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 ind |