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Biomedical subjects

Samuel R Friedman

Publications and source records attributed to Samuel R Friedman.

At least 37 records · Page 2Linked to original sources
PubMed2004

Correlates of attempted suicide among young injection drug users in a multi-site cohort.

The purpose of this study was to determine the prevalence and correlates of attempted suicide among young injection drug users (IDUs) from six study sites in five US cities. Two thousand two hundred and nineteen participants 15-30 years of age underwent interviewer-administered questionnaires relating to self-reported drug use, sociodemographics, suicidal ideation and attempts, and exposure to violence. The 6-month prevalence of suicidal ideation and attempts was 35.8% (n = 795) and 7% (n = 156), respectively. Compared to those not reporting a recent (past 6 months) suicide attempt, those attempting suicide were more likely to have a lifetime history of mental health facility admission or sexual abuse. Participants receiving drug treatment at the time of the baseline interview (53.2% versus 37.1%, odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.39, 2.67) were also more likely to report a recent attempt; as were those reporting a history of experiencing violence. These associations persisted after adjusting for age, sex, race/ethnicity, study site, and other significant covariates by multiple logistic regression. These data suggest that increased access to drug treatment, community mental health, and violence prevention programs may decrease suicidal behavior among young injection drug users.

Adult↗
PubMed2004

"Informed altruism" and "partner restriction" in the reduction of HIV infection in injecting drug users entering detoxification treatment in New York City, 1990-2001.

OBJECTIVE: To assess recent developments in the HIV epidemic in injecting drug users (IDUs) in New York City. With >50,000 cases of AIDS in IDUs, New York has experienced the largest HIV/AIDS epidemic in IDUs of any city in the world. METHODS: Serial cross-sectional surveys conducted continuously from 1990 to 2001 of IDUs entering the Beth Israel Medical Center (BIMC) drug detoxification program in New York City. HIV serostatus, use of prevention services, and risk behaviors were measured. Individuals were permitted to participate multiple times in the surveys but not more than once in any year. RESULTS: Two thousand eight hundred eighty-seven individuals contributed 3100 observations from 1990 to 2001. There was a substantial and consistent decline in the prevalence of HIV infection among IDUs entering the BIMC detoxification program, from 54% (165/304) in 1991 to 13% (39/303) in 2001 (P < 0.0001). The decline was highly linear, with r2 = 0.92 and a slope of -3.7% in seroprevalence per year. The decline occurred for both males and females, both short and long-term IDUs, and the three largest racial/ethnic subgroups (all P < 0.001 by Cochran-Armitage testing). Use of HIV prevention services increased substantially, particularly syringe exchange and voluntary HIV counseling and testing. General reductions in injection risk behaviors occurred, but substantial numbers of IDUs continued to engage in both receptive and distributive syringe sharing. Two conditional types of risk reduction not currently recommended by health authorities were reported: "informed altruism," in which persons who knew that they were HIV seropositive reduced transmission behavior, and "partner restriction," in which persons who shared needles and syringes primarily confined this sharing within small social networks. CONCLUSIONS: HIV infection continues to decline in this population of IDUs in New York City, suggesting the possibility of bringing very high prevalence epidemics under control. Risk elimination may not be required; rather, multiple forms of risk reduction may be effective in reducing HIV transmission within a local population of IDUs.

Adult↗
PubMed2004

Estimating numbers of injecting drug users in metropolitan areas for structural analyses of community vulnerability and for assessing relative degrees of service provision for injecting drug users.

This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area. We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity and limitations were assessed. Prevalence of drug injectors per 10,000 population varied from 19 to 173 (median 60; interquartile range 42-87). Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services.

Counseling↗
PubMed2004

An HIV prevalence-based model for estimating urban risk populations of injection drug users and men who have sex with men.

Issues of cost and complexity have limited the study of the population sizes of men who have sex with men (MSM) and injection drug users (IDUs), two groups at clearly increased risk for human immunodeficiency virus (HIV) and other acute and chronic diseases. We developed a prototypical, easily applied estimation model for these populations and applied it to Miami, Florida. This model combined HIV prevalence estimates, HIV seroprevalence rates, and census data to make plausible estimates of the number and proportion of MSM and IDUs under a number of assumptions. Sensitivity analyses were conducted to test the robustness of the model. The model suggests that approximately 9.5% (plausible range 7.7%-11.3%) of Miami males aged 18 years or older are MSM (point estimate, N = 76,500), and 1.4% (plausible range 0.9%-1.9%) of the total population aged 18 years or older are IDUs (point estimate, N = 23,700). Males may be about 2.5 times more likely than females to be IDUs. The estimates were reasonably robust to biases. The model was used to develop MSM and IDU population estimates in selected urban areas across Florida and should be replicable in other medium-to-large urban areas. Such estimates could be useful for behavioral surveillance and resource allocation, including enhanced targeting of community-based interventions for primary and secondary HIV prevention.

Adult↗
PubMed2004

Audio-computerized self-interviewing versus face-to-face interviewing for research data collection at drug abuse treatment programs.

AIMS: To assess audio computer-assisted self-interviewing (A-CASI) as a mode of data collection with injecting drug users (IDUs) entering two drug treatment programs in New York City. A-CASI has been found to increase reporting of sensitive items among a variety of population subgroups. DESIGN: A field test of A-CASI data collection conducted within an ongoing cross-sectional study of drug use and HIV risk behaviors among IDUs entering drug treatment. Participants were assigned without bias to either a computer-assisted interviewer-administered personal interview (CAPI) or to a mixed CAPI/A-CASI interview. In the latter, 'sensitive' portions (dealing with stigmatized behavior) of the questionnaire were self-administered through A-CASI, while the remaining portions were interviewer-administered. SETTING: The Detoxification Program and the Methadone Maintenance Treatment Program (MMTP) at Beth Israel Medical Center in New York City. PARTICIPANTS: Seven hundred and eighty-three IDUs entering drug treatment. MEASUREMENTS: Odds ratios and adjusted odds ratios (controlling for demographic differences) for comparison of A-CASI versus CAPI responses on 111 sensitive questions. FINDINGS: Twenty-three statistically significant differences (each at P < 0.05), all in the direction of more reporting of the behaviors by the A-CASI group. Forty-one per cent of A-CASI participants said they would prefer any subsequent interviews to be fully A-CASI and 46% said they would prefer the mixed CAPI/A-CASI mode. CONCLUSIONS: A-CASI was associated with greater reporting of potentially stigmatized drug, sex and HIV risk behaviors on a moderate number of questions. Moreover, a large majority of participants who used A-CASI would like to be assigned to this method of data collection in future interviews.

Adult↗
PubMed2004

Urging others to be healthy: "intravention" by injection drug users as a community prevention goal.

"Intravention," prevention activities that are conducted by and sustained through ongoing actions of members of communities-at-risk, is an appropriate goal for HIV intervention activities. Data from 120 injection drug users in a Brooklyn, New York, neighborhood that has seen decreases in HIV prevalence among IDUs and little HIV diffusion to young adults indicate that most of them have recently (3 months) urged other people to engage in one or more self-protective actions. These data suggest that the common image of IDUs as simply being sources of social and medical problems is inaccurate. Research is needed into how to create and diffuse "communities of intravention; " and we suggest that behavioral interventions be evaluated for their success or failure at creating outward-focused health communication by participants as well as for their impact on individual risk behaviors.

Adolescent↗
PubMed2003

Variability in the incidence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among young injecting drug users in New York City.

Cohort studies of young (aged 18-30 years) injecting drug users recruited in 1997-1999 in the Harlem and Lower East Side areas of New York City, New York, were used to assess the incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The authors found that HIV incidence was low at both sites: 0.8/100 person-years at the Harlem site and 0/100 person-years at the Lower East Side site. In contrast, HBV incidence was moderate (12.2/100 person-years) at the Harlem site and high (30.7/100 person-years) at the Lower East Side site. Similarly, HCV incidence was moderate (9.3/100 person-years) at the Harlem site and high (34.0/100 person-years) at the Lower East Side site. Results show that high rates of HBV and HCV transmission do not imply high rates of HIV transmission, even within an area of high HIV seroprevalence.

Adolescent↗
PubMed2003

Drug use patterns and infection with sexually transmissible agents among young adults in a high-risk neighbourhood in New York City.

AIMS: To determine relationships between drug use "hardness" (defined in increasing order of hardness as no drug use, marijuana use, non-injected heroin or cocaine use, crack smoking and injection drug use) and prevalences of several sexually transmissible infections among young adults in a high-risk neighbourhood. Drug users, particularly injection drug users and crack smokers, may be a core group for some sexually transmitted infections. DESIGN: Cross-sectional survey and assays of young adults from (a) a household probability sample and (b) a targeted sample of youth who have used injected drugs, crack, other cocaine or heroin. SETTING: Bushwick, an impoverished New York City minority neighbourhood with major drug markets. PARTICIPANTS: A total of 363 18-24-year-olds from a household probability sample; 165 Bushwick 18-24-year-olds who have used injected drugs, crack, other cocaine or heroin. MEASUREMENTS: Drug use by self-report; serum- and urine-based assays for HIV, hepatitis B and C, syphilis, gonorrhoea, chlamydia and herpes simplex (type 2). FINDINGS: Household-sample prevalences: HIV, hepatitis C and syphilis, 1%; gonorrhoea 3%; chlamydia 5%; past or present hepatitis B infection 8%; herpes simplex (type 2) 18%. In combined household and targeted samples, hepatitis C and HIV were concentrated among drug injectors. Herpes simplex (type 2), syphilis and hepatitis B increased among women with "hardest drug ever used". CONCLUSIONS: Using "harder" drugs is associated with some but not all of these infections. Prevention efforts should help youth avoid unsafe sex and higher-risk drugs.

Adolescent↗
PubMed2002

Risk correlates of prevalent HIV, hepatitis B virus, and hepatitis C virus infections among noninjecting heroin users.

OBJECTIVE: To examine lifetime correlates of HIV and hepatitis B and C (HBV and HCV) infections among noninjecting heroin users (NIUs). METHODS: Between March 1996 and March 2001, 483 eligible NIUs were tested for HIV, HBV, and HCV antibodies and administered structured interviews. Multivariate logistic regression analyses were stratified by injecting history. RESULTS: Among never-injectors (69.8%), significant (p <.05) correlates were unprotected sex with men who have sex with men (HIV and HBV), unprotected sex with NIUs (HIV), self-reported syphilis infection (HBV), longer duration of heroin use (HBV and HCV), shorter duration of cocaine use (HIV), blood transfusion before 1986 (HIV), and having been tattooed (HCV). Among former injectors (30.2%), significant correlates were receptive syringe sharing (HIV and HBV), frequent lifetime injection (HCV), longer duration of sexual activity (HBV), and having been tattooed (HCV). CONCLUSION: Never-injectors infected with HIV and HBV appear to have become infected mainly through sexual transmission, whereas former injectors appear to have become infected with HIV and HCV mainly though injecting risk and with HBV through both injecting and sexual risk. Interventions targeted at NIUs should prevent unsafe sex as well as the initiation or resumption of injecting. In addition, unhygienic tattooing, which may lead to HCV exposure, should be a focus of prevention efforts.

Adult↗
PubMed2002

Risk networks and racial/ethnic differences in the prevalence of HIV infection among injection drug users.

Studies among injection drug users (IDUs) find a higher prevalence of HIV infection among black and Puerto Rican IDUs than among white IDUs. Risk behaviors seldom explain these differences. We examine how risk networks contribute to racial/ethnic variations in HIV prevalence. Six hundred sixty-two IDUs were recruited on the street in Bushwick (New York City), interviewed, and tested for HIV. Risk behaviors and networks were analyzed to explain racial/ethnic variations in HIV. Forty percent of IDUs were infected with HIV. HIV prevalence was greater for Puerto Ricans (45%) and blacks (44%) than for whites (32%). Egocentric sexual and drug risk networks were predominantly racially/ethnically homogeneous. After multivariate adjustments for risk behaviors and risk networks, black-white differences in HIV prevalence were no longer significant. Although differences between Puerto Ricans and whites persisted, post hoc analyses suggested that network partner characteristics might explain these differences. In Bushwick, racially/ethnically discordant risk partnerships involving black IDUs may function as potential bridges of transmission between groups.

Adult↗
PubMed2002

Trends in the AIDS epidemic among New York City's injection drug users: localized or citywide?

The New York City injection drug user acquired immunodeficiency syndrome (IDU AIDS) epidemic accounts for almost one quarter of AIDS cases in IDUs in the United States. Recent studies have reported declines in seroprevalence and risk behaviors among IDUs in New York City during the 1990s. These trends, however, are based on studies primarily conducted in the city's central borough of Manhattan. This article analyzes data from all five boroughs of New York City to examine trends over phases of the epidemic and to determine the level of prevention services available; an exploratory qualitative study was also conducted to assess access to prevention services and injection practices in areas in the "outer boroughs." Findings indicated that (1) borough differences in services and behaviors existed from early in the epidemic; (2) services have been concentrated in Manhattan; and (3) declines in seroprevalence were greatest among Manhattan-recruited IDUs. Enhancing access to services for IDUs in the boroughs outside Manhattan may be needed to continue the positive trends in all areas of New York City.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990-1999.

OBJECTIVES: This study examined HIV prevalence and risk behaviors among male injection drug users (IDUs) who have sex with men and among other male IDUs. METHODS: Male IDUs were interviewed and tested for HIV at a detoxification clinic during 1990 to 1994 and 1995 to 1999. Analyses compared male IDUs who do and do not have sex with men within and between periods. RESULTS: Initially, HIV seroprevalence and risk behaviors were higher among IDUs who have sex with men. Seroprevalence (initially 60.5% vs 48.3%) declined approximately 15% in both groups, remaining higher among those who have sex with men. Generally, injection prevalence, but not sexual risk behaviors, declined. CONCLUSIONS: Male IDUs who have sex with men are more likely to engage in higher-risk behaviors and to be HIV infected. Improved intervention approaches for male IDUs who have sex with men are needed.

Adolescent↗
PubMed1990

Target groups for preventing AIDS among intravenous drug users: 2. The "hard" data studies.

Studies were reviewed with respect to three different target groups for preventing AIDS among intravenous (IV) drug users by (a) providing drug abuse treatment for those who want to stop injecting drugs, (b) providing "safer" injection for those who are likely to continue injecting, and (c) preventing drug injection among those who are at high risk for beginning to inject. The studies reviewed were limited to those that include "hard" data: validated self-reports, seroprevalence outcomes, or self-reports of behavior that is the opposed to any of the demand characteristics generated by the research setting. For two groups of current IV drug users--those entering drug treatment and those continuing to inject--these hard data studies show rapidly induced AIDS risk reduction but suggest a need for large-scale change maintained over long time periods. In terms of preventing initial injection, alternative forms of intense drug use have emerged but have not supplanted drug injection, and basic knowledge of AIDS does not appear to deter initial drug injection.

Acquired Immunodeficiency Syndrome↗