Sherry Deren

Publications (59)119.95 Total impact

• Article: Trends in the AIDS epidemic among New York City’s injection drug users: Localized or citywide?

  Russell Rockwell, Sherry Deren, Marjorie F. Goldstein, Samuel R. Friedman, Don C. Des Jarlais
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  ABSTRACT: 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.
  Journal of Urban Health 04/2012; 79(1):136-146. · 2.13 Impact Factor
• Article: Attitudes of methadone program staff toward provision of harm-reduction and other services.

  Sherry Deren, Sung-Yeon Kang, Milton Mino, Randy M Seewald
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  ABSTRACT: The need for expansion of health services provided in drug treatment programs has been widely discussed since the beginning of the HIV epidemic among drug users. Service expansion has focused on various types of services including medical services (eg, primary care) and harm-reduction services (eg, provision of sterile syringes). A staff survey was conducted in 8 methadone maintenance clinics in the New York/New Jersey area to assess attitudes toward the provision of harm reduction and other services in methadone clinics, and the relationship of these attitudes to other variables. A total of 114 staff members in 8 methadone maintenance clinics completed the survey. The majority of staff was supportive of adding services, over 90% supported medical services, and the majority supported harm-reduction services such as syringe access and disposal services. Higher education and HIV knowledge levels were significant correlates of favorable attitudes toward service provision. Support for providing harm-reduction services in methadone maintenance clinics was found. Enhancing knowledge of staff regarding various types of health services, and engaging them in how best to institute new services, should be undertaken when new services are planned.
  Journal of Addiction Medicine 12/2011; 5(4):289-92. · 1.95 Impact Factor
• Article: Differential gender effects of depression on use of HIV medications among HIV-positive Puerto Rican drug users.

  Sung-Yeon Kang, Sherry Deren, Hector M Colón
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  ABSTRACT: Many barriers to the use of HIV medications have been identified. Research findings have also shown a gender disparity in HIV care behaviors. However, interaction effects of gender with the potential barriers to use of HIV medications among HIV-positive minority drug users remain under-studied. This study examined interaction effects of gender with potential moderating factors (i.e., individual and network characteristics) on the use of HIV medications. Analyses were based on 260 HIV-positive Puerto Rican heroin and cocaine users, recruited in New York (N=178) and Puerto Rico (N=82) in 1998-2003. HIV status was assessed using OraSure, and heroin or cocaine use was verified by urinalysis. All participants were tested and interviewed at baseline and six-month follow-up (183 males; 77 females). In predicting use of HIV medications at follow-up (HIVMEDF), use of HIV medications at baseline (HIVMED), individual characteristics (e.g., depression), network characteristics (e.g., having an intravenous drug user [IDU] sex partner), recruitment site, and interaction effects of these variables with gender, were examined in multiple logistic regression analysis. Use of HIV medications was low (29% at baseline; 40% at follow-up). HIVMED, recruitment site, gender, and depression had significant main effects on HIVMEDF. Depression also had a significant interaction effect with gender on HIVMEDF. Unlike men, women with depression were less likely than women without depression to use the medications. The findings indicate that gender-specific issues should be addressed by treatment programs for HIV-positive drug users, with particular efforts needed to enhance use of medications for depressed women.
  AIDS Care 11/2011; 23(11):1467-71. · 1.60 Impact Factor
• Article: Associations between political/civic participation and HIV drug injection risk.

  Milton Mino, Sherry Deren, Sung-Yeon Kang, Honoria Guarino
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  ABSTRACT: Participating in civic activities has been found to be related to positive health outcomes. This study examines associations between injection drug use health variables (sharing paraphernalia, using shooting galleries) and political/civic engagement (identifying with any political party, attention paid to politics and being registered to vote). Participants (N = 162) were recruited at 6 New York City (NYC) methadone programs as part of an HIV intervention (86% male). In the bivariate analysis, being registered to vote and political party identification were related to lower paraphernalia sharing; higher levels of attention paid to politics were associated with lower shooting gallery use. In the multivariate analysis, political party identification was associated with lower paraphernalia sharing and higher levels of attention paid to politics was related to lower shooting gallery use. Findings suggest that maintaining connections with mainstream civic activities can be related to reduced health risks, including HIV risk behaviors. This study contributes to understanding the relationships between involvement in civic/political participation and health, an area in which few studies have been conducted.
  The American Journal of Drug and Alcohol Abuse 08/2011; 37(6):520-4. · 1.55 Impact Factor
• Article: Conducting peer outreach to migrants: outcomes for drug treatment patients.

  Sherry Deren, Sung-Yeon Kang, Milton Mino, Honoria Guarino
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  ABSTRACT: Peer outreach models have been successful in addressing HIV risk behaviors of drug users. Patients in methadone maintenance treatment programs who were migrants from Puerto Rico and/or familiar with drug use there were trained to conduct HIV-related peer outreach. A group randomized design was implemented; patients in the Experimental (E) condition (n = 80) received training and conducted 12 weeks of outreach. Half of the patients completed the training and outreach. At follow-up, patients in the E condition who conducted outreach felt they were more helpful to their community, showed a trend for engaging in more vocational activities, and were more likely to talk with others about HIV, compared to those who did not conduct outreach and those in the Control condition (n = 78). Drug treatment patients who are migrants can be trained as peer outreach workers and short-term benefits were found. Longer term maintenance of benefits should be assessed.
  Journal of Immigrant and Minority Health 04/2011; 14(2):251-8. · 1.16 Impact Factor
• Article: HIV and Drug Use in Puerto Rico: Findings from the ARIBBA Study.

  Milton Mino, Sherry Deren, Hector M Colón
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  ABSTRACT: This paper presents findings from the Alliance for Research in El Barrio and Bayamón (ARIBBA) research study, which compared HIV-related risk behaviors, HIV infection rates, and mortality rates of 800 Puerto Rican injection drug users and crack smokers in East Harlem, New York, with 399 of their counterparts in Bayamón, Puerto Rico. The study was conducted from 1996 to 2004 and is among the most comprehensive ever undertaken on HIV risk behaviors of drug users in Puerto Rico. This paper presents the main findings, many of which have been published in scientific journals. The study found that drug users in Puerto Rico became infected with HIV at a rate almost 4 times higher than Puerto Rican drug users in New York, and they died at a rate that was more than 3 times as high. The findings indicate that drug users in Puerto Rico are more likely than Puerto Rican drug users in New York to engage in injection drug use and sexual behaviors that put them at risk of becoming infected with HIV. In addition, they have fewer prevention resources available to them. HIV prevention programs are scarce in Puerto Rico and the availability of drug treatment programs in Puerto Rico declined by over one third during the period examined. Additionally, significantly fewer HIV-positive drug users in Puerto Rico were taking HIV-related medications than in New York. The paper concludes with recommendations and lessons learned from the study.
  Journal of the International Association of Physicians in AIDS Care (JIAPAC) 03/2011; 10(4):248-59.
• Article: Introduction: The New York HIV-drug use epidemic: lessons learned and unresolved issues.

  Sherry Deren, Holly Hagan
  Substance Use &amp Misuse 01/2011; 46(2-3):129-30. · 1.10 Impact Factor
• Article: HIV risk and prevention among Hispanic immigrants in New York: the salience of diversity.

  Sherry Deren, Michele Shedlin, Sung-Yeon Kang, Dharma E Cortés
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  ABSTRACT: The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.
  Substance Use &amp Misuse 01/2011; 46(2-3):254-63. · 1.10 Impact Factor
• Article: Current and emerging research needs in studying the NYC HIV-drug use epidemic.

  Sherry Deren, Holly Hagan, Samuel Friedman, Don C Des Jarlais, David Perlman, Marya Gwadz, Charles Cleland, Andrew Osborne, Joseph Lunievicz
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  ABSTRACT: As we begin the fourth decade of the epidemic, it is clear that, as demonstrated by the articles in this Special Issue, much has been learned about factors contributing to the decline in HIV prevalence among drug users in New York. However, there are a number of outstanding research questions that remain or are emerging. Following is a summary of some of the topics requiring further research. While this summary does not represent a comprehensive list, it is based on many of the questions raised in the articles in this Special Issue and identifies some of the directions to be investigated during the next decade.
  Substance Use &amp Misuse 01/2011; 46(2-3):316-9. · 1.10 Impact Factor
• Article: Challenges in recruiting and training drug treatment patients as peer outreach workers: a perspective from the field.

  Rosa M Colón, Sherry Deren, Honoria Guarino, Milton Mino, Sung-Yeon Kang
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  ABSTRACT: Hispanic patients were recruited from methadone maintenance treatment programs in 2005-2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey. Following training, they conducted outreach in their communities for 12 weeks. This paper describes the challenges encountered during the recruitment, training, and outreach phases of the project, from the field perspective. Recommendations for future efforts in training drug treatment patients as outreach workers are provided.
  Substance Use &amp Misuse 04/2010; 45(12):1892-908. · 1.10 Impact Factor
• Article: Training drug treatment patients to conduct peer-based HIV outreach: an ethnographic perspective on peers' experiences.

  Honoria Guarino, Sherry Deren, Milton Mino, Sung-Yeon Kang, Michele G Shedlin
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  ABSTRACT: From 2005 to 2008, the Bienvenidos Project trained Puerto Rican patients of New York City and New Jersey Methadone Maintenance Treatment Programs to conduct peer-based community outreach to migrant Puerto Rican drug users to reduce migrants' HIV risk behaviors. Ethnographic research, including focus groups, individual interviews, and observations, was conducted with a subset of the patients trained as peers (n = 49; 67% male; mean age 40.3 years) to evaluate the self-perceived effects of the intervention. Results of the ethnographic component of this study are summarized. The role of ethnographic methods in implementing and evaluating this kind of intervention is also discussed.
  Substance Use &amp Misuse 02/2010; 45(3):414-36. · 1.10 Impact Factor
• Article: Factors mediating and moderating the relationship between gender and utilization of health care among Puerto Rican drug users in New York.

  Sung-Yeon Kang, Sherry Deren
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  ABSTRACT: This study examined factors that mediate and moderate the relationship between gender and utilization of mental health and medical services in the past year among Puerto Rican drug users (308 females; 892 males) recruited in New York City. Experience of sexual or physical abuse, injection drug use, relationship variables (e.g., having a sexual partner who is an injection drug user), and serious or chronic mental/medical conditions were used as potential mediators and moderators. Both sexual and physical abuse mediated gender effects on use of mental health services. Having chronic medical problems mediated the relationship between gender and utilization of medical and mental health services. Significant interaction effects of gender by depression, physical abuse, and HIV sero-status on utilization of medical services were found. Health (particularly mental health) care was under-utilized by both women and men, despite high rates of depression and chronic medical conditions. The finding of under-use of medical services by HIV-positive drug users (particularly by HIV-positive women) indicates a need for further efforts to engage all HIV-positive persons in care. The findings also indicate an on-going need for mental and other health services for drug users who have been victims of abuse.
  Drug and alcohol dependence 05/2009; 102(1-3):138-43. · 3.60 Impact Factor
• Article: Biculturality and HIV-risk behaviors among Puerto Rican drug users in New York City.

  Sung-Yeon Kang, Sherry Deren, Milton Mino, Dharma E Cortés
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  ABSTRACT: Biculturality refers to two independent processes of acculturation, one to the host society's culture and another to the culture of origin. This study examined the relationship between biculturality and HIV-related risk behaviors in a sample of injecting and noninjecting Puerto Rican drug users (N = 259), recruited in New York City in 2005-2006. Biculturality was measured by two scales: involvement in (i) American culture (AMBIC) and (ii) Puerto Rican culture Biculturality (PRBIC). The majority (78%) of the participants were males, with a mean age of 42 years. About half were born in Puerto Rico, and the average length of stay in the United States was 26 years. In multiple logistic-regression analysis, AMBIC was significantly related to lower injection risk after controlling for other factors including gender, age, and MMTP enrollment, while PRBIC was a significant predictor of higher sex risk. Involvement in the host culture and the culture of origin differed in their relationship to risk behaviors, indicating that incorporating assessments of biculturality may be useful in assessing and addressing migrants' behaviors, including HIV-risk behaviors. The study's limitations have been noted.
  Substance Use &amp Misuse 02/2009; 44(4):578-92. · 1.10 Impact Factor
• Article: Gender comparisons of factors associated with drug treatment utilization among Puerto Rican drug users.

  Sung-Yeon Kang, Sherry Deren, Hector Colón
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  ABSTRACT: This study examined gender-specific effects of social bonds, network characteristics, and other factors on drug treatment enrollment among Puerto Rican drug users. Participants (425 women; 1,374 men) were recruited in New York and Puerto Rico in 1998-2003. Gender differences were found: education (< high school/GED) and having a sex partner who is an injection drug user (IDU) were significantly related to current enrollment in drug treatment (EDT) for women; for men, having an IDU friend (negatively) had a main effect on EDT, and having an IDU friend also had a significant interaction effect with their own injection drug use on EDT. For both women and men, recruitment site (New York), having health insurance, and prior methadone treatment were significant predictors of EDT. The findings may be useful in developing gender-differentiated drug counseling and treatment efforts that engage women's sex partners and men's friendship networks to build support for drug treatment.
  The American Journal of Drug and Alcohol Abuse 02/2009; 35(2):73-9. · 1.55 Impact Factor
• Article: Migrant drug users: predictors of HIV-related sexual and injection risk behaviors.

  Sherry Deren, Sung-Yeon Kang, Milton Mino, Honoria Guarino
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  ABSTRACT: Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term "migrant" was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey). A total of 290 drug users who had previously used drugs in PR were recruited in NY and New Jersey and interviewed regarding drug use history and HIV risk behaviors. Participants engaged in high risk behaviors, e.g., 39% shared injection paraphernalia and 62% reported unprotected sex. Multivariate analyses found that predictors of injection-related risk included being born in PR and purchasing drugs jointly with other drug users; predictors of sex-related risk included younger age and homelessness. Addressing risk reduction among those drug users who were born in Puerto Rico and are younger or homeless was indicated, and efforts to reach those at highest risk through NEPs was recommended.
  Journal of Immigrant and Minority Health 01/2009; 12(2):179-86. · 1.16 Impact Factor
• Article: Sex risk behaviors of drug users: a dual site study of predictors over time.

  Sherry Deren, Shiela Strauss, Sung-Yeon Kang, Hector M Colón, Rafaela R Robles
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  ABSTRACT: Reducing sex risk behaviors among high-risk injection drug users (IDUs) and crack smokers is a continuing challenge for HIV prevention. Based on a longitudinal study of sexually active Puerto Rican IDUs and crack smokers in New York (n = 573) and Puerto Rico (n = 264), baseline predictors of changes in sex risk (number of unprotected sex acts) at 6- and 36-month follow-up interviews were examined. In New York, predictors of higher sex risk were being younger, having primary partners, having more other sex partners, never exchanging sex, having lower self-efficacy for reducing sex risk behaviors and being HIV-negative, and these predictors were significant at both postbaseline periods. In Puerto Rico, short-term predictors included being male, having primary partners, never exchanging sex, lower sex risk norms and lower self-efficacy. However, only having primary partners was significant in longer-term behaviors. Results indicated the need for enhancing self-efficacy and for developing risk reduction strategies related to community differences.
  AIDS Education and Prevention 09/2008; 20(4):325-37. · 1.59 Impact Factor
• Article: Gender differences in health status and care among HIV-infected minority drug users.

  Sung-Yeon Kang, Marjorie F Goldstein, Sherry Deren
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  ABSTRACT: Gender differences were examined in health status and HIV care among HIV-infected minority drug users. More women than men reported having HIV-related symptoms and other health conditions, such as asthma and allergies. Hepatitis B or C was more often reported by men. As compared to men, women delayed HIV care and fewer attended HIV support groups. Delayed entry into HIV treatment was also significantly related to being Hispanic and being diagnosed with HIV in the pre-HAART era. No significant gender difference was found in current use of HIV medications. Use of HIV medications was significantly related to being married, no history of childhood sexual abuse, enrollment in an HIV clinic and attending HIV support groups. The findings demonstrate the importance of family and social support for HIV-positive drug users and also suggest a need for special attention to those who have childhood sexual abuse experience.
  AIDS Care 07/2008; 20(9):1146-51. · 1.60 Impact Factor
• Article: Peer norms and sharing of injection paraphernalia among Puerto Rican injection drug users in New York and Puerto Rico.

  Jonny F Andía, Sherry Deren, Rafaela R Robles, Sung-Yeon Kang, Hector M Colón
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  ABSTRACT: This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamón, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs recruited in the two locations by outreach workers. Multiple logistic regression was conducted using sociodemographic and other control variables (e.g., education, frequency of injection, pooling money to buy drugs, use of needle exchange program, injection in galleries and syringe sharing behaviors) and two types of norms related to sharing of injection paraphernalia-encouraging risk norms (what others approve) and objecting to risk norms (what others disapprove). One type of norms, encouraging or approval norms, was associated with indirect sharing in New York but not in Puerto Rico. Pooling money to buy drugs, use of shooting galleries and syringe sharing was associated with indirect sharing in both locations. Prevention programs to reduce indirect sharing behaviors should take into consideration different types of risk norms in order to reduce indirect sharing risk behaviors.
  AIDS Education and Prevention 07/2008; 20(3):249-57. · 1.59 Impact Factor
• Article: Syringe disposal among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program.

  Charles M Cleland, Sherry Deren, Crystal M Fuller, Shannon Blaney, James M McMahon, Stephanie Tortu, Don C Des Jarlais, David Vlahov
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  ABSTRACT: Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals.
  Health Education &amp Behavior 05/2007; 34(2):390-403. · 1.54 Impact Factor
• Article: The Puerto Rico-New York airbridge for drug users: description and relationship to HIV risk behaviors.

  Sherry Deren, Sung-Yeon Kang, Hector M Colón, Rafaela R Robles
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  ABSTRACT: This study examined mobility on the airbridge between New York (NY) and Puerto Rico (PR) for Puerto Rican drug users and its relationship to HIV risk. Over 1,200 Puerto Rican injection drug users (IDUs) and crack smokers were recruited by outreach workers in NY and PR; interview data included questions on mobility (lifetime residences and recent trips). Two-thirds of the NY sample had lived in PR; one-quarter of the PR sample had lived in NY; the most commonly sited reasons for moving were family-related. Fewer than 10% had visited the other location in the prior 3 years. Variables related to risk were number of moves, recent travel, and having used drugs in PR (all with p < 0.05). Implications included the need to enhance risk reduction efforts for IDUs in PR and address sexual risk among mobile drug users.
  Journal of Urban Health 03/2007; 84(2):243-54. · 2.13 Impact Factor