmitted, while the age-dependent rise in HTLV-I/II seroprevalence suggests cumulative exposure of a less-transmissible agent
MH - Adult
MH - Age Factors
MH - Blacks
MH - Female
MH - HIV Infections
MH - complications
MH - epidemiology
MH - ethnology
MH - HIV Seroprevalence
MH - Hiv-1
MH - immunology
MH - HTLV-I Antibodies
MH - blood
MH - HTLV-I Infections
MH - HTLV-II Antibodies
MH - HTLV-II Infections
MH - Hispanic Americans
MH - Human
MH - Louisiana
MH - Male
MH - Michigan
MH - Middle Age
MH - New Jersey
MH - New York City
MH - Prevalence
MH - Sex Factors
MH - Substance Abuse,Intravenous
MH - Whites
RP - NOT IN FILE
NT - UI - 90324644LA - engRN - 0 (HTLV-I Antibodies)RN - 0 (HTLV-II Antibodies)PT - Journal ArticleDA - 19900827IS - 0022-1899SB - AIMSB - IMCY - UNITED STATESJC - IH3
UR - PM:2373871
SO - J Infect Dis 1990 Aug ;162(2):347-352

133
UI - 133
AU - Neaigus A
AU - Sufian M
AU - Friedman SR
AU - Goldsmith DS
AU - Stepherson B
AU - Mota P
AU - Pascal J
AU - Des J
AD - Narcotic and Drug Research Inc., New York, NY 10013
TI - Effects of outreach intervention on risk reduction among intravenous drug users
AB - Considerable voluntary risk reduction has occurred among IVDUs in New York City. The purpose of the AIDS Outreach Project was to improve upon the existing level of risk reduction by providing information and anonymous HIV testing to street-recruited IVDUs. Intake and follow-up interviews were conducted with 121 subjects (44% of 276 at intake), with a mean of 4.5 months between interviews. Significant risk reduction occurred in many drug and sexual risk behaviors, although not in bleach use, and more than half of the subjects continued to engage in high-risk sexual behavior. An analysis of differences in risk reduction between early and later intake groups indicated that external trends were not sufficient to account for observed risk reduction. Among subjects engaged in high-risk behavior at intake, those who injected less or were enrolled in drug abuse treatment were more likely to stop high-risk drug injecting. Subjects who (at intake) engaged in less frequent unprotected sex, or who had had sex with someone with AIDS, were more likely to stop high-risk sexual behavior. The majority of subjects at low risk at intake maintained low-risk behavior. Informational interventions appear to be most successful among those IVDUs already engaging in lower levels of risk behavior. More effective methods are needed for those whose level of risk behavior is greater. These might include peer pressure and distributing bleach (as opposed to only providing information about bleach)
MH - Acquired Immunodeficiency Syndrome
MH - ethnology
MH - prevention & control
MH - psychology
MH - Adolescence
MH - Adult
MH - Aged
MH - Blacks
MH - Contraceptive Devices,Male
MH - Disinfection
MH - Female
MH - Health Education
MH - Hispanic Americans
MH - Human
MH - Male
MH - Middle Age
MH - Multivariate Analysis
MH - Regression Analysis
MH - Sex Behavior
MH - Sodium Hypochlorite
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Whites
RP - NOT IN FILE
NT - UI - 91144975LA - engRN - 7681-52-9 (Sodium Hypochlorite)PT - Journal ArticleID - DA05283/DA/NIDADA - 19910404IS - 0899-9546SB - IMCY - UNITED STATESJC - AUY
UR - PM:2099157
SO - AIDS Educ Prev 1990 ;2(4):253-271

134
UI - 138
AU - Brickner PW
AU - Torres RA
AU - Barnes M
AU - Newman RG
AU - Des J
AU - Whalen DP
AU - Rogers DE
AD - Department of Community Medicine, St. Vincent's Hospital and Medical Center, New York, NY 10011
TI - Recommendations for control and prevention of human immunodeficiency virus (HIV) infection in intravenous drug users
AB - Considerable evidence indicates that intravenous drug users are emerging as the group at greatest risk for both acquiring and spreading human immunodeficiency virus (HIV) infection. Thus, all possible methods to control the spread of HIV infection in intravenous drug users should be explored. Key recommendations are that HIV antibody testing of intravenous drug users should be voluntary, because mandatory testing is counterproductive; free distribution of needles and syringes to intravenous drug users should occur only in carefully controlled circumstances to determine its effectiveness in decreasing infection rates; and drug-free and methadone maintenance treatment programs should be available on demand to all intravenous drug users as a means of reducing the spread of HIV infection. At present, the primary strategy for prevention must be education resulting in behavioral change. Education is currently the only definitive means for controlling the spread of HIV infection among intravenous drug users, their sex contacts, and to fetuses
MH - AIDS Serodiagnosis
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Health Education
MH - Health Policy
MH - Human
MH - Injections,Intravenous
MH - adverse effects
MH - Needles
MH - supply & distribution
MH - Substance-Related Disorders
MH - complications
MH - therapy
MH - Syringes
RP - NOT IN FILE
NT - UI - 89226728LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19890526IS - 0003-4819SB - AIMSB - IMCY - UNITED STATESJC - 5A6
UR - PM:2653157
SO - Ann Intern Med 1989 May 15 ;110(10):833-837

135
UI - 139
AU - Des J
AU - Friedman SR
AU - Novick DM
AU - Sotheran JL
AU - Thomas P
AU - Yancovitz SR
AU - Mildvan D
AU - Weber J
AU - Kreek MJ
AU - Maslansky R
AD - New York State Division of Substance Abuse Services, NY 10013
TI - HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987
AB - Intravenous drug users are the second largest group to develop the acquired immunodeficiency syndrome, and they are the primary source for heterosexual and perinatal transmission in the United States and Europe. Understanding long-term trends in the spread of human immunodeficiency virus among intravenous drug users is critical to controlling the acquired immunodeficiency syndrome epidemic. Acquired immunodeficiency syndrome surveillance data and seroprevalence studies of drug treatment program entrants are used to trace seroprevalence trends among intravenous drug users in the borough of Manhattan. The virus entered this drug-using group during the mid-1970s and spread rapidly in 1979 through 1983. From 1984 through 1987, the seroprevalence rate stabilized between 55% and 60%--well below hepatitis B seroprevalence rates. This relatively constant rate is attributed to new infections, new seronegative persons beginning drug injection, seropositive persons leaving drug injection, and increasing conscious risk reduction
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - transmission
MH - Adult
MH - Female
MH - HIV Seropositivity
MH - Human
MH - Injections,Intravenous
MH - adverse effects
MH - Male
MH - New York City
MH - Substance-Related Disorders
MH - complications
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 89125784LA - engPT - Journal ArticleID - DA 03574/DA/NIDADA - 19890313IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:2915408
SO - JAMA 1989 Feb 17 ;261(7):1008-1012

136
UI - 136
AU - Des J
AU - Friedman SR
AD - Beth Israel Medical Center, New York, NY 10003
TI - AIDS and i.v. drug use
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Health Education
MH - Human
MH - Injections,Intravenous
MH - Risk Factors
MH - Substance-Related Disorders
RP - NOT IN FILE
NT - UI - 89346740LA - engPT - Journal ArticleDA - 19890912IS - 0036-8075SB - IMCY - UNITED STATESJC - UJ7
UR - PM:2762809
SO - Science 1989 Aug 11 ;245(4918):578

137
UI - 137
AU - Friedman SR
AU - Des J
AU - Neaigus A
AU - Abdul-Quader A
AU - Sotheran JL
AU - Sufian M
AU - Tross S
AU - Goldsmith D
AD - Narcotic and Drug Research Inc., New York, New York 10013
TI - AIDS and the new drug injector
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - transmission
MH - Human
MH - Injections,Intravenous
MH - adverse effects
MH - New York City
MH - Street Drugs
MH - administration & dosage
MH - Substance-Related Disorders
MH - complications
RP - NOT IN FILE
NT - UI - 89262043LA - engRN - 0 (Street Drugs)PT - Journal ArticleDA - 19890706IS - 0028-0836SB - IMCY - ENGLANDJC - NSC
UR - PM:2725656
SO - Nature 1989 Jun 1 ;339(6223):333-334

138
UI - 135
AU - Friedman SR
AU - Sterk C
AU - Sufian M
AU - Des J
TI - Will bleach decontaminate needles during cocaine binges in shooting galleries?
MH - Cocaine
MH - Decontamination
MH - Disinfection
MH - Human
MH - Needles
MH - Sodium Hypochlorite
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 89362745LA - engRN - 50-36-2 (Cocaine)RN - 7681-52-9 (Sodium Hypochlorite)PT - LetterID - DA03574/DA/NIDAID - DA05283/DA/NIDADA - 19891006IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:2769890
SO - JAMA 1989 Sep 15 ;262(11):1467

139
UI - 134
AU - Novick DM
AU - Trigg HL
AU - Des J
AU - Friedman SR
AU - Vlahov D
AU - Kreek MJ
AD - Department of Medicine, Beth Israel Medical Center, New York, NY 10003
TI - Cocaine injection and ethnicity in parenteral drug users during the early years of the human immunodeficiency virus (HIV) epidemic in New York City
AB - Parenteral drug users have a high prevalence of infection with human immunodeficiency virus (HIV), the etiologic agent of acquired immune deficiency syndrome (AIDS). New York City has had a prolonged and extensive epidemic of HIV infection and AIDS. In this study, we analyze, in relation to antibody to HIV (anti-HIV), available data from sera from parenteral drug users collected in New York City during 1978 through 1983 in the course of studies of liver disease. Among parenteral users of both heroin and cocaine, 30 (52%) of 58 had anti- HIV, compared with six (13%) of 48 injectors of heroin only (P less than 0.0001). Only two (11%) of 18 white patients were HIV-infected, compared with 34 (39%) of 88 black or Hispanic patients (P = 0.03). No other factors studied were linked to anti-HIV. In a multiple logistic regression, anti-HIV was significantly more common in parenteral users of both cocaine and heroin (P less than 0.0001), black patients (P = 0.02), and Hispanic patients (P = 0.049). We conclude that parenteral users of both cocaine and heroin as well as black and Hispanic patients were disproportionately HIV-infected during the early years of the HIV epidemic. Use of cocaine and heroin as well as ethnicity were independently linked to anti-HIV. Measures to prevent or treat drug use, HIV infection, and other medical problems while addressing the specific needs of cocaine users and black and Hispanic patients are urgently needed
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - immunology
MH - Blacks
MH - Cocaine
MH - administration & dosage
MH - Disease Outbreaks
MH - Female
MH - Hiv
MH - HIV Antibodies
MH - Hispanic Americans
MH - Human
MH - Male
MH - New York City
MH - ethnology
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
RP - NOT IN FILE
NT - UI - 90132611LA - engRN - 0 (HIV Antibodies)RN - 50-36-2 (Cocaine)PT - Journal ArticleID - DA-00049/DA/NIDAID - DA-03574/DA/NIDAID - IP50-DA-0513-01/DA/NIDADA - 19900314IS - 0146-6615SB - IMCY - UNITED STATESJC - I9N
UR - PM:2614398
SO - J Med Virol 1989 Nov ;29(3):181-185

140
UI - 142
AU - Des J
AU - Friedman SR
TI - Needle sharing among IVDUs at risk for AIDS
MH - Acquired Immunodeficiency Syndrome
MH - transmission
MH - Human
MH - Injections,Intravenous
MH - adverse effects
MH - Needles
MH - Substance-Related Disorders
MH - complications
RP - NOT IN FILE
NT - UI - 89023702LA - engPT - LetterDA - 19881117IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:3177734
SO - Am J Public Health 1988 Nov ;78(11):1498-1499

141
UI - 150
AU - Des J
AU - Friedman SR
AD - New York State Division of Substance Abuse Services, New York 10013
TI - HIV and intravenous drug use
AB - There is now evidence from a wide variety of geographic areas that many intravenous drug users will change their behavior in order to reduce their risk of developing AIDS. There is even evidence from some areas that the behavior change has led to relative stabilization of seroprevalence rates, although longer-term studies will be needed to establish this definitively. AIDS behavior change in the area of sexual risk reduction appears to be much more difficult than change of drug injection behavior. Conceptual models of AIDS-related behavior change are needed, particularly models that can incorporate the injection of different drugs and variation in social and psychological characteristics among drug injectors. There is increasing evidence for a wider spectrum of HIV-related morbidity and mortality among intravenous drug users than is captured by the current surveillance definition for AIDS, again emphasizing the need for effective prevention programs
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - prevention & control
MH - transmission
MH - Asia
MH - Behavior
MH - Epidemiologic Methods
MH - Human
MH - Injections,Intravenous
MH - New York City
MH - Risk Factors
MH - Sex Behavior
MH - South America
MH - Substance-Related Disorders
MH - complications
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 89149997LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA05360/DA/NIDADA - 19890411IS - 0269-9370SB - IMCY - ENGLANDJC - AID
UR - PM:3147682
SO - AIDS 1988 ;2 Suppl 1():S65-S69

142
UI - 151
AU - Des J
AU - Friedman SR
AU - Sotheran JL
AU - Stoneburner R
AD - New York State Division of Substance Abuse Services, NY 10027
TI - The sharing of drug injection equipment and the AIDS epidemic in New York City: the first decade
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - prevention & control
MH - Female
MH - Human
MH - Injections,Intravenous
MH - Male
MH - Needles
MH - New York City
MH - Substance-Related Disorders
MH - complications
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 88302333LA - engPT - Journal ArticleID - R01-DA03574/DA/NIDADA - 19880915IS - 1046-9516SB - IMCY - UNITED STATESJC - NRM
UR - PM:3136341
SO - NIDA Res Monogr 1988 ;80():160-175

143
UI - 146
AU - Des J
AU - Friedman SR
TI - Intravenous cocaine, crack, and HIV infection
MH - Acquired Immunodeficiency Syndrome
MH - transmission
MH - Cocaine
MH - administration & dosage
MH - Human
MH - Injections,Intravenous
MH - adverse effects
MH - Risk Factors
RP - NOT IN FILE
NT - UI - 88155825LA - engRN - 50-36-2 (Cocaine)PT - LetterDA - 19880419IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:3346974
SO - JAMA 1988 Apr 1 ;259(13):1945-1946

144
UI - 147
AU - Des J
AU - Friedman SR
AD - New York State Division of Substance Abuse Services, New York, New York 10047
TI - Gender differences in response to HIV infection
AB - There is strong epidemiologic evidence from studies of i.v. drug users in New York City for the existence of one or more gender-related cofactors in response to HIV infection. The strength of the evidence comes from the variety of data sets that indicate a gender-related cofactor and from the consistency of the pattern found: in all of the data sets, females appear to have a more "favorable" response than do males. The extent of underrepresentation of females in the cases of AIDS in i.v. drug users--a possible 35% reduction in the development of clinical AIDS-suggests that such a cofactor should be considered of practical importance. Identifying the mechanism(s) for a gender difference may lead to ways of deliberately affecting the course of the infection. Further research on the gender difference may also contribute to our understanding of interactions among the various components of the immune system and the interaction of the immune system with other behavioral and physiologic systems
MH - Acquired Immunodeficiency Syndrome
MH - transmission
MH - Female
MH - Heroin Dependence
MH - complications
MH - Human
MH - Male
MH - New York City
MH - Risk Factors
MH - Sex Factors
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 88291910LA - engPT - Journal ArticleID - DA 03574/DA/NIDADA - 19880908IS - 0065-2229SB - IMCY - UNITED STATESJC - 2I8
UR - PM:3400486
SO - Adv Biochem Psychopharmacol 1988 ;44():159-163

145
UI - 141
AU - Des J
AU - Friedman SR
TI - The psychology of preventing AIDS among intravenous drug users. A social learning conceptualization
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - psychology
MH - Health Behavior
MH - Human
MH - Injections,Intravenous
MH - Substance-Related Disorders
MH - complications
RP - NOT IN FILE
NT - UI - 89104007LA - engPT - Journal ArticleDA - 19890222IS - 0003-066XSB - IMCY - UNITED STATESJC - 41V
UR - PM:3214002
SO - Am Psychol 1988 Nov ;43(11):865-870

146
UI - 148
AU - Des J
AU - Friedman SR
AU - Stoneburner RL
AD - New York State Division of Substance Abuse Services, New York 10027
TI - HIV infection and intravenous drug use: critical issues in transmission dynamics, infection outcomes, and prevention
AB - As the second largest group of persons to have been infected with human immunodeficiency virus (HIV), and the most likely to transmit HIV to heterosexual partners in the United States and Europe, iv drug users will play an increasingly important role in the future of the AIDS epidemic. This paper reviews five emerging critical issues regarding HIV infection among iv drug users. In epidemiology, rates of drug injection and anonymous sharing of injection equipment appear related to rapid spread of HIV among iv drug users, while heterosexual transmission from iv drug users appears to have been occurring at a relatively slow but constant rate. Data exist that support a gender- related cofactor and a continuing drug injection cofactor, but mechanisms for these potential cofactors have not been determined. Besides frank AIDS, HIV infection also appears to lead to epidemic- level increases in a variety of fatal infections among iv drug users. Several studies of prevention show active risk reduction among iv drug users, but new methods are urgently needed to increase amount of risk reduction
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - prevention & control
MH - transmission
MH - Human
MH - Injections,Intravenous
MH - New York City
MH - Risk Factors
MH - Substance-Related Disorders
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
RP - NOT IN FILE
NT - UI - 88177740LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA 03574/DA/NIDADA - 19880506IS - 0162-0886SB - IMCY - UNITED STATESJC - SXN
UR - PM:3281219
SO - Rev Infect Dis 1988 Jan ;10(1):151-158

147
UI - 149
AU - Des J
AU - Friedman SR
AD - New York State Division of Substance Abuse Services, NY 10013
TI - HIV infection among persons who inject illicit drugs: problems and prospects
AB - Intravenous drug use continues as the second most common risk behavior associated with acquired immune deficiency syndrome (AIDS) in the United States and Europe. Recently there has been increased public and research attention to this problem. Five areas of public health concern for AIDS among i.v. drug users are identified and discussed: (a) the potential spread of human immunodeficiency virus (HIV) to drug users in developing countries; (b) the emergence of cocaine use associated with HIV infection; (c) ethnic differences in seroprevalence rates among i.v. drug users, with ethnic minorities tending to have higher rates; (d) difficulties in changing the sexual behavior of i.v. drug users; and (e) an increased frequency of fatal infections among HIV seropositive drug users that are not counted with the current surveillance definition of AIDS. There have been numerous studies of AIDS risk reduction among i.v. drug users, but the ultimate effect of the behavior change on spread of the virus is not yet clear. Preliminary studies from New York City, San Francisco, and Stockholm indicate a relative stabilization of seroprevalence in those cities, suggesting that the behavior changes reported in those cities may be significantly slowing the rate of viral spread
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - epidemiology
MH - prevention & control
MH - transmission
MH - Female
MH - Human
MH - Injections,Intravenous
MH - Male
MH - Risk Factors
MH - Sex Behavior
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 89110728LA - engPT - Journal ArticleID - R13 DA 05360/DA/NIDADA - 19890309IS - 0894-9255SB - IMCY - UNITED STATESJC - JOF
UR - PM:3216310
SO - J Acquir Immune Defic Syndr 1988 ;1(3):267-273

148
UI - 145
AU - Farci P
AU - Novick DM
AU - Lai ME
AU - Orgiana G
AU - Strazzera A
AU - Beatrice ST
AU - Des J
AU - Balestrieri A
AD - Department of Internal Medicine, University of Cagliari, Via San Giorgio, Italy
TI - Introduction of human immunodeficiency virus infection among parenteral drug abusers in Sardinia: a seroepidemiologic study
MH - Adult
MH - Enzyme-Linked Immunosorbent Assay
MH - Female
MH - HIV Seropositivity
MH - epidemiology
MH - transmission
MH - Human
MH - Italy
MH - Male
MH - Substance-Related Disorders
MH - complications
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 88220312LA - engPT - Journal ArticleID - DA 03574/DA/NIDADA - 19880610IS - 0002-9262SB - IMCY - UNITED STATESJC - 3H3
UR - PM:3369428
SO - Am J Epidemiol 1988 Jun ;127(6):1312-1314

149
UI - 143
AU - Novick DM
AU - Des J
AU - Kreek MJ
AU - Spira TJ
AU - Friedman SR
AU - Gelb AM
AU - Stenger RJ
AU - Schable CA
AU - Kalyanaraman VS
AD - Department of Medicine, Beth Israel Medical Center, New York, NY 10003
TI - Specificity of antibody tests for human immunodeficiency virus in alcohol and parenteral drug abusers with chronic liver disease
AB - Parenteral drug abusers are at risk for acquired immunodeficiency syndrome (AIDS), which is caused by human immunodeficiency virus (HIV). We tested stored sera for antibody to HIV (anti-HIV) using two enzyme- linked immunosorbent assay (ELISA) methods and Western blot. The patients were parenteral drug abusers who had undergone percutaneous liver biopsy for chronic liver disease. Current or former alcohol abuse was noted in 88 (80%) of the 110 patients. The sensitivities of the two ELISA tests in comparison with Western blot, the more specific test for HIV, were 100 and 94%, respectively; the specificities were 94 and 99%. Western blot was positive in 36 (33%) of 110 patients. False-positive ELISA reactions for anti-HIV were seen in five (7%) of 70 patients with negative Western blot analyses. Compared to true-negatives, false- positives had significantly more years of alcohol abuse, younger ages of onset of alcohol abuse, greater frequencies of jaundice and edema, higher levels of alkaline phosphatase, total billirubin, total protein, and globulins, and lower levels of serum albumin. In a stepwise logistic regression, only hyperglobulinemia was significantly associated with a false-positive anti-HIV. We conclude that: (a) ELISA tests for anti-HIV are useful for screening abusers of alcohol and parenteral drugs with chronic liver disease for HIV infection, but positive results must be confirmed with more specific tests such as Western blot; (b) false-positive ELISA reactions in this population are associated with hyperglobulinemia; and (c) studies of HIV testing are needed in other populations of patients with alcoholism or liver disease
MH - Acquired Immunodeficiency Syndrome
MH - diagnosis
MH - immunology
MH - Adult
MH - Alcoholism
MH - Antibody Specificity
MH - Blotting,Western
MH - Enzyme-Linked Immunosorbent Assay
MH - False Positive Reactions
MH - Female
MH - Hiv
MH - HIV Antibodies
MH - analysis
MH - Hepatitis,Alcoholic
MH - Human
MH - Liver Cirrhosis,Alcoholic
MH - Male
MH - Risk Factors
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 89148678LA - engRN - 0 (HIV Antibodies)PT - Journal ArticleID - DA-00049/DA/NIDAID - DA03574/DA/NIDADA - 19890331IS - 0145-6008SB - IMCY - UNITED STATESJC - 35X
UR - PM:3067617
SO - Alcohol Clin Exp Res 1988 Oct ;12(5):687-690

150
UI - 144
AU - Novick DM
AU - Pascarelli EF
AU - Joseph H
AU - Salsitz EA
AU - Richman BL
AU - Des J
AU - Anderson M
AU - Dole VP
AU - Nyswander ME
AD - Department of Medicine, Beth Israel Medical Center, New York, NY 10003
TI - Methadone maintenance patients in general medical practice. A preliminary report
AB - Medical maintenance is the treatment by primary care physicians of rehabilitated methadone maintenance patients who are stable, employed, not abusing drugs, and not in need of supportive services. In this research project, physicians with experience in drug abuse treatment provided both the pharmacologic treatment of addiction as well as therapy for other medical problems, as needed. Decisions regarding treatment were based on the individual needs of the patient and on currently accepted medical practice rather than on explicit regulations. We studied the first 40 former heroin addicts who were transferred to this program from more conventional methadone clinics. At a follow-up visit at 12 to 55 months, 33 (82.5%) of 40 patients had remained in treatment; five (12.5%) had been discharged because of cocaine abuse and two (5%) had been voluntarily discharged. Personal benefits of medical maintenance include the dignity of a standard professional atmosphere and a more flexible reporting schedule. This program has the potential for improving treatment of selected methadone maintenance patients
MH - Counseling
MH - Heroin Dependence
MH - rehabilitation
MH - Human
MH - Methadone
MH - administration & dosage
MH - therapeutic use
MH - New York City
MH - Outpatient Clinics,Hospital
MH - Primary Health Care
MH - methods
MH - Support,Non-U.S.Gov't
RP - NOT IN FILE
NT - UI - 88230752LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleDA - 19880629IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:3373662
SO - JAMA 1988 Jun 10 ;259(22):3299-3302

151
UI - 140
AU - Stoneburner RL
AU - Des J
AU - Benezra D
AU - Gorelkin L
AU - Sotheran JL
AU - Friedman SR
AU - Schultz S
AU - Marmor M
AU - Mildvan D
AU - Maslansky R
AD - AIDS Research Unit, New York City Department of Health, NY 10013
TI - A larger spectrum of severe HIV-1--related disease in intravenous drug users in New York City
AB - Increasing mortality in intravenous (IV) drug users not reported to surveillance as acquired immunodeficiency syndrome (AIDS) has occurred in New York City coincident with the AIDS epidemic. From 1981 to 1986, narcotics-related deaths increased on average 32% per year from 492 in 1981 to 1996 in 1986. This increase included deaths from AIDS increasing from 0 to 905 and deaths from other causes, many of which were infectious diseases, increasing from 492 to 1091. Investigations of these deaths suggest a causal association with human immunodeficiency virus (HIV) infection. These deaths may represent a spectrum of HIV-related disease that has not been identified through AIDS surveillance and has resulted in a large underestimation of the impact of AIDS on IV drug users and blacks and Hispanics
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - epidemiology
MH - microbiology
MH - Cause of Death
MH - Comparative Study
MH - Endocarditis
MH - Hiv
MH - HIV Seropositivity
MH - Homosexuality
MH - Human
MH - Male
MH - New York City
MH - Pneumonia
MH - Substance-Related Disorders
MH - mortality
MH - Tuberculosis
RP - NOT IN FILE
NT - UI - 89043968LA - engPT - Journal ArticleDA - 19881214IS - 0036-8075SB - IMCY - UNITED STATESJC - UJ7
UR - PM:3187532
SO - Science 1988 Nov 11 ;242(4880):916-919

152
UI - 157
AU - Brunet JB
AU - Des J
AU - Koch MA
AD - WHO Collaborating Centre on AIDS, Hopital Claude Bernard, Paris, France
TI - Report on the European Community Workshop on Epidemiology of HIV Infections: Spread among intravenous drug abusers and the heterosexual population. Robert Koch-Institute, Berlin, 12-14 November 1986
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - prevention & control
MH - transmission
MH - Europe
MH - Female
MH - Human
MH - Injections,Intravenous
MH - Male
MH - Substance-Related Disorders
MH - complications
MH - Support,Non-U.S.Gov't
RP - NOT IN FILE
NT - UI - 88107048LA - engPT - Journal ArticleDA - 19880324IS - 0269-9370SB - IMCY - ENGLANDJC - AID
UR - PM:3122792
SO - AIDS 1987 May ;1(1):59-61

153
UI - 152
AU - Des J
AU - Stoneburner R
AU - Thomas P
AU - Friedman SR
TI - Declines in proportion of Kaposi's sarcoma among cases of AIDS in multiple risk groups in New York City
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - Female
MH - Homosexuality
MH - Human
MH - Male
MH - New York City
MH - Risk Factors
MH - Sarcoma,Kaposi
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 88037723LA - engPT - LetterID - DA 05574/DA/NIDADA - 19871207IS - 0140-6736SB - AIMSB - IMCY - ENGLANDJC - L0S
UR - PM:2889930
SO - Lancet 1987 Oct 31 ;2(8566):1024-1025

154
UI - 154
AU - Des J
AU - Friedman SR
AD - New York State Division of Substance Abuse Services, NY 10027
TI - HIV infection among intravenous drug users: epidemiology and risk reduction
AB - Research on the epidemiology of HIV infection among IV drug users is still at a relatively early stage. Multilocation studies that would permit better geographic comparisons are greatly needed. Multi-method studies within single geographic areas are also needed to assess possible biases with respect to sample recruitment and data collection procedures. The continuation of the epidemic provides a changing historical context that complicates any comparisons. Despite these problems, there are some consistencies that can be seen across studies. Studies of HIV seroprevalence among IV drug users show wide variation among cities in the United States and Europe. The time that the virus was introduced into the IV drug using group within the city is one factor in explaining these differences; other cross-city factors have yet to be identified. Once HIV has been introduced into the IV drug use group within a particular geographic area, there is the possibility of rapid spread up to seroprevalence levels of 50% or greater. Thus, a currently low seroprevalence rate should not be seen as a stable situation. Frequency of injection and sharing of equipment with multiple other drug users (particularly at shooting galleries) have been frequently associated with HIV exposure. Being female, ethnicity (in the USA) and engaging in prostitution also may be associated with increased risk for HIV exposure, suggesting that prevention programs should include special consideration of sex and ethnic differences. Studies of AIDS risk reduction show that substantial proportions of IV drug users are changing their behavior to avoid exposure to HIV. This risk reduction is probably more advanced in New York, with its high seroprevalence and incidence of cases, but is also occurring in cities with lower seroprevalence and limited numbers of cases. The primary forms of risk reduction are increasing the use of sterile equipment, reducing the number of needle sharing partners, and reducing the frequency of injection. These behavior changes are very similar to the frequently identified behavioral risk factors associated with HIV exposure, suggesting that they should be effective in at least slowing the spread of HIV among IV drug users. No linkage of risk reduction to decreases in seroconversion has yet been shown, however, and greater risk reduction is clearly required. A variety of prevention strategies will probably be needed to reduce the spread of HIV among IV drug users. Prevention of initiation into drug injection is an undeniable long-term goal for the control of HIV infection, but there is very little research being conducted in this area
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - prevention & control
MH - psychology
MH - Antibodies,Viral
MH - isolation & purification
MH - Behavior
MH - Epidemiologic Methods
MH - Europe
MH - Hiv
MH - immunology
MH - HIV Antibodies
MH - Human
MH - Injections,Intravenous
MH - adverse effects
MH - Substance-Related Disorders
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 88209289LA - engRN - 0 (Antibodies, Viral)RN - 0 (HIV Antibodies)PT - Journal ArticlePT - ReviewPT - Review, AcademicID - R01 DA 03574/DA/NIDADA - 19880614IS - 0269-9370SB - IMCY - ENGLANDJC - AID
UR - PM:3130084
SO - AIDS 1987 Jul ;1(2):67-76

155
UI - 155
AU - Des J
AU - Friedman SR
AU - Marmor M
AU - Cohen H
AU - Mildvan D
AU - Yancovitz S
AU - Mathur U
AU - el Sadr W
AU - Spira TJ
AU - Garber J
AU - .
AD - New York State Division of Substance Abuse Services, NY 10027
TI - Development of AIDS, HIV seroconversion, and potential co-factors for T4 cell loss in a cohort of intravenous drug users
AB - A cohort of 334 intravenous (IV) drug users from New York City drug treatment programs were followed over a mean 9-month period. Among the 165 who were seropositive at enlistment, four developed clinical AIDS, for an annual rate of 3%. Elevated IgA was a significant predictor of developing AIDS. Among 72 subjects who were initially seronegative and who were re-interviewed, four were seropositive at follow-up, for a seroconversion rate of 7% per year among seronegatives. Among seropositive subjects who did not develop AIDS or fatal AIDS related complex (ARC), continued drug injection was associated with rate of T4 cell loss, and there was a non-significant trend for males to lose T4 cells more rapidly than females. While it was not possible to distinguish the mechanism underlying the relationship between continued drug injection and T4 cell loss, seropositive IV drug users should be warned that continued injection may lead to increased HIV-related immunosuppression as well as, if injection equipment is shared, risking viral transmission to others
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - immunology
MH - Antibodies,Viral
MH - biosynthesis
MH - Epidemiologic Methods
MH - Female
MH - Hiv
MH - HIV Antibodies
MH - Human
MH - Immune Tolerance
MH - Injections,Intravenous
MH - adverse effects
MH - Male
MH - New York City
MH - Substance-Related Disorders
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - T-Lymphocytes
RP - NOT IN FILE
NT - UI - 88209280LA - engRN - 0 (Antibodies, Viral)RN - 0 (HIV Antibodies)PT - Journal ArticleID - DA 03574/DA/NIDADA - 19880614IS - 0269-9370SB - IMCY - ENGLANDJC - AID
UR - PM:2896511
SO - AIDS 1987 Jul ;1(2):105-111

156
UI - 156
AU - Des J
AU - Wish E
AU - Friedman SR
AU - Stoneburner R
AU - Yancovitz SR
AU - Mildvan D
AU - el Sadr W
AU - Brady E
AU - Cuadrado M
TI - Intravenous drug use and the heterosexual transmission of the human immunodeficiency virus. Current trends in New York City
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - transmission
MH - Female
MH - Human
MH - Injections,Intravenous
MH - Male
MH - New York City
MH - Sex Behavior
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,Non-P.H.S.
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 87229891LA - engPT - Journal ArticleID - R01 DA 03574/DA/NIDADA - 19870715IS - 0028-7628SB - IMCY - UNITED STATESJC - OBA
UR - PM:3473333
SO - N Y State J Med 1987 May ;87(5):283-286

157
UI - 160
AU - Feldman DA
AU - Friedman SR
AU - Des J
TI - Public awareness of AIDS in Rwanda
AB - AIDS is a rapidly growing epidemic in Kigali, Rwanda. To understand the level of public awareness of AIDS in that city, 33 informants (15 men and 18 women) were interviewed during September, 1985. Most (66.7%) said that they first heard of the disease only within the previous eight months. About half (46.9%) could not mention one or more AIDS symptoms. Younger informants and women reported less knowledge of AIDS symptoms. While nearly everyone recognized AIDS as a stigmatized disease, most informants apparently did not know why it is stigmatized. Only about one-third of the informants (34.4%) could correctly state the mode of AIDS transmission. People who are at greatest risk for the disease, unmarried men and women, were least likely to know how it is transmitted. Half (50.0%) of those informants who responded to the question of the origins of AIDS said that it began in 'America.' While many informants are frightened by the disease, no one has yet changed their sexual behavior as a response to the epidemic. All informants agreed that more information about AIDS should be made available in Rwanda. Preventive measures against the spread of AIDS are urgently needed in central Africa
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - prevention & control
MH - Adolescence
MH - Adult
MH - Disease Outbreaks
MH - Female
MH - Human
MH - Male
MH - Middle Age
MH - Public Opinion
MH - Rwanda
MH - Sex Behavior
MH - Support,Non-U.S.Gov't
RP - NOT IN FILE
NT - UI - 87178107LA - engPT - Journal ArticleDA - 19870429IS - 0277-9536SB - IMCY - ENGLANDJC - UT9
UR - PM:3563560
SO - Soc Sci Med 1987 ;24(2):97-100

158
UI - 159
AU - Friedman SR
AU - Des J
AU - Sotheran JL
AU - Garber J
AU - Cohen H
AU - Smith D
TI - AIDS and self-organization among intravenous drug users
AB - Gays and intravenous (i.v.) drug users are the two largest risk groups for AIDS. Gays, unlike drug users, have formed many organizations to deal with AIDS. Data are presented indicating that gay individuals have more risk-reducing behavioral changes than have i.v. drug users. It is also shown that i.v. drug users are more likely to protect themselves if their acquaintances do so. It is suggested that collective self- organization can lead to peer support for risk reduction and that this can help i.v. drug users to reduce their risks on an ongoing basis. Difficulties that face i.v. drug users' attempts to organize collectively and examples of i.v. drug user collective organization to deal with AIDS and other problems are discussed
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Adult
MH - Attitude to Health
MH - Female
MH - Homosexuality
MH - Human
MH - Injections,Intravenous
MH - Life Style
MH - Male
MH - Middle Age
MH - New York City
MH - Risk
MH - Self-Help Groups
MH - organization & administration
MH - Social Environment
MH - Street Drugs
MH - Substance-Related Disorders
MH - complications
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 87221027LA - engRN - 0 (Street Drugs)PT - Journal ArticleID - DA 03574/DA/NIDADA - 19870702IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:3583474
SO - Int J Addict 1987 Mar ;22(3):201-219

159
UI - 161
AU - Friedman SR
AU - Sotheran JL
AU - Abdul-Quader A
AU - Primm BJ
AU - Des J
AU - Kleinman P
AU - Mauge C
AU - Goldsmith DS
AU - el Sadr W
AU - Maslansky R
AD - Narcotic and Drug Research, Inc., New York, NY 10013
TI - The AIDS epidemic among blacks and Hispanics
AB - Social researchers and epidemiologists, as well as their major institutions and the general public, have been slow to address the racial and ethnic aspects of the AIDS epidemic. Whether measured by categories associated with major routes of infection, age level, gender, or by diminished length of survival, blacks and Hispanics are disproportionately affected by AIDS. Education, care, and outreach efforts based upon stereotypes of gay white males will have to yield to greater attention to cultural differences--and potential strengths-- within each of the special "communities at risk." Evidence indicates areas of social resistance along with unique possibilities for change
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - mortality
MH - transmission
MH - Adolescence
MH - Adult
MH - Blacks
MH - Child
MH - Disease Outbreaks
MH - Female
MH - HIV Seropositivity
MH - Hispanic Americans
MH - Homosexuality
MH - Human
MH - Male
MH - New York City
MH - Risk Factors
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 88232589LA - engPT - Journal ArticleID - DA 03574/DA/NIDADA - 19880708IS - 0887-378XSB - IMCY - UNITED STATESJC - M9Q
UR - PM:3451064
SO - Milbank Q 1987 ;65 Suppl 2():455-499

160
UI - 158
AU - Marmor M
AU - Des J
AU - Cohen H
AU - Friedman SR
AU - Beatrice ST
AU - Dubin N
AU - el Sadr W
AU - Mildvan D
AU - Yancovitz S
AU - Mathur U
AU - .
AD - Department of Environmental Medicine, New York University Medical Center, NY
TI - Risk factors for infection with human immunodeficiency virus among intravenous drug abusers in New York City
AB - We report here the results of a survey of 308 intravenous drug abusers recruited from hospital-based methadone maintenance or drug detoxification programmes located in Manhattan, New York City. Complete interviews and serological analyses for antibodies to human immunodeficiency virus (HIV) using both enzyme-linked immunosorbent and Western blot assays were obtained from 290 (94%) of the subjects. HIV antibodies were found by both assays in 147 (50.7%) of the tested subjects; conflicting results were found in three (1%) of the subjects; and negative results on both tests were found in 140 (48.3%) of the subjects. Logistic regression analysis identified significant relative risks for HIV infection associated with the frequency of drug injection and the proportion of injections in 'shooting galleries'. Additional risk among men was associated with a history of homosexual relations. Traditional efforts taken by subjects to clean syringes between uses, such as washing with water or alcohol, showed no evidence of being protective. Programmes aimed at prevention of HIV infection should focus on reducing use of shooting galleries and sharing of needles and syringes as well as reducing intravenous drug abuse generally
MH - Adult
MH - Female
MH - HIV Seropositivity
MH - transmission
MH - Human
MH - Injections,Intravenous
MH - Male
MH - New York City
MH - Risk Factors
MH - Substance-Related Disorders
MH - complications
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 88107044LA - engPT - Journal ArticleID - CA13343/CA/NCIID - CA33205/CA/NCIID - DA03574/DA/NIDAID - etcDA - 19880324IS - 0269-9370SB - IMCY - ENGLANDJC - AID
UR - PM:3122788
SO - AIDS 1987 May ;1(1):39-44

161
UI - 153
AU - Zolla-Pazner S
AU - Des J
AU - Friedman SR
AU - Spira TJ
AU - Marmor M
AU - Holzman R
AU - Mildvan D
AU - Yancovitz S
AU - Mathur-Wagh U
AU - Garber J
AU - .
TI - Nonrandom development of immunologic abnormalities after infection with human immunodeficiency virus: implications for immunologic classification of the disease
AB - Blood specimens from 165 intravenous drug users who were seropositive for the human immunodeficiency virus (HIV), from 158 seropositive homosexual men with lymphadenopathy, and from 77 patients with acquired immunodeficiency syndrome (AIDS) were assessed immunologically. Immunologic parameters were analyzed by the Guttman scalogram technique to determine if immunologic abnormalities occurred in a nonrandom pattern. The following four patterns emerged: (i) seropositivity for HIV with no immunologic abnormalities; (ii) seropositivity for HIV with a depressed T4/T8 cell ratio; (iii) seropositivity with a depressed T4/T8 cell ratio and T4-cell depletion; and (iv) seropositivity with a depressed T4/T8 cell ratio, T4-cell depletion, and lymphopenia. Ninety- two to 100% of subjects in each of the three groups of patients were found "to scale" because the abnormalities occurred in the cumulative, ordered fashion described. This nonrandom occurrence of abnormalities indicates an ordered progression of immunologic abnormalities in individuals infected with HIV, a finding useful in the staging of both symptomatic and asymptomatic HIV-seropositive subjects
MH - AIDS-Related Complex
MH - blood
MH - immunology
MH - Acquired Immunodeficiency Syndrome
MH - Hiv
MH - Homosexuality
MH - Human
MH - Immunity,Cellular
MH - Male
MH - Substance-Related Disorders
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,Non-P.H.S.
MH - Support,U.S.Gov't,P.H.S.
MH - T-Lymphocytes
MH - analysis
MH - cytology
RP - NOT IN FILE
NT - UI - 87260994LA - engPT - Journal ArticleID - AI 62542/AI/NIAIDID - DA 03574/DA/NIDAID - ES 00260/ES/NIEHSDA - 19870826IS - 0027-8424SB - IMCY - UNITED STATESJC - PV3
UR - PM:3496603
SO - Proc Natl Acad Sci U S A 1987 Aug ;84(15):5404-5408

162
UI - 165
AU - Des J
AU - Friedman SR
AU - Spira TJ
AU - Zolla-Pazner S
AU - Marmor M
AU - Holzman R
AU - Mildvan D
AU - Yancovitz S
AU - Mathur-Wagh U
AU - Garber J
AU - .
TI - A stage model of HTLV-III LAV infection in intravenous drug users
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - immunology
MH - Antibodies,Viral
MH - analysis
MH - HIV Antibodies
MH - Htlv-Blv Viruses
MH - Human
MH - Lymphocytes
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 - 86311227LA - engRN - 0 (Antibodies, Viral)RN - 0 (HIV Antibodies)PT - Journal ArticleID - CA 15585/CA/NCIID - DA 03574/DA/NIDADA - 19861016IS - 1046-9516SB - IMCY - UNITED STATESJC - NRM
UR - PM:3018574
SO - NIDA Res Monogr 1986 ;67():328-334

163
UI - 163
AU - Des J
AD - New York State Division of Substance Abuse Services, Office of Alcoholism and Substance Abuse, NY 10047
TI - Locus of control and need for control among heroin users
MH - Administration,Intranasal
MH - Heroin
MH - administration & dosage
MH - Heroin Dependence
MH - psychology
MH - Human
MH - Internal-External Control
MH - Motivation
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 88094672LA - engRN - 561-27-3 (Heroin)PT - Journal ArticleID - R01 DA 03574/DA/NIDADA - 19880212IS - 1046-9516SB - IMCY - UNITED STATESJC - NRM
UR - PM:3122052
SO - NIDA Res Monogr 1986 ;74():37-44

164
UI - 162
AU - Friedman SR
AU - Des J
AU - Sotheran JL
TI - AIDS health education for intravenous drug users
AB - Intravenous (IV) drug users are the second largest risk group for AIDS and the main source of infection for heterosexual partner and pediatric AIDS cases. IV drug users have an addiction and a subculture that make risk reduction difficult; for example, to refuse to share needles can endanger personal relationships, and carrying clean works (rather than renting them in a shooting gallery) risks arrest. In New York City, at least, knowledge about AIDS transmission is widespread among IV drug users, and most drug injectors report having changed their drug use practices to reduce their risks. The main functions of health education in areas where IV drug users have this level of knowledge are to disseminate news of new discoveries; reach those drug users who have not yet learned AIDS basics; reinforce what is already known; and provide information about new programs to help drug users deal with AIDS-related problems. To encourage behavior change requires going beyond simple education, however; it entails trying to change IV drug user subculture. Drug user groups in the Netherlands and in New York City are attempting to do this from within the subculture. Outside intervention requires repeated messages from multiple sources; face-to- face, interactive communication; and perhaps the use of ex-addicts as health educators
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Behavior
MH - Health Education
MH - methods
MH - Homosexuality
MH - Human
MH - Injections,Intravenous
MH - Interpersonal Relations
MH - New York City
MH - Risk
MH - Social Behavior
MH - Substance-Related Disorders
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 87056492LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19870122IS - 0195-8402SB - IMCY - UNITED STATESJC - G2O
UR - PM:3781862
SO - Health Educ Q 1986 ;13(4):383-393

165
UI - 164
AU - Novick DM
AU - Kreek MJ
AU - Des J
AU - Spira TJ
AU - Khuri ET
AU - Ragunath J
AU - Kalyanaraman VS
AU - Gelb AM
AU - Miescher A
TI - Antibody to LAV, the putative agent of AIDS, in parenteral drug abusers and methadone-maintained patients: therapeutic, historical, and ethical aspects
MH - Acquired Immunodeficiency Syndrome
MH - immunology
MH - Antibodies,Viral
MH - analysis
MH - Ethics,Medical
MH - HIV Antibodies
MH - Human
MH - Methadone
MH - therapeutic use
MH - Substance-Related Disorders
MH - therapy
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 86311225LA - engRN - 0 (Antibodies, Viral)RN - 0 (HIV Antibodies)RN - 76-99-3 (Methadone)PT - Journal ArticleID - DA-00049/DA/NIDAID - DA03574/DA/NIDADA - 19861016IS - 1046-9516SB - IMCY - UNITED STATESJC - NRM
UR - PM:3092085
SO - NIDA Res Monogr 1986 ;67():318-320

166
UI - 166
AU - Des J
AU - Hopkins W
TI - "Free" needles for intravenous drug users at risk for AIDS: current developments in New York City
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Human
MH - Injections,Intravenous
MH - instrumentation
MH - Needles
MH - New York City
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 86040315LA - engPT - LetterID - DA 03574/DA/NIDADA - 19851219IS - 0028-4793SB - AIMSB - IMCY - UNITED STATESJC - NOW
UR - PM:4058552
SO - N Engl J Med 1985 Dec 5 ;313(23):1476

167
UI - 167
AU - Des J
AU - Friedman SR
AU - Hopkins W
TI - Risk reduction for the acquired immunodeficiency syndrome among intravenous drug users
AB - Intravenous drug users are the second largest risk group for the acquired immunodeficiency syndrome (AIDS) and a bridge to two other groups: children and heterosexual partners. In the absence of effective treatment or vaccines, control of the epidemic among drug users will rely on efforts to reduce needle sharing. However, the traditional image of intravenous drug users leads one to expect little or no risk reduction. We review characteristics of AIDS as a disease that impede efforts at risk reduction among drug users and report on current risk reduction among intravenous drug users in New York City. There has been a sustained increase in the demand for new, unused needles, as shown in the emergence of "resealed" needles and in interviews with persons selling needles in illicit drug-purchasing areas
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Attitude to Health
MH - Behavior
MH - Commerce
MH - Health Education
MH - Human
MH - Injections,Intravenous
MH - Interviews
MH - Needles
MH - New York City
MH - Perception
MH - Risk
MH - Substance-Related Disorders
MH - complications
MH - mortality
MH - psychology
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 86023894LA - engPT - Journal ArticleID - 1 R01 DA 03574/DA/NIDADA - 19851115IS - 0003-4819SB - AIMSB - IMCY - UNITED STATESJC - 5A6
UR - PM:4051350
SO - Ann Intern Med 1985 Nov ;103(5):755-759

168
UI - 168
AU - Des J
AU - Joseph H
AU - Dole VP
AU - Nyswander ME
TI - Medical maintenance feasibility study
MH - Adult
MH - Consumer Satisfaction
MH - Dose-Response Relationship,Drug
MH - Female
MH - Heroin Dependence
MH - psychology
MH - rehabilitation
MH - Human
MH - Male
MH - Methadone
MH - therapeutic use
MH - Professional-Patient Relations
MH - Rehabilitation,Vocational
MH - Self Concept
RP - NOT IN FILE
NT - UI - 85296233LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleDA - 19851009IS - 1046-9516SB - IMCY - UNITED STATESJC - NRM
UR - PM:3929122
SO - NIDA Res Monogr 1985 ;58():101-110

169
UI - 169
AU - Des J
AU - Chamberland ME
AU - Yancovitz SR
AU - Weinberg P
AU - Friedman SR
TI - Heterosexual partners: a large risk group for AIDS
MH - Acquired Immunodeficiency Syndrome
MH - transmission
MH - Female
MH - Human
MH - Male
MH - New York City
MH - Risk
MH - Sex Behavior
MH - Substance-Related Disorders
MH - complications
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 85059987LA - engPT - LetterID - 1 R01 DA03574-01/DA/NIDADA - 19850114IS - 0140-6736SB - AIMSB - IMCY - ENGLANDJC - L0S
UR - PM:6150359
SO - Lancet 1984 Dec 8 ;2(8415):1346-1347

170
UI - 171
AU - Marmor M
AU - Des J
AU - Friedman SR
AU - Lyden M
AU - el Sadr W
TI - The epidemic of acquired immunodeficiency syndrome (AIDS) and suggestions for its control in drug abusers
AB - Intravenous (IV) users of illicit drugs have accounted for 17% of AIDS cases seen in the United States. Previous research has shown that more than half of IV drug abusers entering a drug detoxification program in New York City had serologic evidence of exposure to the virus believed to cause AIDS. Spread of AIDS among drug abusers presumably occurs by transmission of the virus via shared needles, works, or drug-containing solutions. Secondary spread of AIDS from IV drug abusers to others may occur by venereal transmission or by perinatal transmission to infants. In this article, relevant characteristics of the AIDS epidemic are presented to assist the staff of drug treatment programs in their work with IV drug abusers. Suggestions regarding the education of drug treatment personnel and the dissemination of information about AIDS to drug abusers and their families are offered. Fact sheets on AIDS for drug treatment and prison staff, and for drug abusers with and without the disease are presented. Finally, possible approaches to the prevention of AIDS in drug users are discussed
MH - Acquired Immunodeficiency Syndrome
MH - blood
MH - diagnosis
MH - epidemiology
MH - etiology
MH - prevention & control
MH - transmission
MH - Female
MH - Htlv-Blv Viruses
MH - Health Education
MH - Human
MH - Infant
MH - Injections,Intravenous
MH - adverse effects
MH - Male
MH - New York City
MH - Prisons
MH - Rehabilitation Centers
MH - Substance-Related Disorders
MH - complications
MH - therapy
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 85264931LA - engPT - Journal ArticleID - CA13343/CA/NCIID - CA33205/CA/NCIID - DAO3574/DA/NIDAID - etcDA - 19850903IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:6100315
SO - J Subst Abuse Treat 1984 ;1(4):237-247

171
UI - 170
AU - Spira TJ
AU - Des J
AU - Marmor M
AU - Yancovitz S
AU - Friedman S
AU - Garber J
AU - Cohen H
AU - Cabradilla C
AU - Kalyanaraman VC
TI - Prevalence of antibody to lymphadenopathy-associated virus among drug- detoxification patients in New York
MH - Antibodies,Viral
MH - analysis
MH - Htlv-Blv Viruses
MH - immunology
MH - Human
MH - Retroviridae
MH - Substance-Related Disorders
MH - rehabilitation
RP - NOT IN FILE
NT - UI - 84270548LA - engRN - 0 (Antibodies, Viral)PT - LetterDA - 19840904IS - 0028-4793SB - AIMSB - IMCY - UNITED STATESJC - NOW
UR - PM:6087140
SO - N Engl J Med 1984 Aug 16 ;311(7):467-468

172
UI - 172
AU - Langrod J
AU - Des J
AU - Alksne L
AU - Lowinson J
TI - Locus of control and initiation of detoxification among male methadone maintenance patients
AB - Two hypotheses were derived linking locus of control to voluntary, "completion of treatment" detoxification from methadone maintenance: (1) methadone maintenance patients with an internal locus of control will be more likely to indicate a willingness to begin detoxification, and (2) among patients indicating a willingness to begin, those with an internal locus of control would be more likely to actually begin. Subjects were 115 male methadone patients. A nonsignificant trend was found in support of the first hypothesis, while the second was reversed at a statistically significant level (r = -.30, p less than .012)
MH - Adolescence
MH - Adult
MH - Human
MH - Internal-External Control
MH - Male
MH - Methadone
MH - therapeutic use
MH - Middle Age
MH - New York City
MH - Opioid-Related Disorders
MH - psychology
MH - rehabilitation
RP - NOT IN FILE
NT - UI - 84031176LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleDA - 19831220IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:6629579
SO - Int J Addict 1983 Aug ;18(6):783-790

173
UI - 173
AU - Des J
TI - Retention rates among New York City methadone patients: a response to Bayer and Koenigsberg
MH - Human
MH - Methadone
MH - therapeutic use
MH - New York City
MH - Opioid-Related Disorders
MH - rehabilitation
MH - Patient Dropouts
RP - NOT IN FILE
NT - UI - 83029885LA - engRN - 76-99-3 (Methadone)PT - LetterDA - 19821216IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:7129708
SO - Int J Addict 1982 Jul ;17(5):929-930

174
UI - 174
AU - Des J
AU - Joseph H
AU - Dole VP
TI - Long-term outcomes after termination from methadone maintenance treatment
MH - Adult
MH - Alcoholism
MH - complications
MH - Evaluation Studies
MH - Female
MH - Follow-Up Studies
MH - Human
MH - Male
MH - Methadone
MH - administration & dosage
MH - Opioid-Related Disorders
MH - rehabilitation
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 81254155LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleID - 5 H81-DA-01778-02/DA/NIDADA - 19810922IS - 0077-8923SB - IMCY - UNITED STATESJC - 5NM
UR - PM:6942709
SO - Ann N Y Acad Sci 1981 ;362():231-238

175
UI - 175
AU - Des J
AU - Uppal GS
TI - Heroin activity in New York City, 1970-1978
AB - Heroin activity in New York City is traced from 1970 using a variety of indicators. A steady decline in the number of new "intensive" users (those who required treatment) is noted, beginning around 1970. Various possible explanations of this decline are examined. Reductions in the supply of heroin or in the demand for heroin do not appear to be causes of the decline in new users, as these reductions occurred after the decline in new users had already begun. Demographic changes--the passing of the baby boom cohort through the period of highest risk of beginning heroin use--also does not appear to be a viable explanation, as trends in use of other drugs do not show a decline. Changes in attitudes toward heroin as a specific drug are left as the most plausible explanation of the decline in the number of new intensive heroin users
MH - Attitude
MH - Heroin
MH - supply & distribution
MH - Heroin Dependence
MH - epidemiology
MH - rehabilitation
MH - Human
MH - New York City
MH - Risk
MH - Time Factors
RP - NOT IN FILE
NT - UI - 81252841LA - engRN - 561-27-3 (Heroin)PT - Journal ArticleDA - 19810915IS - 0095-2990SB - IMCY - UNITED STATESJC - 3GW
UR - PM:7258166
SO - Am J Drug Alcohol Abuse 1980 ;7(3-4):335-346

176
UI - 176
AU - Dembo R
AU - Pilaro L
AU - Burgos W
AU - Des J
AU - Schmeidler J
TI - Self-concept and drug involvement among urban junior high school youths
AB - Relationships between self-concept and drug involvement were examined through a survey given to 1,100 urban junior high school youths from mixed socioeconomic and ethnic backgrounds. The students were presented with 14 descriptions of "types" of youth, which they rated in terms of similarity to themselves. Factor analyses produced three "self-image" factors each for both males and females. "Gang" and "drug culture" self- images were positively associated with self-reported drug use (r's for .35 to .46), while an "educational" self-image was negatively associated with drug involvement (r's from -.20 to -.30). Implications for further research and for drug abuse prevention planning are discussed
MH - Adolescence
MH - Attitude
MH - Female
MH - Human
MH - Male
MH - Self Concept
MH - Social Adjustment
MH - Socioeconomic Factors
MH - Substance-Related Disorders
MH - psychology
MH - Urban Population
RP - NOT IN FILE
NT - UI - 80136380LA - engPT - Journal ArticleDA - 19800514IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:536059
SO - Int J Addict 1979 Nov ;14(8):1125-1144

177
UI - 177
AU - Deren S
AU - Des J
TI - Risk-taking related to drug use: an application of the shift-to-risk design
AB - The utility of the shift-to-risk design for studying the influence of peer groups on drug taking was investigated. Two studies using this design with drug content were conducted, varying the level of information provided about a drug. Subjects were from two college classes consisting of 26 and 28 students. Results indicated that the specification of possible harmful drug effects which are somewhat minimal lead to a significantly greater willingness to recommend trying the drug. In addition, a tendency for a shift-to-caution was found. It was concluded that the shift-to-risk designwas useful for studying decision-making regarding drug use, and that both users and nonusers of drugs should be included in future research
MH - Adolescence
MH - Adult
MH - Decision Making
MH - Female
MH - Human
MH - Male
MH - Peer Group
MH - Risk-Taking
MH - Students
MH - Substance-Related Disorders
MH - psychology
RP - NOT IN FILE
NT - UI - 78163379LA - engPT - Journal ArticleDA - 19780617IS - 0095-2990SB - IMCY - UNITED STATESJC - 3GW
UR - PM:612205
SO - Am J Drug Alcohol Abuse 1977 ;4(3):391-399

178
UI - 178
AU - Des J
AU - Kott A
AU - Savarese J
AU - Bersamin J
TI - Rules and rule breaking in a therapeutic community
MH - Acting Out
MH - Goals
MH - Group Processes
MH - Helping Behavior
MH - Human
MH - New York City
MH - Patient Compliance
MH - Patient Dropouts
MH - Role
MH - Social Conformity
MH - Stress,Psychological
MH - Substance-Related Disorders
MH - rehabilitation
MH - Therapeutic Community
RP - NOT IN FILE
NT - UI - 77019035LA - engPT - Journal ArticleDA - 19761203IS - 0094-0267SB - IMCY - UNITED STATESJC - 2H4
UR - PM:973576

1
UI - 4
AU - Des J
AU - Jones A
TI - Small world, big challenges: a report from the 9th International Congress of the World Federation of Public Health Associations
MH - Commerce
MH - economics
MH - Developing Countries
MH - Health Planning
MH - Human
MH - International Cooperation
MH - World Health
RP - NOT IN FILE
NT - UI - 21030001LA - engPT - CongressesPT - EditorialDA - 20010112IS - 0090-0036SB - AIMSB - IMCY - United StatesJC - 3XW
UR - PM:11189810
SO - Am J Public Health 2001 Jan ;91(1):14-15

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 individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs
MH - Adult
MH - Cohort Studies
MH - Comparative Study
MH - Female
MH - Follow-Up Studies
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - HIV Seropositivity
MH - virology
MH - Human
MH - Incidence
MH - Male
MH - Middle Age
MH - Multivariate Analysis
MH - Needle-Exchange Programs
MH - New York City
MH - Proportional Hazards Models
MH - Risk Factors
MH - Risk-Taking
MH - Saliva
MH - Sterilization
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
RP - NOT IN FILE
NT - UI - 97008738LA - engPT - Journal ArticlePT - Meta-AnalysisID - DA03574/DA/NIDAID - DA05283/DA/NIDAID - DA06001/DA/NIDAID - etcDA - 19961107IS - 0140-6736SB - AIMSB - IMCY - ENGLANDJC - L0S
UR - PM:8855855
SO - Lancet 1996 Oct 12 ;348(9033):987-991

58
UI - 63
AU - Grund JP
AU - Friedman SR
AU - Stern LS
AU - Jose B
AU - Neaigus A
AU - Curtis R
AU - Des J
AD - Lindesmith Center, New York, NY 10106, USA
TI - Syringe-mediated drug sharing among injecting drug users: patterns, social context and implications for transmission of blood-borne pathogens
AB - Drug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public discussion have focused primarily on the sharing of syringes and needles. While the focus on syringe sharing has sparked important interventions (bleach distribution, syringe exchange) it may have obscured the social relationship in which injecting equipment is used. Drug sharing plays a crucial role in the social organization of the drug using subculture. In this paper, various drug sharing practices and other distinguishable aspects of the injecting process-collectively termed Syringe-Mediated Drug Sharing (SMDS)-are described. All of these behaviors may put injecting drug users (IDUs) at risk for infection. The purpose of this paper is to stimulate scientific inquiry into SMDS behaviors and the social contexts which shape them. Descriptions are based primarily on field studies in Rotterdam and New York City. Recommendations for safer injecting training and education are proposed, as are directions for future research
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Anthropology,Cultural
MH - Blood-Borne Pathogens
MH - Contact Tracing
MH - Cross-Cultural Comparison
MH - Human
MH - Needle Sharing
MH - statistics & numerical data
MH - Netherlands
MH - epidemiology
MH - New York City
MH - Risk Factors
MH - Social Environment
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Syringes
MH - Urban Population
RP - NOT IN FILE
NT - UI - 96243481LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19960822IS - 0277-9536SB - IMCY - ENGLANDJC - UT9
UR - PM:8685737
SO - Soc Sci Med 1996 Mar ;42(5):691-703

59
UI - 58
AU - Hershow RC
AU - Galai N
AU - Fukuda K
AU - Graber J
AU - Vlahov D
AU - Rezza G
AU - Klein RS
AU - Des J
AU - Vitek C
AU - Khabbaz R
AU - Freels S
AU - Zuckerman R
AU - Pezzotti P
AU - Kaplan JE
AD - University of Illinois, Chicago College of Medicine and School of Public Health 60612, USA
TI - An international collaborative study of the effects of coinfection with human T-lymphotropic virus type II on human immunodeficiency virus type 1 disease progression in injection drug users
AB - To determine whether human T-lymphotropic virus (HTLV) type II coinfection affects progression of human immunodeficiency virus type 1 (HIV) infection, longitudinal data on 370 HIV-infected injection drug users (IDUs) with known HIV seroconversion dates from four cohort studies were pooled. HTLV infection was determined by EIA and confirmed and typed by Western blot. Proportional hazards models were used to determine whether HTLV-II infection was associated with AIDS or AIDS- related mortality. Regression analyses were used to compare declines in CD4 cell percents in singly and dually infected persons. Of 370 IDUs, 61 (16%) were HTLV-II-coinfected. During follow-up, 43 (12%) developed and 24 (6%) died of AIDS. HTLV-II coinfection was not associated with progression to AIDS (relative hazard [RH], .82; 95% confidence interval [CI], 0.34-1.94]) or AIDS mortality (RH, 1.69; 95% CI, 0.62-4.60). Rates of decline in CD4 cell percent were similar in singly and dually infected IDUs. These results suggest that HTLV-II does not affect the progression of HIV infection
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - mortality
MH - Adult
MH - CD4 Lymphocyte Count
MH - Comparative Study
MH - Disease Progression
MH - Follow-Up Studies
MH - HIV Seropositivity
MH - complications
MH - Hiv-1
MH - HTLV-II Infections
MH - Human
MH - Longitudinal Studies
MH - Multivariate Analysis
MH - Prevalence
MH - Regression Analysis
MH - Rome
MH - epidemiology
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
MH - United States
RP - NOT IN FILE
NT - UI - 96313007LA - engPT - Journal ArticlePT - Multicenter StudyID - DA-04334/DA/NIDAID - DA-06589/DA/NIDAID - U64/CCU506834-01/PHSID - etcDA - 19960905IS - 0022-1899SB - AIMSB - IMCY - UNITED STATESJC - IH3
UR - PM:8699060
SO - J Infect Dis 1996 Aug ;174(2):309-317

60
UI - 53
AU - Kochems LM
AU - Paone D
AU - Des J
AU - Ness I
AU - Clark J
AU - Friedman SR
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA
TI - The transition from underground to legal syringe exchange: the New York City experience
AB - The most common method of syringe exchange program (SEP) development in the United States has been for SEPs to be started by activists without funding and then to become a government-funded community-based organization. This developmental process, which has not been studied to date, involves major organizational change. We report our findings on three New York City syringe exchanges experiencing this type of transition. Our data illustrate that following legalization, increased legitimacy and funding allowed all three SEPs to expand the size and scope of their programs (e.g., adding hours, sites, referral services, and the ability to support user groups), resulting in a rapid growth in participation (over 15,000 in 18 months). Regulation accompanying legalization posed significant challenges to SEPs, including added record-keeping and reporting tasks, increased demand for referrals, and accommodating evaluation, which affected already overburdened staffs. The transition process poses significant challenges to these developing organizations as well as opportunities for improved services
MH - Attitude of Health Personnel
MH - Community Health Services
MH - organization & administration
MH - Facility Regulation and Control
MH - legislation & jurisprudence
MH - Financing,Government
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Needle-Exchange Programs
MH - New York City
MH - Organizational Innovation
MH - Program Development
MH - Questionnaires
MH - Referral and Consultation
MH - Support,Non-U.S.Gov't
MH - Total Quality Management
RP - NOT IN FILE
NT - UI - 97163701LA - engPT - Journal ArticleDA - 19970328IS - 0899-9546SB - IMCY - UNITED STATESJC - AUY
UR - PM:9010508
SO - AIDS Educ Prev 1996 Dec ;8(6):471-489

61
UI - 57
AU - Marmor M
AU - Titus S
AU - Harrison C
AU - Cord-Cruz EA
AU - Shore RE
AU - Vogler M
AU - Krasinski K
AU - Mildvan D
AU - Des J
AD - Department of Environmental Medicine, New York University School of Medicine, New York 10010-2598, USA
TI - Weight loss associated with HIV seroconversion among injection-drug users
AB - To describe symptoms associated with human immunodeficiency virus (HIV) seroconversion, we studied a cohort of 366 injection-drug users (IDUs) with a study design that included recall every 3 months to collect symptom histories using a structured questionnaire. Eleven HIV seroconversions were observed in 621.5 person years at risk (PYAR), equivalent to 1.8 seroconversions/100 PYAR. Cox regression analysis showed age < or = 35 years to be a significant risk factor for HIV seroconversion after controlling for gender, race, and the frequency of drug injection. An embedded case-control analysis then compared symptom histories of HIV seroconverters with those of age-(+/- 5 years) and visit number-matched controls who remained HIV seronegative for > or = 3 months longer than the HIV-seroconverters. Multivariate case-control analysis adjusted for injection frequency yielded significant associations of HIV seroconversion with histories of weight loss > or = 4.5 kg (seven of 11 cases; odds ratio [OR] = 11.6, 95% confidence interval [CI] 3.1, 43.1) and oral ulcers (three of 11 cases; OR = 7.6, 95% CI = 1.2, 48.2) in the 3 months before the subjects' first HIV- seropositive study visit. We conclude that histories of recent symptoms reported by HIV-seroconverting IDUs differ from those reported by non- HIV-seroconverting IDUs, and weight loss may be particularly common among IDUs experiencing primary HIV infection
MH - Adult
MH - Case-Control Studies
MH - Cohort Studies
MH - Confidence Intervals
MH - Female
MH - Follow-Up Studies
MH - HIV Seropositivity
MH - complications
MH - physiopathology
MH - Human
MH - Male
MH - Middle Age
MH - Odds Ratio
MH - Questionnaires
MH - Regression Analysis
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Weight Loss
RP - NOT IN FILE
NT - UI - 96335115LA - engPT - Journal ArticleID - 1P30AI27742/AI/NIAIDID - DA06001/DA/NIDAID - NO1-AI-35176/AI/NIAIDID - etcDA - 19960918IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:8757430
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1996 Aug 15 ;12(5):514-518

62
UI - 62
AU - Neaigus A
AU - Friedman SR
AU - Jose B
AU - Goldstein MF
AU - Curtis R
AU - Ildefonso G
AU - Des J
AD - National Development and Research Institutes, New York, NY 10013, USA
TI - High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug injectors
AB - In a cross-sectional study of 174 new injecting drug users (IDUs) in New York City who had injected for < or = 6 years, we examined whether those who both share syringes and have personal risk networks that include high-risk injectors are particularly likely to be infected with HIV. Subjects were street recruited between July 1991 and January 1993, were interviewed about their risk behaviors in the prior 2 years and their personal risk networks with other IDUs in the prior 30 days, and were tested for HIV; 20% were HIV seropositive. Among those who both shared syringes and had a personal risk network member who injected more than once a day, 40% were HIV seropositive (versus 14% for others, p < 0.001). In simultaneous multiple logistic regression, the interaction of both sharing syringes and having a personal risk network member who injected more than once a day remained independently and significantly associated with being HIV seropositive (OR, 3.57; 95% CI, 1.22, 10.43; p < 0.020), along with Latino race/ethnicity and exchanging sex for money or drugs. These findings suggest that the combination of sharing syringes with having a high-risk personal network is a risk factor for HIV infection among new IDUs. Studies of risk factors for HIV infection among new IDUs and interventions to reduce the spread of HIV among them should focus on their risk networks as well as their risk behaviors
MH - Adult
MH - Cross-Sectional Studies
MH - Female
MH - HIV Infections
MH - complications
MH - epidemiology
MH - HIV Seropositivity
MH - Health Behavior
MH - Hispanic Americans
MH - Human
MH - Interpersonal Relations
MH - Interviews
MH - Logistic Models
MH - Male
MH - Needle Sharing
MH - adverse effects
MH - New York City
MH - Prevalence
MH - Risk Factors
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
RP - NOT IN FILE
NT - UI - 96198889LA - engPT - Journal ArticleID - R01 DA06723/DA/NIDADA - 19960523IS - 1077-9450SB - IMCY - UNITED STATESJC - B7J
UR - PM:8605596
SO - J Acquir Immune Defic Syndr Hum Retrovirol 1996 Apr 15 ;11(5):499-509

63
UI - 59
AU - Orr MF
AU - Glebatis D
AU - Friedmann P
AU - Des J
AU - Prevots DR
TI - Incidence of HIV infection in a New York City methadone maintenance treatment program
MH - HIV Infections
MH - epidemiology
MH - HIV Seroprevalence
MH - Human
MH - Incidence
MH - New York City
MH - Substance Abuse Treatment Centers
MH - statistics & numerical data
RP - NOT IN FILE
NT - UI - 96272939LA - engPT - LetterDA - 19960801IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:8656520
SO - JAMA 1996 Jul 10 ;276(2):99

64
UI - 60
AU - Shore RE
AU - Marmor M
AU - Titus S
AU - Des J
AD - Department of Environmental Medicine, New York University School of Medicine, NY, USA
TI - Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use
AB - The objective of this study was to determine what sociodemographic, lifestyle, or drug-related characteristics predict temporal changes in self reported drug injection frequencies among HIV-seronegative injection-drug users (IDUs) who were being given HIV testing and risk reduction counseling. The 277 subjects were given 4-11 quarterly interviews including detailed history of drug use and other HIV risk factors, HIV risk reduction counseling, and venipuncture for HIV antibody testing. A regression slope of change over time in drug injection frequency was calculated for each subject, and categories were created of decreasing temporal slope, increasing slope, relapse (decrease initially, then increase), or no substantial change. Only 44% of subjects decreased their drug injection frequencies despite repetitive HIV testing and counseling. In multivariate logistic analyses, decreasing temporal trends were associated with consistent enrollment in methadone maintenance (p < .1), whereas increasing trends conversely were associated with inconsistent enrollment (p < .01) and also with an absence of crack use (p < .01). Relapses were significantly associated with needle sharing with multiple partners and a low frequency of smoking. The data suggest that methadone maintenance facilitates a positive response to HIV risk reduction counseling. However, the fact that only a minority of subjects displayed a decreasing temporal trend in drug injection frequencies emphasizes the need for improved therapeutic and counseling techniques
MH - Adult
MH - Aged
MH - Cohort Studies
MH - Female
MH - HIV Infections
MH - transmission
MH - Human
MH - Life Style
MH - Male
MH - Methadone
MH - therapeutic use
MH - Middle Age
MH - New York City
MH - Risk Factors
MH - Socioeconomic Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - rehabilitation
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 97170024LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleID - DA06001/DA/NIDAID - IP30AI27742/AI/NIAIDID - NO1-A1-35176/PHSID - etcDA - 19970409IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:9017567
SO - J Subst Abuse Treat 1996 May ;13(3):241-248

65
UI - 73
AU - Des J
TI - Harm reduction--a framework for incorporating science into drug policy
MH - Drug and Narcotic Control
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Psychotropic Drugs
MH - Substance Abuse,Intravenous
MH - complications
MH - Substance-Related Disorders
MH - therapy
MH - United States
RP - NOT IN FILE
NT - UI - 95133638LA - engRN - 0 (Psychotropic Drugs)PT - EditorialDA - 19950223IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:7832242
SO - Am J Public Health 1995 Jan ;85(1):10-12

66
UI - 66
AU - Des J
AU - Paone D
AU - Friedman SR
AU - Peyser N
AU - Newman RG
AD - Beth Israel Medical Center, New York City, USA
TI - Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs
AB - One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Drug and Narcotic Control
MH - history
MH - History of Medicine,20th Cent.
MH - Human
MH - Methadone
MH - therapeutic use
MH - Needle-Exchange Programs
MH - legislation & jurisprudence
MH - Public Health
MH - trends
MH - Substance Abuse Treatment Centers
MH - Substance Abuse,Intravenous
MH - rehabilitation
MH - Support,Non-U.S.Gov't
MH - United States
RP - NOT IN FILE
NT - UI - 96036593LA - engRN - 76-99-3 (Methadone)PT - Historical ArticlePT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19951205IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:7485676
SO - Am J Public Health 1995 Nov ;85(11):1577-1584

67
UI - 67
AU - Des J
AU - Hagan H
AU - Friedman SR
AU - Friedmann P
AU - Goldberg D
AU - Frischer M
AU - Green S
AU - Tunving K
AU - Ljungberg B
AU - Wodak A
AU - .
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, NY, USA
TI - Maintaining low HIV seroprevalence in populations of injecting drug users
AB - OBJECTIVES--To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUs), but where seroprevalence has nevertheless remained low (< 5%) during at least 5 years. DESIGN AND SETTING--A literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUs. PARTICIPANTS--Injecting drug users recruited from both drug treatment and non-treatment settings in each city. INTERVENTIONS--A variety of HIV prevention activities for IDUs had been implemented in each of the five cities. RESULTS--There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low, (2) provision of sterile injection equipment, and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one third or more of the IDUs reporting recent unsafe injections. CONCLUSIONS--In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUs, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUs are at risk for rapid spread of HIV
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - HIV Seroprevalence
MH - Human
MH - Risk-Taking
MH - Seroepidemiologic Studies
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Urban Population
RP - NOT IN FILE
NT - UI - 96017572LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19951107IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:7563513
SO - JAMA 1995 Oct 18 ;274(15):1226-1231

68
UI - 69
AU - Des J
AU - Friedman SR
AU - Friedmann P
AU - Wenston J
AU - Sotheran JL
AU - Choopanya K
AU - Vanichseni S
AU - Raktham S
AU - Goldberg D
AU - Frischer M
AU - .
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA
TI - HIV/AIDS-related behavior change among injecting drug users in different national settings
AB - OBJECTIVES: To identify factors associated with effective AIDS behavior change among injecting drug users (IDU) in different national settings. DESIGN: Cross-sectional surveys of IDU, with determination of HIV status. Trends in city HIV seroprevalence among IDU also used to validate effectiveness of behavior change. SETTING AND PARTICIPANTS: Subjects recruited from drug-use treatment programs and outreach efforts in Bangkok, Thailand (n = 601), Glasgow, Scotland (n = 919), New York City, USA (n = 2539), and Rio de Janeiro, Brazil (n = 466). RESULTS: Evidence for the effectiveness of self-reported risk reduction was available for all cities. Univariate followed by multiple logistic regression analyses were used to identify factors associated with self- reported AIDS behavior change. Separate analyses were conducted for each city. Talking about AIDS with drug-using friends was significantly associated with behavior change in all four cities. Talking with sex partners about AIDS, educational level, knowing that someone can be HIV- infected and still look healthy, and having been tested previously for HIV were each significantly associated with behavior change in three of the four cities. CONCLUSIONS: Despite the substantial differences in these national settings, there were common factors associated with effective risk reduction. In particular, risk reduction appears to occur through social processes rather than through individual attitude change. HIV prevention programs need to explicitly incorporate social processes into their work
MH - Acquired Immunodeficiency Syndrome
MH - etiology
MH - prevention & control
MH - psychology
MH - Adult
MH - Behavior
MH - Brazil
MH - Cross-Sectional Studies
MH - Female
MH - HIV Infections
MH - Human
MH - Male
MH - New York City
MH - Regression Analysis
MH - Scotland
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
RP - NOT IN FILE
NT - UI - 95391171LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19951006IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:7662201
SO - AIDS 1995 Jun ;9(6):611-617

69
UI - 68
AU - Friedman SR
AU - Jose B
AU - Deren S
AU - Des J
AU - Neaigus A
AD - National Development and Research Institutes, Inc., New York, NY 10013, USA
TI - Risk factors for human immunodeficiency virus seroconversion among out- of-treatment drug injectors in high and low seroprevalence cities. The National AIDS Research Consortium
AB - From 1988 to 1991, 6,882 drug injectors in 15 US cities were interviewed and had serum samples collected. The interviews and samples were analyzed for determination of significant predictors of human immunodeficiency virus (HIV) seroconversion in the 10 low seroprevalence cities and the five high seroprevalence cities. The unit of analysis was the period of observation between consecutive paired interviews/blood samples. In Cox proportional hazards regression, significant predictors of seroconversion in the low seroprevalence cities were: not being in drug treatment, injecting in outdoor settings or abandoned buildings, using crack cocaine weekly or more frequently, engaging in woman-to-woman sex, being of non-Latino race/ethnicity, and city seroprevalence. Predictors in high seroprevalence cities were: injecting with potentially infected syringes, not being in drug treatment, and having a sex partner who injected drugs. These findings suggest that HIV may be concentrated in sociobehavioral pockets of infection in low seroprevalence cities. For reducing HIV transmission, these results suggest: 1) in low seroprevalence cities, localized monitoring to detect specific emerging sociobehavioral pockets of infection, and quick implementation of appropriate targeted interventions if necessary; 2) in high seroprevalence cities, relatively more emphasis on locality-wide outreach and syringe-exchange projects to reduce risky behavior; and 3) in both types of cities, considerable expansion of drug treatment programs
MH - Adult
MH - Comparative Study
MH - Female
MH - HIV Seropositivity
MH - blood
MH - epidemiology
MH - transmission
MH - HIV Seroprevalence
MH - Health Behavior
MH - Human
MH - Male
MH - Predictive Value of Tests
MH - Proportional Hazards Models
MH - Questionnaires
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - prevention & control
MH - Support,U.S.Gov't,P.H.S.
MH - United States
MH - Urban Health
RP - NOT IN FILE
NT - UI - 96017410LA - engPT - Journal ArticlePT - Multicenter StudyID - DA05283/DA/NIDAID - DA06723/DA/NIDADA - 19951114IS - 0002-9262SB - IMCY - UNITED STATESJC - 3H3
UR - PM:7572963
SO - Am J Epidemiol 1995 Oct 15 ;142(8):864-874

70
UI - 70
AU - Paone D
AU - Caloir S
AU - Shi Q
AU - Des J
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York City
TI - Sex, drugs, and syringe exchange in New York City: women's experiences
AB - The sex and drug human immunodeficiency virus (HIV) risk factors of drug-injecting women participating in New York City syringe exchange programs were studied and racial/ethnic differences examined. African- American women reported injecting least frequently and had lower rates of injecting with borrowed or used syringes. Women attending syringe exchange reported high levels of sexual risk behavior, and syringe exchange provides an opportunity for a sexual risk reduction intervention. Women were more likely to "always" use condoms with causal partners than with primary partners. About 60% of the women engaging in commercial sex work reported "always" using condoms. Three independent predictors for consistent condom use with primary partners were: knowing one's HIV status, any risky injection during the past 30 days, and being African-American, compared with white or Latina. The profile of African-American women attending syringe exchange in New York City suggests a higher level of stabilization than is found in the other groups of women. White women appear to be more socially isolated and to engage in higher risk behaviors. Although women attending New York City syringe exchange programs have significantly reduced risky drug injection, consistent with other studies, sexual risk behavior has remained at a high level. Syringe exchange and drug treatment programs have a great opportunity to target drug-injecting women for sexual risk reduction interventions
MH - Adult
MH - Female
MH - HIV Infections
MH - ethnology
MH - prevention & control
MH - transmission
MH - Human
MH - Needle-Exchange Programs
MH - New York City
MH - Odds Ratio
MH - Program Evaluation
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,Non-U.S.Gov't
MH - Women's Health
RP - NOT IN FILE
NT - UI - 95386838LA - engPT - Journal ArticleDA - 19951004IS - 0098-8421SB - IMCY - UNITED STATESJC - H7R
UR - PM:7657943
SO - J Am Med Womens Assoc 1995 May ;50(3-4):109-114

71
UI - 71
AU - Paone D
AU - Des J
AU - Caloir S
AU - Clark J
AU - Jose B
AD - Chemical Dependency Institute, Beth Israel Medical Center, N.Y., NY 10003, USA
TI - Operational issues in syringe exchanges: the New York City tagging alternative study
AB - It is estimated that 50% of the approximate 200,000 intravenous drug users (IDUs) in New York City (NYC) are infected with HIV. Syringe exchange, a common method of HIV prevention in many countries was legalized in NYC in 1992. As syringe exchange has gained public support and the number of functioning exchangers has grown in the country, more attention has been given to the study of operational characteristics of syringe exchanges. Syringe exchanges may be considered health service delivery organizations, and the specific methods of service delivery may greatly influence their effectiveness in reducing HIV risk behavior among injecting drug users. Improving operational characteristics of syringe exchanges requires both careful data collection, in order to reduce ambiguity in interpretation, and methods for cumulating knowledge, so that previous learning experiences need not be repeated with each new exchange. We report here on the practice of marking ("tagging") syringes distributed by exchanges in NYC during the period from 1990 through 1994. During this period the NYC exchanges operated illegally as underground exchanges, and then received legal status and expanded greatly. Developing regulations that reflect the reality of the program operations while allowing for monitoring and oversight is a complicated process, especially when implemented in states that maintain paraphernalia and prescription laws and where "unauthorized" possession of injection equipment remains a criminal activity under existing legal statutes. The particular situation in NYC which required the revision of existing regulations during a period of rapid program expansion and implementation of a large system of syringe exchange further illustrates the multiple pressures which accompany such a process. In order to implement meaningful regulations which maximize the public health benefits of syringe exchange programs on an individual and community level, recommendations are made
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Interinstitutional Relations
MH - Needle-Exchange Programs
MH - economics
MH - legislation & jurisprudence
MH - organization & administration
MH - New York
MH - Police
MH - Program Development
MH - methods
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
RP - NOT IN FILE
NT - UI - 95370451LA - engPT - Journal ArticleDA - 19950920IS - 0094-5145SB - IMCY - UNITED STATESJC - HUT
UR - PM:7642778
SO - J Community Health 1995 Apr ;20(2):111-123

72
UI - 72
AU - Paone D
AU - Des J
AU - Gangloff R
AU - Milliken J
AU - Friedman SR
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA
TI - Syringe exchange: HIV prevention, key findings, and future directions
AB - HIV among injecting drug users (IDUs) has now been documented in over 60 countries in the world, and there are an additional 40 countries where injecting drug use has been reported including widespread epidemics in Southeast and southern Asia and in Latin America. At present HIV infection is almost always fatal, and there is no promise that a preventive vaccine will become available soon. Given the enormity of the HIV epidemic among IDUs and the critical need to reduce the spread of HIV transmission to and from IDUs, prevention efforts are essential. Syringe-exchange programs have become a major component of HIV prevention strategies in most developed countries and work within the philosophy of harm reduction. Increasing access to sterile syringes has been met with considerable controversy. Opponents of syringe exchange have generally argued that increasing access to sterile syringes would simultaneously increase the number of injecting drug users, increase the frequency of injection for already active IDUs, and appear to "condone" an illegal behavior. To date many research studies and four major reviews of syringe exchange literature have been conducted. All studies thus far have shown no increase in illicit drug injection associated with syringe exchanges, and significant decrease in drug risk behaviors
MH - Cross-Sectional Studies
MH - Forecasting
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Health Services Accessibility
MH - trends
MH - Human
MH - Incidence
MH - Needle-Exchange Programs
MH - Program Evaluation
MH - Substance Abuse,Intravenous
MH - epidemiology
MH - rehabilitation
RP - NOT IN FILE
NT - UI - 96122207LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialDA - 19960227IS - 0020-773XSB - IMCY - UNITED STATESJC - GQ8
UR - PM:8557411
SO - Int J Addict 1995 ;30(12):1647-1683

73
UI - 65
AU - Perlman DC
AU - Salomon N
AU - Perkins MP
AU - Yancovitz S
AU - Paone D
AU - Des J
AD - Department of Medicine, Beth Israel Medical Center, New York, New York 10003, USA
TI - Tuberculosis in drug users
AB - The rise in tuberculosis (TB) has disproportionately affected specific populations. Historically, many patients with TB became iatrogenic opiate addicts through therapeutic use of these drugs for symptom control. Demographic trends reshaped the relationship between drug use and TB into one in which drug use became a risk factor for tuberculosis as a result of the overlap of epidemiological and social factors associated with both drug use and TB. The spread of human immunodeficiency virus infection has amplified the spread of TB among drug users. We review the epidemiology of TB in drug users as well as the factors relevant to screening and compliance in drug-using populations. Drug users constitute a high-risk group for whom screening, prevention of infection, diagnosis, and treatment pose particular challenges. The development of TB services capable of engaging drug users (those both in and out of drug treatment programs) has potential for disrupting a significant chain of rapid TB transmission
MH - AIDS-Related Opportunistic Infections
MH - complications
MH - epidemiology
MH - Epidemiologic Factors
MH - Female
MH - Human
MH - Male
MH - Mass Screening
MH - Risk Factors
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - Tuberculosis,Multidrug-Resistant
MH - Tuberculosis,Pulmonary
MH - prevention & control
MH - United States
RP - NOT IN FILE
NT - UI - 96126012LA - engPT - Journal ArticlePT - ReviewPT - Review, AcademicID - RO1-DA09005-01A1/DA/NIDADA - 19960327IS - 1058-4838SB - IMCY - UNITED STATESJC - A4J
UR - PM:8589151
SO - Clin Infect Dis 1995 Nov ;21(5):1253-1264

74
UI - 77
AU - Curtis R
AU - Friedman SR
AU - Neaigus A
AU - Jose B
AU - Goldstein M
AU - Des J
AD - NDRI, Inc., New York, NY 10013
TI - Implications of directly observed therapy in tuberculosis control measures among IDUs
AB - Tuberculosis (TB) is a rapidly growing problem among injecting drug users (IDU), especially those infected with human immunodeficiency virus. The authors review IDUs' responses to current TB control strategies and discuss the implications of their findings for the proposed implementation of directly observed therapy (DOT), a method for ensuring that patients take prescribed medication. Field workers carried out 210 ethnographic interviews with 68 IDUs in a Brooklyn, NY, community during 1990-93. Case studies suggested that many IDUs are uninformed about TB and often misinformed about their personal TB status. Ethnographic interviews and observations indicated that the threat of TB-related involuntary detainment may lead IDUs to avoid TB diagnostic procedures, treatment for TB, or drug abuse treatment, and to avoid AIDS outreach workers and other health-related services. IDUs who tested positive for the purified protein derivative (PPD) of TB sometimes have left hospitals before definitive diagnoses were made, because of a perceived lack of respectful treatment, fear of detention, or lack of adequate methadone therapy to relieve the symptoms of withdrawal from drugs. Current TB diagnosis and treatment systems are, at best, inadequate. The threat of TB-related detention discourages some IDUs from seeking any type of health care. There is an urgent need to educate IDUs about TB and to educate and sensitize health care providers about the lifestyles of IDUs. DOT may help in servicing this difficult-to-serve population, particularly if techniques are incorporated that have been developed for other successful public health interventions for IDUs
MH - Adult
MH - Case Report
MH - Female
MH - HIV Seropositivity
MH - complications
MH - Human
MH - Male
MH - New York
MH - Patient Compliance
MH - Prisons
MH - Professional-Patient Relations
MH - Public Health Administration
MH - methods
MH - Substance Abuse,Intravenous
MH - psychology
MH - Support,U.S.Gov't,P.H.S.
MH - Tuberculosis
MH - prevention & control
RP - NOT IN FILE
NT - UI - 94248282LA - engPT - Journal ArticleID - DA 06723/DA/NIDADA - 19940623IS - 0033-3549SB - AIMSB - IMCY - UNITED STATESJC - QJA
UR - PM:8190855
SO - Public Health Rep 1994 May ;109(3):319-327

75
UI - 75
AU - Des J
AU - Paone D
AU - Friedman SR
AU - Peyser N
AU - Newman RG
TI - Regulating syringe exchange programs: a cautionary note
MH - HIV Infections
MH - prevention & control
MH - Human
MH - Needles
MH - supply & distribution
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - Syringes
RP - NOT IN FILE
NT - UI - 94315712LA - engPT - LetterDA - 19940819IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:8040972
SO - JAMA 1994 Aug 10 ;272(6):431-432

76
UI - 83
AU - Des J
AU - Friedman SR
AU - Sotheran JL
AU - Wenston J
AU - Marmor M
AU - Yancovitz SR
AU - Frank B
AU - Beatrice S
AU - Mildvan D
AD - Beth Israel Medical Center, National Development and Research Institutes Inc, New York, NY 10013
TI - Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992
AB - OBJECTIVES--To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. DESIGN AND SETTING--Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. PARTICIPANTS--Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. INTERVENTIONS--Community-based AIDS prevention programs, including underground syringe exchanges. MAIN OUTCOME MEASURES--Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. RESULTS--The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. CONCLUSIONS--The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission
MH - Adult
MH - Community Health Services
MH - statistics & numerical data
MH - trends
MH - Drug Administration Routes
MH - Female
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - psychology
MH - HIV Seroprevalence
MH - Human
MH - Male
MH - New York City
MH - Risk-Taking
MH - Substance Abuse Treatment Centers
MH - Substance Abuse,Intravenous
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - Urban Health
RP - NOT IN FILE
NT - UI - 94087890LA - engPT - Journal ArticleID - DA03574/DA/NIDAID - DA06001/DA/NIDADA - 19940127IS - 0098-7484SB - AIMSB - IMCY - UNITED STATESJC - KFR
UR - PM:8264066
SO - JAMA 1994 Jan 12 ;271(2):121-127

77
UI - 74
AU - Des J
AU - Padian NS
AU - Winkelstein W
AD - Beth Israel Medical Center, New York, NY 10013
TI - Targeted HIV-prevention programs
AB - An effective program to prevent HIV infection must have both universal and targeted components. The universal component includes reducing HIV- related discrimination, removing commercial restrictions on the materials necessary for safer behavior, and providing information about the risk of HIV. The targeted component involves focusing the limited resources for intensive programs of behavioral change on situations in which the risk of HIV transmission is highest. Such a strategy would follow the dictum "Warn widely and spend wisely."
MH - Communicable Disease Control
MH - methods
MH - HIV Infections
MH - prevention & control
MH - Health Education
MH - Human
MH - Politics
MH - Public Policy
MH - Risk-Taking
MH - United States
RP - NOT IN FILE
NT - UI - 95059237LA - engPT - Journal ArticleDA - 19941128IS - 0028-4793SB - AIMSB - IMCY - UNITED STATESJC - NOW
UR - PM:7969287
SO - N Engl J Med 1994 Nov 24 ;331(21):1451-1453

78
UI - 80
AU - Des J
AU - Choopanya K
AU - Vanichseni S
AU - Plangsringarm K
AU - Sonchai W
AU - Carballo M
AU - Friedmann P
AU - Friedman SR
AD - Beth Israel Medical Center, New York, NY
TI - AIDS risk reduction and reduced HIV seroconversion among injection drug users in Bangkok
AB - Human immunodeficiency virus (HIV) seroconversion was studied in a group of 173 injection drug users in Bangkok, Thailand, who had been previously tested for HIV and were interviewed and retested in the fall of 1989. Ten percent of the group had seroconverted. Two factors protected against HIV seroconversion: having stopped sharing injection equipment in response to the acquired immunodeficiency syndrome (AIDS) and having a regular sexual partner. The association between self- reported deliberate risk reduction and reduced HIV seroconversion among persons continuing to inject illicit drugs indicates that injection drug users can change their behavior in response to AIDS and will accurately report on the behavior change, and that the changes can protect against HIV infection
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - psychology
MH - Female
MH - HIV Seropositivity
MH - Health Education
MH - Human
MH - Logistic Models
MH - Male
MH - Needle Sharing
MH - Risk-Taking
MH - Sex Behavior
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
RP - NOT IN FILE
NT - UI - 94175192LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19940412IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:8129064
SO - Am J Public Health 1994 Mar ;84(3):452-455

79
UI - 78
AU - Des J
AD - Beth Israel Medical Center, New York, NY 10003
TI - The 1993 Okey Memorial Lecture. Cross-national studies of AIDS among injecting drug users
AB - HIV infection among injecting drug users has become a world-wide public health problem. This raises fundamental questions about the modifiability of drug-using behavior and of the influence of different national settings upon the modification of drug use behavior. Data from the World Health Organization Multi-site Study of HIV and Injecting Drug Use and studies of HIV among drug injectors in New York City (the US component of the WHO study) are used to address these questions. There is no clear relationship between HIV seroprevalence and current levels of risk behavior in the WHO cities, and the range in seroprevalence is much greater than the range in current risk behavior. Nonetheless, historical trend data enable us to discern at least two broad patterns in different cities. HIV epidemics appear to have been successfully prevented among IDUs in some cities, in that seroprevalence has remained low and stable over several years. These cities are characterized by community outreach programs and good access to sterile injection equipment. On the other hand, high seroprevalence epidemics have also occurred in many different cities. Stabilization of seroprevalence has eventually also occurred in these cities, but this still includes moderate rates of new HIV infections. How to reverse high-seroprevalence situations remains one of the more difficult questions in HIV epidemiology. The epidemiology of HIV infection among injecting drug users also needs to include analyses of the impacts of decisions by political and public health leaders. A three-category scheme for classifying political decisions is offered: data-free decisions, data-based decisions, and data-proof decisions
MH - Acquired Immunodeficiency Syndrome
MH - complications
MH - epidemiology
MH - prevention & control
MH - Comorbidity
MH - Cross-Cultural Comparison
MH - HIV Seropositivity
MH - Health Promotion
MH - Human
MH - Needle Sharing
MH - Public Health
MH - Risk-Taking
MH - Sex Behavior
MH - Social Problems
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - World Health
MH - World Health Organization
RP - NOT IN FILE
NT - UI - 94297490LA - engPT - Journal ArticlePT - ReviewPT - Review, TutorialID - DA 03574/DA/NIDADA - 19940809IS - 0965-2140SB - IMCY - ENGLANDJC - BM3
UR - PM:8025490
SO - Addiction 1994 Apr ;89(4):383-392

80
UI - 81
AU - Des J
AD - Beth Israel Medical Center, New York, New York
TI - Self-help and science in the treatment of addiction
MH - Alcoholics Anonymous
MH - Alcoholism
MH - psychology
MH - rehabilitation
MH - Follow-Up Studies
MH - Human
MH - Outcome and Process Assessment (Health Care)
MH - Patient Care Team
MH - Recurrence
MH - Self Care
MH - Substance-Related Disorders
MH - Temperance
RP - NOT IN FILE
NT - UI - 94315648LA - engPT - CommentPT - Journal ArticleDA - 19940824IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:8040911
SO - J Subst Abuse Treat 1994 Mar ;11(2):109-110

81
UI - 79
AU - Friedman P
AU - Des J
AU - Peyser NP
AU - Nichols SE
AU - Drew E
AU - Newman RG
AD - Chemical Dependency Institute, Beth Israel Medical Center, New York, New York 10003
TI - Retention of patients who entered methadone maintenance via an interim methadone clinic
AB - Time in treatment is considered an important predictor of good outcomes for drug abuse treatment. Patient retention would be of particular concern for low-service types of treatment. Interim methadone maintenance was developed as an alternative to waiting lists and as a method of providing HIV risk-reduction services to heroin addicts waiting for treatment, and does not include the regular counseling required in comprehensive methadone treatment. This analysis compares the retention of patients first admitted to an interim methadone clinic versus that of patients admitted directly to a comprehensive methadone clinic. The two groups did not differ with regard to demographic characteristics and drug of abuse at the time of admission. The two groups did not differ with respect to demographics. The three-, six-, and 12-month retention rates of patients first admitted to the interim clinic were 78%, 69%, and 62%, respectively. The three-, six-, and 12- month retention rates for patients admitted directly to a traditional methadone clinic were 84%, 76%, and 68%, respectively. Life-table analysis revealed that the two groups did not differ significantly with regard to retention (p = 0.17). Interim treatment does not appear to adversely affect overall retention in treatment. Three- and six-month retention rates of interim clinic patients fall within the range of six- month nationwide retention rates reported by the GAO. Factors associated with discharge from treatment are examined for both groups
MH - Adolescence
MH - Adult
MH - Female
MH - Human
MH - Male
MH - Methadone
MH - therapeutic use
MH - Opioid-Related Disorders
MH - economics
MH - rehabilitation
MH - Patient Admission
MH - Pennsylvania
MH - Substance Abuse Treatment Centers
MH - organization & administration
MH - Time Factors
MH - Waiting Lists
RP - NOT IN FILE
NT - UI - 95017323LA - engRN - 76-99-3 (Methadone)PT - Journal ArticleDA - 19941123IS - 0279-1072SB - IMCY - UNITED STATESJC - JLP
UR - PM:7931866
SO - J Psychoactive Drugs 1994 Apr ;26(2):217-221

82
UI - 82
AU - Friedman SR
AU - Jose B
AU - Neaigus A
AU - Goldstein M
AU - Curtis R
AU - Ildefonso G
AU - Mota P
AU - Des J
AD - National Development and Research Institutes (NDRI), Inc., New York, NY 10013
TI - Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs
AB - OBJECTIVES: To study how condom use in injecting drug users' (IDU) relationships differs according to whether they are HIV-infected, and to whether their sex partner is an IDU. DESIGN AND METHODS: A total of 317 street-recruited IDU were HIV-antibody tested and interviewed about 421 relationships with particular sex partners. RESULTS: Condoms were consistently (100%) used in sex between partners (during the previous 30 days) in 33% of these relationships, and their use was significantly more frequent in relationships of seropositive IDU and in relationships with non-IDU partners. In relationships between seropositive IDU and non-IDU, consistent condom use was reported to be high (68%); this remained unchanged under multivariate controls. CONCLUSIONS: Self- reported condom use by IDU in New York, with its relatively mature epidemic, appears to be concentrated where it may most reduce the spread of HIV to non-IDU heterosexuals, i.e., in relationships between infected IDU and non-IDU partners. Differential condom use by serostatus and by partners' drug injection should be incorporated into mathematical models of the HIV epidemic. Causes of the high level of condom use in this subset of relationships may include drug injector altruism and pressure by sex partners; prevention programs should develop ways to use both of these factors to motivate increased condom use
MH - Adult
MH - Condoms
MH - utilization
MH - Female
MH - HIV Infections
MH - transmission
MH - HIV Seropositivity
MH - complications
MH - epidemiology
MH - psychology
MH - Human
MH - Male
MH - New York City
MH - Questionnaires
MH - Sex Behavior
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 94304557LA - engPT - Journal ArticleID - RO1 DA06723/DA/NIDADA - 19940816IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:8031514
SO - AIDS 1994 Mar ;8(3):357-361

83
UI - 76
AU - Lima ES
AU - Friedman SR
AU - Bastos FI
AU - Telles PR
AU - Friedmann P
AU - Ward TP
AU - Des J
AD - Nucleo de Estudos e Pesquisas em Atencao ao Uso de Drogas (NEPAD), Rio de Janeiro, Brazil
TI - Risk factors for HIV-1 seroprevalence among drug injectors in the cocaine-using environment of Rio de Janeiro
AB - To determine risk factors for HIV-1 among drug injectors in Rio de Janeiro, where cocaine is the dominant drug of injection, subjects were recruited using the criteria and interview instrument of the World Health Organization's Cross-National Study of HIV infection and risk behaviour in injecting drug users. HIV antibody test results were derived both from serum tests and from self-reports of previous tests (documented evidence of self-reported seropositivity was required). The analytical sample consists of 123 subjects, recruited both at drug abuse treatment sites and at street locations. Of 27 subjects with both serological and self-reported antibody status data, 20 reported previous negative tests; of these three had positive sera and may have seroconverted. Seven subjects reporting prior positive serostatus all tested positive. For the 123 subjects, seroprevalence was 34%. Independent significant risk factors in multivariate logistic regression with backwards elimination are: years of injection greater than 5; being a male who has had sex with men in the previous 5 years; and not having taken deliberate steps to protect oneself against AIDS. These findings indicate that homosexual/bisexual male drug injectors may be a bridge group through which HIV is entering drug-injecting networks in Rio de Janeiro. Efforts by drug injectors to reduce their risk of infection seem to have protective effects. This underscores the importance of HIV prevention efforts aimed at drug injectors
MH - Brazil
MH - epidemiology
MH - Cocaine
MH - Comorbidity
MH - HIV Seropositivity
MH - complications
MH - diagnosis
MH - Hiv-1
MH - Human
MH - Male
MH - Risk Factors
MH - Self Assessment (Psychology)
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 94348362LA - engRN - 50-36-2 (Cocaine)PT - Journal ArticleID - RO1 DA03574/DA/NIDADA - 19940923IS - 0965-2140SB - IMCY - ENGLANDJC - BM3
UR - PM:8069170
SO - Addiction 1994 Jun ;89(6):689-698

84
UI - 85
AU - Marmor M
AU - Titus S
AU - Wolfe H
AU - Krasinski K
AU - Maslansky R
AU - Simberkoff M
AU - Beatrice S
AU - Nichols S
AU - Des J
AD - Department of Environmental Medicine, New York University School of Medicine, NY 10010
TI - Preparations for AIDS vaccine trials. Retention, behavior change, and HIV-seroconversion among injecting drug users (IDUs) and sexual partners of IDUs
AB - The likelihood that subjects in human immunodeficiency virus (HIV) vaccine efficacy trials will alter their behavioral risks for HIV infection over time must be considered in evaluating the feasibility of such trials and in estimating the necessary sample sizes to be enrolled. Potential subjects for future vaccine efficacy trials include injecting drug users (IDUs) and others who may be difficult to retain in studies and who may alter HIV-risk-related behaviors substantially over time. We have investigated behavior change, retention, and HIV seroconversion among 577 New York City resident IDUs and sexual partners of IDUs enlisted between July 1 and December 31, 1992. We attempted to see all subjects every 3 months for interviews, blood donation and HIV testing. We were able to retain 68% of subjects in the study through the third scheduled recall at 7.5-10.5 months after enlistment. HIV seroconversion through March 1, 1994, was 1.33/100 person-years at risk. There was a significant inverse relationship between HIV seroconversion and retention at the 9-month recall after adjusting for age, gender, and the amount of locator information provided by subjects at enlistment. Among subjects seen at each of the scheduled visits at 3, 6, and 9 months after enrollment, modest but statistically significant behavior changes that reduced risk were observed in self-reported drug injection frequency, heroin injection frequency, sexual contact with IDUs, and sharing of needles/syringes. The magnitude of these changes in risk, however, was small and may be transient. The behavior changes observed to date do not appear to be large enough to substantially alter calculations of sample sizes needed in future HIV vaccine efficacy trials
MH - AIDS Vaccines
MH - pharmacology
MH - Adolescence
MH - Adult
MH - Aged
MH - Clinical Trials
MH - methods
MH - psychology
MH - Cohort Studies
MH - Female
MH - HIV Seropositivity
MH - complications
MH - epidemiology
MH - Human
MH - Male
MH - Middle Age
MH - New York City
MH - Odds Ratio
MH - Patient Compliance
MH - Patient Selection
MH - Risk-Taking
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Time Factors
RP - NOT IN FILE
NT - UI - 95169483LA - engRN - 0 (AIDS Vaccines)PT - Journal ArticleID - AI25702/AI/NIAIDID - AI29184/AI/NIAIDID - DA06001/DA/NIDAID - etcDA - 19950330IS - 0889-2229SB - IMCY - UNITED STATESJC - ART
UR - PM:7865302
SO - AIDS Res Hum Retroviruses 1994 ;10 Suppl 2():S207-S213

85
UI - 84
AU - Neaigus A
AU - Friedman SR
AU - Curtis R
AU - Des J
AU - Furst RT
AU - Jose B
AU - Mota P
AU - Stepherson B
AU - Sufian M
AU - Ward T
AU - .
AD - National Development and Research Institutes, Inc., New York City 10013
TI - The relevance of drug injectors' social and risk networks for understanding and preventing HIV infection
AB - Focusing on the social environment as well as the individual should both enhance our understanding of HIV transmission and assist in the development of more effective prevention programs. Networks are an important aspect of drug injectors' social environment. We distinguish between (1) risk networks (the people among whom HIV risk behaviors occur) as vectors of disease transmission, and (2) social networks (the people among whom there are social interactions with a mutual orientation to one another) as generators and disseminators of social influence. These concepts are applied to analyses of data from interviews with drug injectors in two studies. In the first study drug injectors' risk networks converge with their social networks: 70% inject or share syringes with a spouse or sex partner, a running partner, or with friends or others whom they know. Qualitative data from interviews with injectors in the second study also show that the social relationships between drug injectors and members of their risk network are often based on long-standing and multiplex relationships, such as those based on kinship, friendship, marital and sexual ties, and economic activity. In the first study the vast majority of injectors, over 90%, have social ties with non-injectors. Injectors with more frequent social contacts with non-injectors engage in lower levels of injecting risk behavior. Risk settings may function as risk networks: injectors in this study who inject at shooting galleries are more likely than those who do not to rent used syringes, borrow used syringes and inject with strangers. Since the adoption of a network approach is relatively new, a number of issues require further attention. These include: how to utilize social networks among drug injectors to reduce risk through peer pressure; how to promote risk reduction by encouraging ties between injectors and non-injectors; and how to integrate biographical and historical change into understanding network processes. Appropriate methodologies to study drug injectors' networks should be developed, including techniques to reach hidden populations, computer software for managing and analyzing network data bases, and statistical methods for drawing inferences from data gathered through dependent sampling designs
MH - Adult
MH - Female
MH - HIV Infections
MH - etiology
MH - prevention & control
MH - psychology
MH - Human
MH - Male
MH - Peer Group
MH - Risk-Taking
MH - Social Environment
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 - 94196423LA - engPT - Journal ArticleID - DA05283/DA/NIDAID - DA06723/DA/NIDADA - 19940504IS - 0277-9536SB - IMCY - ENGLANDJC - UT9
UR - PM:8146717
SO - Soc Sci Med 1994 Jan ;38(1):67-78

86
UI - 93
AU - Des J
AU - Friedman SR
AU - Ward TP
AD - Beth Israel Medical Center, New York, NY 10013
TI - Harm reduction: a public health response to the AIDS epidemic among injecting drug users
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - prevention & control
MH - transmission
MH - Adult
MH - Child
MH - Female
MH - Human
MH - Infant,Newborn
MH - Male
MH - Philosophy,Medical
MH - Preventive Health Services
MH - organization & administration
MH - Program Evaluation
MH - Public Health
MH - Risk Factors
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
MH - supply & distribution
RP - NOT IN FILE
NT - UI - 93312384LA - engPT - Journal ArticlePT - ReviewPT - Review LiteratureID - DA03574/DA/NIDADA - 19930812IS - 0163-7525SB - IMCY - UNITED STATESJC - ABA
UR - PM:8323596
SO - Annu Rev Public Health 1993 ;14():413-450

87
UI - 90
AU - Des J
AU - Friedman SR
AU - Marmor M
AU - Mildvan D
AU - Yancovitz S
AU - Sotheran JL
AU - Wenston J
AU - Beatrice S
AD - Beth Israel Medical Center, New York, New York
TI - CD4 lymphocytopenia among injecting drug users in New York City
AB - Recent cases of "AIDS-like" CD4 lymphocytopenia in the absence of HIV infection have generated considerable scientific and public interest. We studied CD4 cell counts and percentages from 1984 to 1992 among 1,246 HIV-seronegative injecting drug users in New York City, a population at very high risk for exposure to bloodborne pathogens. Severe CD4 lymphocytopenia was rare, and there was no evidence of an increase over time. Of 229 subjects with longitudinal data, only four met the surveillance definition for "idiopathic CD4 lymphocytopenia" (ICL). CD4 cell counts of < 500 cells/microliters were, however, associated with subsequent HIV seroconversion (12.7/100 person-years at risk, relative risk (RR) = 4.53, 95% exact binomial confidence interval (CI) 1.7-10.7, p = 0.002)
MH - Adult
MH - Binomial Distribution
MH - CD4-Positive T-Lymphocytes
MH - Female
MH - Human
MH - Leukocyte Count
MH - Longitudinal Studies
MH - Lymphopenia
MH - epidemiology
MH - etiology
MH - Male
MH - Middle Age
MH - New York City
MH - Substance Abuse,Intravenous
MH - blood
MH - complications
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 93286879LA - engPT - Journal ArticleID - DA03574/DA/NIDAID - DA06001/DA/NIDADA - 19930713IS - 0894-9255SB - IMCY - UNITED STATESJC - JOF
UR - PM:8099613
SO - J Acquir Immune Defic Syndr 1993 Jul ;6(7):820-822

88
UI - 89
AU - Des J
AU - Widdus R
TI - The missing AIDS science
MH - Acquired Immunodeficiency Syndrome
MH - Behavioral Sciences
MH - Human
MH - Risk-Taking
MH - Sex Behavior
MH - Street Drugs
MH - Substance-Related Disorders
RP - NOT IN FILE
NT - UI - 93342497LA - engRN - 0 (Street Drugs)PT - CommentPT - LetterDA - 19930831IS - 0036-8075SB - IMCY - UNITED STATESJC - UJ7
UR - PM:8342031
SO - Science 1993 Aug 6 ;261(5122):665

89
UI - 94
AU - Des J
AU - Friedman SR
AD - Beth Israel Medical Center, New York, N.Y
TI - Critical issues regarding AIDS among injecting drug users
AB - The paper identifies and reviews some critical issues in the field of human immunodeficiency virus (HIV) transmission among intravenous drug users. First, it discusses political denial and compartmentalization of the problem, giving an example from the United States that illustrates the lack of a coherent national strategy. It then reviews the role that stereotypes play in policy-making and points out that behaviour change can be considerable, giving details of successful safer injection programmes. The conditions that foster injection as a mode of ingesting drugs are reviewed, as in the role of drug trans-shipment patterns, particularly as a possible conduit of HIV. Finally, the role of prisons as places for the spread of HIV, and therefore for its prevention, is discussed
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - prevention & control
MH - transmission
MH - Denial (Psychology)
MH - Health Behavior
MH - Health Policy
MH - Human
MH - Politics
MH - Primary Prevention
MH - methods
MH - Prisons
MH - Risk Factors
MH - Stereotyping
MH - Substance Abuse,Intravenous
MH - complications
MH - psychology
MH - United States
RP - NOT IN FILE
NT - UI - 94138317LA - engPT - Journal ArticlePT - ReviewPT - Review LiteratureDA - 19940317IS - 0007-523XSB - IMCY - UNITED STATESJC - BQ7
UR - PM:8305907
SO - Bull Narc 1993 ;45(1):61-75

90
UI - 92
AU - Friedman SR
AU - Des J
AD - National Development and Research Institutes, Inc, New York
TI - Controlling the HIV epidemic among drug injectors
MH - Disease Outbreaks
MH - prevention & control
MH - HIV Infections
MH - transmission
MH - Hiv-1
MH - Human
MH - Spain
MH - Substance Abuse,Intravenous
MH - Urban Population
RP - NOT IN FILE
NT - UI - 93224263LA - engPT - Journal ArticleDA - 19930510IS - 0213-9111SB - IMCY - SPAINJC - GSZ
UR - PM:8468147
SO - Gac Sanit 1993 Jan ;7(34):41-44

91
UI - 88
AU - Friedman SR
AU - Des J
TI - Re: "The harm reduction approach and risk factors for human immunodeficiency virus (HIV) seroconversion in injecting drug users, Amsterdam"
MH - Cohort Studies
MH - HIV Seropositivity
MH - epidemiology
MH - Human
MH - Logistic Models
MH - Methadone
MH - therapeutic use
MH - Needle Sharing
MH - Netherlands
MH - Preventive Health Services
MH - Regression Analysis
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - psychology
MH - Syringes
RP - NOT IN FILE
NT - UI - 94056378LA - engRN - 76-99-3 (Methadone)PT - CommentPT - LetterDA - 19931214IS - 0002-9262SB - IMCY - UNITED STATESJC - 3H3
UR - PM:8292200
SO - Am J Epidemiol 1993 Nov 1 ;138(9):768-771

92
UI - 87
AU - Hagan H
AU - Des J
AU - Purchase D
AU - Friedman SR
AU - Reid T
AU - Bell TA
AD - Tacoma-Pierce County Health Department, Washington
TI - An interview study of participants in the Tacoma, Washington, syringe exchange
AB - Although European and Australian studies of syringe exchange programs have reported safer injection among participants and no increase in drug use, the generalizability of these findings to the US is uncertain. We report on the operations and potential effectiveness of the longest-operating syringe exchange in the US and compare our results to studies of exchange programs outside the US. The sample of 204 study subjects reported no change in the frequency of injection, from 155 to 152 injections per month, and a decline in the frequency of unsafe injections, from 56 to 30 times per month, while participating in the program. In all studies, participants report reduction in unsafe injections, and no increase in illicit drug use. However, the comparison also suggests that a high proportion of Tacoma exchangers have higher initial rates of drug injection, unsafe injection and homelessness, all of which were associated with unsafe injection while using the exchange. These indicate a need for additional services but that the Tacoma program is no less effective than European and Australian programs
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - Adult
MH - Female
MH - Health Promotion
MH - Health Surveys
MH - Human
MH - Male
MH - Questionnaires
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Syringes
MH - utilization
MH - United States
MH - Washington
RP - NOT IN FILE
NT - UI - 94177074LA - engPT - Journal ArticleDA - 19940418IS - 0965-2140SB - IMCY - ENGLANDJC - BM3
UR - PM:8130708
SO - Addiction 1993 Dec ;88(12):1691-1697

93
UI - 86
AU - Jose B
AU - Friedman SR
AU - Neaigus A
AU - Curtis R
AU - Grund JP
AU - Goldstein MF
AU - Ward TP
AU - Des J
AD - National Development and Research Institutes, Inc., New York, New York 10013
TI - Syringe-mediated drug-sharing (backloading): a new risk factor for HIV among injecting drug users
AB - BACKGROUND: In syringe-mediated drug-sharing (backloading), injecting drug users (IDU) use their syringes to mix drugs and to give measured shares to other IDU by squirting drug solution into the syringes of other IDU. Backloading has been discussed as a potential HIV risk factor, but its role as an HIV transmission route has not been established empirically. METHODS: Six hundred and sixty IDU who had injected drugs in the previous 2 years were street-recruited from Bushwick, New York City through chain referral, tested for HIV antibody and interviewed about sexual and drug-risk behaviors. RESULTS: Receiving drugs via backloading in the previous 2 years was reported by 24.5% of the subjects. These subjects had significantly higher HIV seroprevalence than those who did not receive drugs by backloading (odds ratio, 2.2; 95% confidence interval, 1.5-3.1). Backloading remained positively and significantly associated with HIV seropositivity in stepwise logistic regression, and in a series of simultaneous logistic models controlling for sociodemographic variables and for sexual and drug risk variables. CONCLUSIONS: Backloading can be a route of HIV transmission among IDU and should be incorporated into risk-factor studies and HIV transmission modeling. Many IDU who avoid other high-risk drug-injection practices may overlook the risk of backloading. HIV prevention programs should warn IDU against syringe- mediated drug-sharing and work together to develop ways to avoid it
MH - Adult
MH - Confidence Intervals
MH - Female
MH - HIV Infections
MH - epidemiology
MH - transmission
MH - HIV Seropositivity
MH - Human
MH - Male
MH - Needle Sharing
MH - Odds Ratio
MH - Risk Factors
MH - Sex Behavior
MH - Substance Abuse,Intravenous
MH - Support,U.S.Gov't,P.H.S.
MH - Syringes
RP - NOT IN FILE
NT - UI - 94114142LA - engPT - Journal ArticleID - DA06723/DA/NIDADA - 19940223IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:8286076
SO - AIDS 1993 Dec ;7(12):1653-1660

94
UI - 91
AU - Vanichseni S
AU - Des J
AU - Choopanya K
AU - Friedmann P
AU - Wenston J
AU - Sonchai W
AU - Sotheran JL
AU - Raktham S
AU - Carballo M
AU - Friedman SR
AD - Bangkok Metropolitan Administration, Thailand
TI - Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States
AB - OBJECTIVE: To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities. DESIGN AND METHODS: Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990- 1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer. RESULTS: A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities. CONCLUSIONS: Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV
MH - Adult
MH - Communication
MH - Comorbidity
MH - Comparative Study
MH - Condoms
MH - utilization
MH - Dangerous Behavior
MH - Ethnic Groups
MH - Female
MH - HIV Infections
MH - epidemiology
MH - prevention & control
MH - psychology
MH - Human
MH - Interpersonal Relations
MH - Logistic Models
MH - Male
MH - Multivariate Analysis
MH - New York City
MH - Risk Factors
MH - Sex Behavior
MH - statistics & numerical data
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - Support,Non-U.S.Gov't
MH - Support,U.S.Gov't,P.H.S.
MH - Thailand
RP - NOT IN FILE
NT - UI - 93371720LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19931004IS - 0269-9370SB - IMCY - UNITED STATESJC - AID
UR - PM:8363764
SO - AIDS 1993 Jun ;7(6):887-891

95
UI - 95
AU - Wodak A
AU - Des J
AD - Alcohol and Drug Service, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
TI - Strategies for the prevention of HIV infection among and from injecting drug users
AB - Despite a substantial reduction in the level of high-risk behaviours among injecting drug users (IDUs) documented in an impressive number of studies from many countries, human immunodeficiency virus (HIV) infection continues to spread among and from this population, reflecting the high baseline levels of these risk behaviours before the epidemic. In many countries, the control of HIV spread among IDUs is critical to efforts to control the epidemic in the population as a whole. Although the evaluation of individual or multiple strategies is problematic, there is accumulating evidence and increasing confidence that the course of the epidemic can be altered by implementing some or all of a range of strategies. Authorities mindful of their public health responsibilities should estimate the risk of spread of HIV among and from IDU populations in their jurisdiction and plan their response accordingly by selecting prevention measures that are appropriate for local conditions and by vigilantly monitoring developments
MH - AIDS Serodiagnosis
MH - Condoms
MH - utilization
MH - Disinfection
MH - HIV Infections
MH - diagnosis
MH - etiology
MH - prevention & control
MH - transmission
MH - Health Behavior
MH - Human
MH - Needle Sharing
MH - Needles
MH - Patient Education
MH - Primary Prevention
MH - methods
MH - Prisons
MH - Research
MH - Risk-Taking
MH - Substance Abuse,Intravenous
MH - complications
RP - NOT IN FILE
NT - UI - 94138316LA - engPT - Journal ArticlePT - ReviewPT - Review LiteratureDA - 19940317IS - 0007-523XSB - IMCY - UNITED STATESJC - BQ7
UR - PM:8305906
SO - Bull Narc 1993 ;45(1):47-60

96
UI - 98
AU - Abdul-Quader AS
AU - Des J
AU - Tross S
AU - McCoy E
AU - Morales G
AU - Velez I
AD - Narcotic and Drug Research, Inc., New York, NY 10013
TI - Outreach to injecting drug users and female sexual partners of drug users on the lower east side of New York City
AB - In 1984, outreach to injecting drug users and their female sexual partners was initiated as part of HIV behavioral research projects. HIV, health, drug treatment and family planning information and services were provided in addition to recruiting subjects to the research program. Such outreach also poses certain problems--especially potential disruption of neighborhood day-to-day life and clashes with police. This paper discusses an outreach program to injecting drug users and their female sexual partners that was initiated in New York City to provide HIV-related information and services. We examine the successes of the program and problems that were involved in conducting outreach to persons who are typically not accessible through formal institutional channels
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - prevention & control
MH - Behavior Therapy
MH - Cocaine
MH - Communication
MH - Community Health Services
MH - organization & administration
MH - Ethnic Groups
MH - Female
MH - Health Education
MH - Human
MH - Interpersonal Relations
MH - Male
MH - New York City
MH - Sex Behavior
MH - Sexual Partners
MH - Substance Abuse,Intravenous
MH - rehabilitation
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
MH - United States
MH - Verbal Behavior
RP - NOT IN FILE
NT - UI - 92274068LA - engRN - 50-36-2 (Cocaine)PT - Journal ArticleID - U62/CCU201085/PHSDA - 19920626IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1591518
SO - Br J Addict 1992 May ;87(5):681-688

97
UI - 107
AU - Des J
AU - Wenston J
AU - Friedman SR
AU - Sotheran JL
AU - Maslansky R
AU - Marmor M
AD - Beth Israel Medical Center, New York, New York 10013
TI - Crack cocaine use in a cohort of methadone maintenance patients
AB - We examined crack use in a cohort of methadone patients originally enrolled in 1984-86. Crack use questions were added to the study in 1987. Of the 494 methadone patients originally enrolled, 228 subjects remained in methadone and were re-interviewed in 1987-88, and 234 remained in methadone and were re-interviewed in 1988-89. Approximately one-quarter of the subjects were using crack at each of the 1987-88 and 1988-89 data collection points, and only 3% of the subjects were using crack at daily or greater frequencies at each of the 1987-88 and 1988- 89 interviews. Concurrent crack use was associated with (a) the number of noninjected drugs being used; (b) the number of IV drug-using sexual partners; (c) drug injection; and (d) the use of nonheroin opiates. Persistent crack use, defined as use in both 1987-88 and 1988-89, was associated with previous noninjected drug use and previous suicide attempts. While the potential problem of crack use among methadone patients should not be minimized, it appears that, compared to illicit drug injectors not in treatment, being in methadone maintenance may offer a protective effect against crack use
MH - Adult
MH - Cohort Studies
MH - Comorbidity
MH - Crack Cocaine
MH - Female
MH - Follow-Up Studies
MH - HIV Infections
MH - prevention & control
MH - transmission
MH - Human
MH - Longitudinal Studies
MH - Male
MH - Methadone
MH - therapeutic use
MH - Needle Sharing
MH - adverse effects
MH - statistics & numerical data
MH - New York City
MH - epidemiology
MH - Opioid-Related Disorders
MH - complications
MH - rehabilitation
MH - Risk Factors
MH - Sex Behavior
MH - Substance Abuse Detection
MH - Substance Abuse,Intravenous
MH - Substance-Related Disorders
MH - Support,U.S.Gov't,P.H.S.
RP - NOT IN FILE
NT - UI - 93124523LA - engRN - 0 (Crack Cocaine)RN - 76-99-3 (Methadone)PT - Journal ArticleID - DA03574/DA/NIDADA - 19930211IS - 0740-5472SB - IMCY - UNITED STATESJC - KAI
UR - PM:1479629
SO - J Subst Abuse Treat 1992 ;9(4):319-325

98
UI - 96
AU - Des J
AU - Wenston J
AU - Friedman SR
AU - Sotheran JL
AU - Maslansky R
AU - Marmor M
AU - Yancovitz S
AU - Beatrice S
AD - Beth Israel Medical Center, National Development and Research Institutes, Inc., New York City, NY 10013
TI - Implications of the revised surveillance definition: AIDS among New York City drug users
AB - The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase in the number of persons recognized as living with AIDS. Among 440 HIV-seropositive research subjects recruited from drug treatment programs and through street outreach in New York City, 59 met this definition, yet only 25% of those had been reported to the New York City AIDS registry. The new definition, if combined with HIV and T-cell testing at drug treatment and street outreach programs, could thus yield very large increases in the number of injecting drug users meeting the new surveillance definition of AIDS
MH - Acquired Immunodeficiency Syndrome
MH - epidemiology
MH - etiology
MH - CD4-Positive T-Lymphocytes
MH - Centers for Disease Control and Prevention (U.S.)
MH - Female
MH - HIV Seropositivity
MH - immunology
MH - HIV Seroprevalence
MH - Human
MH - Leukocyte Count
MH - Male
MH - New York City
MH - Population Surveillance
MH - Prevalence
MH - Substance Abuse,Intravenous
MH - complications
MH - Support,U.S.Gov't,P.H.S.
MH - United States
RP - NOT IN FILE
NT - UI - 93072565LA - engPT - Journal ArticleID - DA03574/DA/NIDADA - 19921211IS - 0090-0036SB - AIMSB - IMCY - UNITED STATESJC - 3XW
UR - PM:1359800
SO - Am J Public Health 1992 Nov ;82(11):1531-1533

99
UI - 99
AU - Des J
AU - Casriel C
AU - Friedman SR
AU - Rosenblum A
AD - Beth Israel Medical Center, Chemical Dependency Institute, New York, New York 10003
TI - AIDS and the transition to illicit drug injection--results of a randomized trial prevention program
AB - Illicit drug injection is a major component of the AIDS epidemic in the United States, Europe and some developing countries. Prevention of illicit drug injection would not only reduce HIV transmission but would also reduce the other health, psychological and social problems associated with illicit drug injection. One hundred and four subjects who were using heroin intranasally ('sniffing') were recruited for a study of the transition to drug injection. Eligibility criteria included sniffing as the most frequent route of administration and no more than 60 injections in the past 2 years. All subjects received thorough basic information about AIDS, including HIV antibody test counseling. Subjects were then randomly assigned to a four-session social learning based AIDS/drug injection prevention program or a control condition. Eighty-three subjects were successfully followed at a mean time of 8.9 months. Twenty (24%) of the followed subjects reported injecting illicit drugs during the follow-up period. Drug injection during follow-up was associated with being in the control group, intensity of non-injected drug use, prior injection, and having close personal relationships with current intravenous (IV) drug users
MH - Acquired Immunodeficiency Syndrome
MH - prevention & control
MH - transmission
MH - Administration,Intranasal
MH - Adolescence
MH - Adult
MH - Female
MH - Follow-Up Studies
MH - HIV Seroprevalence
MH - trends
MH - Heroin Dependence
MH - complications
MH - rehabilitation
MH - Human
MH - Male
MH - Middle Age
MH - New York City
MH - Risk Factors
MH - Street Drugs
MH - Substance Abuse,Intravenous
RP - NOT IN FILE
NT - UI - 92216643LA - engRN - 0 (Street Drugs)PT - Clinical TrialPT - Journal ArticlePT - Randomized Controlled TrialDA - 19920514IS - 0952-0481SB - IMCY - ENGLANDJC - BJD
UR - PM:1559048
SO - Br J Addict 1992 Mar ;87(3):493-498