Current
Community Vulnerability and Responses to Drug-User-Related HIV/AIDS (CVAR)
Funding Source: National Institute on Drug Abuse
Funding Period: 2000-2014
Principal Investigator: Samuel R. Friedman, Ph.D.
CDUHR Co-Investigator(s): Barbara Tempalski, Ph.D., M.P.H.
Project Director: Enrique Pouget, Ph.D.
Other Project Staff: Sudip Chatterjee, Ph.D. (Principal Research Associate)
This is a competing continuation study of why large US metropolitan areas vary over time in their vulnerability to HIV/AIDS among drug users and in their responses, i.e., in policies and programs that may affect the epidemic. Drug use and HIV epidemics change over time. In the last funding period, the study showed that HIV prevalence in the 96 largest U.S. metropolitan areas declined among injection drug users (IDUs) from 1992 to 2002, and that the population prevalence of IDUs declined in these areas from 1992 to 2000, but then began to rise again. It also showed that metropolitan areas varied in these trajectories, and that a variety of social and policy forces shaped IDU prevalence, racial disparities in IDU prevalence, HIV prevalence among IDUs, racial disparities in AIDS prevalence among IDUs, drug abuse treatment coverage, and syringe exchange access and coverage. Ominously, our recent analyses indicate that the prevalence of IDUs among youth (aged 15-29) has begun to rise. Further, as others have shown, HIV has spread widely among NIDUs (non-injecting users of heroin, cocaine, crack, amphetamines or methamphetamine) in some metropolitan areas. These changes are occurring against the backdrop of an economy that has recently shifted from slow to rapid decline, a shift that will lead to great difficulty in maintaining, let alone expanding, services for drug users.
The specific aims of this continuation are: 1. To describe trends, in the 96 largest US metropolitan areas from 1992-2012, in (a) critical epidemiologic outcomes (population prevalence of IDUs and NIDUs, and particularly their prevalence among youth; and, among IDUs, HIV prevalence, late-diagnosis HIV cases, and AIDS incidence and mortality) as well as in (b) the implementation of evidence-based drug- related interventions (drug abuse treatment, syringe exchange, HIV counseling and testing) and (c) non- evidence-based drug-related interventions (incarceration and arrests of drug users). 2. To understand how macro-social contexts (e.g., economic changes, social integration, racial residential segregation) and epidemiologic need affect interventions; how interventions and macro-social contexts together affect epidemiologic contexts; how some interventions (e.g., arrests, incarceration) affect others (e.g., syringe exchange coverage); and how some epidemiologic outcomes (e.g., prevalence of young IDUs) affect others (e.g., HIV prevalence). 3. To develop an integrated theory, using agent based modeling, of how these processes interact and thus what the impacts of various intervention mixes are likely to be in given social contexts. 4. To disseminate estimates, results and theoretical understandings to public health agencies and continue to advise them on how they might respond.
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Roberts, E. T., Friedman, S. R., Brady, J. E., Pouget, E. R., Tempalski, B., & Galea, S. (2010). Environmental conditions, political economy, and rates of injection drug use in large US metropolitan areas 1992-2002. Drug and Alcohol Dependence, 106 (2-3), 142-153.
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Cooper, H. L., Bossak, B., Tempalski, B., Des Jarlais, D. C., & Friedman, S. R. (2009). Geographic approaches to quantifying the risk environment: Drug-related law enforcement and access to syringe exchange programmes. International Journal of Drug Policy, 20 (3), 217-226.
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Friedman, S. R., Cooper, H. L., & Osborne, A. H. (2009). Structural and social contexts of HIV risk among African Americans. American Journal of Public Health, 99 (6), 1002-1008.
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Friedman, S. R., Rossi, D., & Braine, N. (2009). Theorizing "Big Events" as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks. International Journal of Drug Policy, 20 (3), 283-291.
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Friedman, S. R., Rossi, D., & Phaswana-Mafuya, N. (2009). Globalization and interacting large-scale processes and how they may affect the HIV/AIDS epidemic. In C. Pope, R. T. White, & R. Malow (Eds.), HIV/AIDS: Global frontiers in prevention/intervention (491-499). New York: Routledge.
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Tempalski, B., & McQuie, H. (2009). Drugscapes and the role of place and space in injection drug use-related HIV risk environments. International Journal of Drug Policy, 20 (1), 4-13.
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Tempalski, B., Lieb, S., Cleland, C. M., Cooper, H., Brady, J. E., & Friedman, S. R. (2009). HIV prevalence rates among injection drug users in 96 large US metropolitan areas, 1992-2002. Journal of Urban Health, 86 (1), 132-154.
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Brady, J. E., Friedman, S. R., Cooper, H. L., Flom, P. L., Tempalski, B., & Gostnell, K. (2008). Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from 1992 to 2002. Journal of Urban Health, 85 (3), 323-351.
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Cooper, H. L. F., Friedman, S. R., Tempalski, B., & Friedman, R. (2008). Residential segregation and the prevalence of injection drug use among Black adult residents of US metropolitan areas. In Y. F. Thomas, D. Richardson, & I. Cheung (Eds.), Geography and drug addiction (145-157). New York: Springer.
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Cooper, H. L., Brady, J. E., Friedman, S. R., Tempalski, B., Gostnell, K., & Flom, P. L. (2008). Estimating the prevalence of injection drug use among Black and White adults in large U.S. metropolitan areas over time (1992-2002): Estimation methods and prevalence trends. Journal of Urban Health, 85 (6), 826-857.
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Friedman, S. R., Tempalski, B., Cooper, H., Lieb, S., Brady, J., Flom, P. L., Friedman, R., Gostnell, K., & Des Jarlais, D. C. (2008). Metropolitan area characteristics, injection drug use and HIV among injectors. In Y. F. Thomas, D. Richardson, & I. Cheung (Eds.), Geography and drug addiction (255-265). New York: Springer.
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Tempalski, B. (2008). Placing the dynamics of syringe exchange programs in the United States. In Y. F. Thomas, D. Richardson, & I. Cheung (Eds.), Geography and drug addiction (319-335). New York: Springer.
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Tempalski, B., Cooper, H. L., Friedman, S. R., Des Jarlais, D. C., Brady, J., & Gostnell, K. (2008). Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug. International Journal of Drug Policy, 19 (Supplement 1), S47-S58.
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Cooper, H. L., Brady, J. E., Ciccarone, D., Tempalski, B., Gostnell, K., & Friedman, S. R. (2007). Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clinical Infectious Diseases, 45 (9), 1200-1203.
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Cooper, H. L., Friedman, S. R., Tempalski, B., & Friedman, R. (2007). Residential segregation and injection drug use prevalence among Black adults in US metropolitan areas. American Journal of Public Health, 97 (2), 344-352.
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Friedman, S. R., Tempalski, B., Brady, J. E., Friedman, J. J., Cooper, H. L., Flom, P. L., McGrath, M. M., Gostnell, K., & Des Jarlais, D. C. (2007). Predictors of the degree of drug treatment coverage for injection drug users in 94 metropolitan areas in the United States of America. International Journal of Drug Policy, 18 (6), 475-485.
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Tempalski, B. (2007). Placing the dynamics of syringe exchange programs in the United States. Health and Place, 13 (2), 417-431.
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Tempalski, B., Flom, P. L., Friedman, S. R., Des Jarlais, D. C., Friedman, J. J., McKnight, C., & Friedman, R. (2007). Social and political factors predicting the presence of syringe exchange programs in 96 US metropolitan areas. American Journal of Public Health, 97 (3), 437-447.
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Tempalski, B., Friedman, R., Keem, M., Cooper, H., & Friedman, S. R. (2007). NIMBY localism and national inequitable exclusion alliances: The case of syringe exchange programs in the United States. Geoforum, 38 (6), 1250-1263.
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Aceijas, C., Friedman, S. R., Cooper, H. L., Wiessing, L., Stimson, G. V., & Hickman, M. (2006). Estimates of injecting drug users at the national and local level in developing and transitional countries, and gender and age distribution. Sexually Transmitted Infections, 82 (Supplement 3), iii10-iii17.
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Blankenship, K. M., Friedman, S. R., Dworkin, S., & Mantell, J. E. (2006). Structural interventions: Concepts, challenges and opportunities for research. Journal of Urban Health, 83 (1), 59-72.
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Friedman, S. R., & Touze, G. (2006). Policy bereft of research or theory: A failure of harm reduction science. International Journal of Drug Policy, 17 (2), 133-135.
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Friedman, S. R., Cooper, H. L., Tempalski, B., Keem, M., Friedman, R., Flom, P. L., & Des Jarlais, D. C. (2006). Relationships of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas. AIDS, 20 (1), 93-99.
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Friedman, S. R., Kippax, S. C., Phaswana-Mafuya, N., Rossi, D., & Newman, C. E. (2006). Emerging future issues in HIV/AIDS social research. AIDS, 20 (7), 959-965.
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Cooper, H., Friedman, S. R., Tempalski, B., Friedman, R., & Keem, M. (2005). Racial/ethnic disparities in injection drug use in large US metropolitan areas. Annals of Epidemiology, 15 (5), 326-334.
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Friedman, S. R., Lieb, S., Tempalski, B., Cooper, H., Keem, M., Friedman, R., & Flom, P. L. (2005). HIV among injection drug users in large US metropolitan areas, 1998. Journal of Urban Health, 82 (3), 434-445.
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Rhodes, T., Singer, M., Bourgois, P., Friedman, S. R., & Strathdee, S. A. (2005). The social structural production of HIV risk among injecting drug users. Social Science and Medicine, 61 (5), 1026-1044.
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Friedman, S. R., Tempalski, B., Cooper, H., Perlis, T., Keem, M., Friedman, R., & Flom, P. L. (2004). 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. Journal of Urban Health, 81 (3), 377-400.
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Friedman, S. R., & Knight, K. (2003). What is the role of structural interventions in HIV prevention?. University of California, San Francisco, Center for AIDS Prevention Studies Fact Sheet.
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Tempalski, B., Friedman, S. R., Des Jarlais, D. C., McKnight, C., Keem, M., & Friedman, R. (2003). What predicts which metropolitan areas in the USA have syringes exchanges?. International Journal of Drug Policy, 14 (5), 417-424.
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Friedman, S. R., & Reid, G. (2002). The need for dialectical models as shown in the response to the HIV/AIDS epidemic. International Journal of Sociology and Social Policy, 22, 177-200.
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Hankins, C. A., Friedman, S. R., Zafar, T., & Strathdee, S. A. (2002). Transmission and prevention of HIV and sexually transmitted infections in war settings: Implications for current and future armed conflicts. AIDS, 16 (17), 2245-2252.
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Friedman, S. R., Perlis, T., & Des Jarlais, D. C. (2001). Laws prohibiting over-the-counter syringe sales to injection drug users: Relations to population density, HIV prevalence, and HIV incidence. American Journal of Public Health, 91 (5), 791-793.
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