Mark Beardsley

Medical College of Wisconsin, Milwaukee, Wisconsin, United States

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Publications (27)41.2 Total impact

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    ABSTRACT: This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p <. 001), and more New York IDUs lived in their own home (30% vs. 14%, p <. 001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.
    The American Journal of Drug and Alcohol Abuse 11/2001; 27(4):719-735. DOI:10.1081/ADA-100107664 · 1.78 Impact Factor
  • Sherry Deren · Mark Beardsley · Susan Coyle · Merrill Singer · Sung-Yeon Kang ·
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    ABSTRACT: Although injection drug users (IDUs) are at high risk of HIV, seroprevalence rates vary throughout the United States. This paper compares HIV-related risk behaviors for IDUs across communities with low, moderate, and high seroprevalence rates among IDUs. Data are based on interviews with 12,072 seronegative IDUs from 22 communities participating in a multisite study. Injection- and sex-related risk behaviors (e.g., using others' syringes, unprotected sex acts) were found to be significantly higher in the low seroprevalence communities. This indicates that efforts to reduce risk behaviors should be continued across all IDU communities. Further research on the social/environmental context of risk-taking is needed.
    AIDS and Behavior 02/2001; 5(1):45-50. DOI:10.1023/A:1009507421406 · 3.49 Impact Factor
  • M F Goldstein · S Deren · M Beardsley · B L Richman ·
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    ABSTRACT: Time in drug treatment has been shown to be one of the best predictors of post-treatment success. Since as many as half of the enrollees leave methadone treatment during the first year, the project described in this article was designed to test the effectiveness of an alternative program for individuals who have recently dropped out of methadone maintenance treatment. The goals of this "Alternative Program" are to help participants re-connect with formal drug treatment and other community or medical programs, reduce their HIV risk behavior, decrease or eliminate drug use, join self-help groups, and obtain entitlements. Program components include: contacts by local outreach workers, cognitive-behavioral relapse-prevention group counseling, and individual counseling for needs assessment and referral. This paper describes the basis for development of the intervention, summarizes the methodology being used, and provides preliminary data on participation in the Alternative Program.
    Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 02/2001; 68(1):33-40. · 1.62 Impact Factor
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    ABSTRACT: Quantitative and qualitative data are used to compare alternative sources of syringes, including syringe exchange programs (SEPs), accessed by 165 Puerto Rican injection drug users (IDUs) in East Harlem, New York (NY), and 115 in Bayamn, Puerto Rico (PR). IDUs in PR obtained, on average, 45.2% of their syringes from syringe sellers, 18.0% from pharmacies, and 17.6% from a SEP. By contrast, IDUs in NY obtained 55.0% of their syringes from SEPs and 22.9% from syringe sellers. Compared to their island counterparts, IDUs in NY received significantly more syringes from SEPs (NY, 104.5; PR, 9.2) in the prior 30 days, and were more likely to be referred by SEPs to drug treatment and HIV/TB-testing services. The results of this study suggest the need in Puerto Rico to eliminate restrictive syringe exchange policies, reform drug paraphernalia laws to protect SEP clients, and address police harassment related to carrying syringes.
    AIDS and Behavior 11/2000; 4(4):341-351. DOI:10.1023/A:1026498321919 · 3.49 Impact Factor
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    ABSTRACT: Many studies have found that the longer a drug user remains in treatment, the more positive the outcome. The majority of studies on the effects of time in treatment have followed subjects from the time they enter treatment. The subjects of the present study are injection drug users and crack users who were out of treatment at the time of their recruitment to the study. Between the initial and six-month follow-up interviews, some chose to enroll in drug treatment. The more time a subject spent in treatment during the follow-up period, the more likely it was that s/he was not using heroin or cocaine at follow-up (OR=.51; 95% C.I., .39-.67; p<.001). Unlike the results of some prior studies, positive effects of time in treatment were found even when time in treatment was less than 90 days. The findings of the present study strongly suggest that treatment is beneficial even for those who remain for less than 90 days. Those who provide treatment services to drug users should attempt to maintain contact with dropouts, and support their return to treatment.
    Journal of psychoactive drugs 09/2000; 32(3):305-10. DOI:10.1080/02791072.2000.10400454 · 1.10 Impact Factor
  • S Tortu · M Beardsley · S Deren · M Williams · H V McCoy · M Stark · A Estrada · M Goldstein ·
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    ABSTRACT: As AIDS cases among US women continue to increase, a better understanding of women's behavioural risk patterns is needed to inform intervention efforts. Data were from 2,945 women drug injectors and crack users. Statistical analyses compared sociodemographic variables, lifetime behavioural risk patterns, HIV sero-prevalence and history of sexually transmitted diseases, and determined predictors of HIV infection separately in 16 low and four high sero-prevalence sites. Based on risk patterns, four behaviourally-defined sub-groups were constructed, and rates of HIV sero-prevalence were compared. In comparisons between low and high sero-prevalence sites, there were significant differences on most variables examined, and in the relative importance of the sociodemographic characteristics and risk patterns predicting HIV. Drug injection and sex exchange were each independent, significant, behavioural predictors of infection, with no significant difference between the odds ratios attributed to each predictor. HIV sero-prevalence was significantly different among four sub-groups. Interventions must be tailored to address observed differences among women in low and high sero-prevalence sites. Injection drug use and exchanging sex each play a major role in the transmission of HIV infection to US women. Prevention efforts targeted at women should address differences in behavioural risk patterns. Aggressive and innovative interventions are needed for women who exchange sex. AIDS research must investigate how socioeconomic factors impact women's risk for HIV infection.
    AIDS Care 03/2000; 12(1):65-76. DOI:10.1080/09540120047486 · 1.60 Impact Factor
  • Rahul Hamid · Sherry Deren · Mark Beardsley · Stephanie Tortu ·
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    ABSTRACT: One hundred fifty-eight drug users received an interview that included self-reported drug use. Opiate/cocaine use in the prior 48 hours was assessed by urinalysis. Fifty-five subjects received a urine test after the interview and 103 were tested before. Chi-square tests were performed to determine if agreement between self-reported drug use and urine test results was associated with timing of urine testing. The rate of agreement was 58% when the urine test was performed after the interview and 93% when performed before the interview (chi2 = 28.6, p < .001). Conducting urine tests before an interview can increase the accuracy of self-reports.
    Substance Use &amp Misuse 09/1999; 34(11):1585-92. DOI:10.3109/10826089909039416 · 1.23 Impact Factor
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    ABSTRACT: This study assessed the relation between year of recruitment into an AIDS prevention project and likelihood of engaging (yes/no) in injection risk behaviors. In total, 834 injection drug users were recruited over a 44-month period (January 1992-August 1995) in New York City. Logistic regression was used to examine trends in three behaviors, across four successive annual cohorts: using needles/syringes that were previously used by another person, using injection supplies (e.g., cookers, cotton, rinse water) that had been previously used, and giving or lending of used needles/syringes to another person. Significant (p < .0001) decreasing trends occurred in two behaviors: giving or lending of used needles/syringes to another person and use of injection supplies that had been used by another person. Sample characteristics were generally consistent over time and did not obviate significant injection risk trends. Decreasing trends in injection risk behaviors could not be explained by changing sample characteristics. Even though some injectors report engaging in risky injection practices, the confluence of numerous AIDS prevention efforts in the 1990s has contributed to an overall reduction in the likelihood of such behaviors.
    Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 04/1999; 20(3):283-9. DOI:10.1097/00042560-199903010-00011
  • S Deren · M Beardsley · S Tortu · M F Goldstein ·
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    ABSTRACT: Crack cocaine users are at high risk for HIV, with higher frequency crack users engaging in higher rates of HIV-related sexual risk behaviors. This study will assess the variables impacting changes in crack use frequency. Out-of-treatment crack users were street recruited in East Harlem, NY. Subjects (n = 727) were 33% female, 91% minority, and 28% reported recent drug injecting. Baseline and 6-month follow-up interviews were administered. There was a significant reduction in crack use over time (p < .0001). Subjects were categorized according to five groups, based on their change in level of crack use between the two interviews, to predict those who stopped, maintained, or changed their level of use. Discriminant analyses identified six variables as the best predictors of the five groups, including having been in drug treatment since baseline and having been a drug injector (both related to reduced levels of crack use). The overall reduction in crack use for the sample masked the fact that important subgroups remained at high use levels or increased their use. The identification of subgroups who may be most resistant to reducing drug use can be helpful in developing more effective interventions.
    American Journal on Addictions 01/1999; 8(2):94-100. DOI:10.1080/105504999305893 · 1.74 Impact Factor
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    ABSTRACT: This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City. 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. 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). 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.
    American Journal of Public Health 01/1999; 88(12):1801-6. DOI:10.2105/AJPH.88.12.1801 · 4.55 Impact Factor
  • Sherry Deren · Mark Beardsley · Susan Coyle · Merrill Singer ·
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    ABSTRACT: In developing HIV prevention efforts, it is critical to determine whether interventions are effective in achieving declines in risk behavior among both HIV-positive and HIV-negative individuals. Based on a multisite intervention study of injection drug users (IDUs) and crack smokers, 488 seropositive IDUs and 364 seropositive crack users were compared with randomly selected matched samples of seronegatives (with matching based on recruitment site, gender, age group and ethnicity) at baseline and six-month follow-up to compare changes in risk behaviors by serostatus. Results indicated that overall, risk behaviors declined substantially over time; significant interaction effects indicated that seropositives reported a greater decline in sex risk behaviors than seronegatives. These data support the utility of HIV testing for high-risk drug users, and indicate that interventions have produced reductions in risk behaviors of both seropositives and seronegatives. Further research on the impact of site seroprevalence, and to enhance our understanding of those who continue to engage in risky behaviors, is needed.
    Journal of psychoactive drugs 09/1998; 30(3):239-45. DOI:10.1080/02791072.1998.10399698 · 1.10 Impact Factor
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    ABSTRACT: Interventions targeting high-risk drug users have found reductions in HIV risk behaviors over time. It is important to determine whether these changes occur among both HIV+ and HIV– drug users. A total of 225 drug injectors (31% HIV+) and 316 crack users (15% HIV+) were administered a baseline interview, received HIV testing, received test results, and participated in a 6-month follow-up interview. Both HIV+ and HIV– subjects significantly reduced risk behaviors over time, with greater reduction in some behaviors (e.g., percent of injectors sharing drug injection paraphernalia, p .05) by HIV+ subjects. This finding supports the utility of HIV testing for high-risk drug users. Further research is needed to enhance understanding of risk behaviors and risk reduction among seropositives.
    AIDS and Behavior 05/1998; 2(2):171-176. DOI:10.1023/A:1022103131608 · 3.49 Impact Factor
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    ABSTRACT: This study assessed gender differences in drug use, HIV risk, and health status in a sample of urban crack users. Using targeted sampling, 1434 crack users (66% male and primarily African-American and Puerto Rican), were recruited from the streets of East Harlem, New York City. A standardized, structured interview was administered, drug use was validated by urinalysis, and HIV testing was offered. Gender differences were observed on sociodemographic variables and patterns of drug use. Other than welfare, men and women cited different major sources of income. Women reported greater use of crack, and men were more likely to use injection drugs as well as crack. Data on sexual risk indicated that women had more sexual partners than men, but the percentage of unprotected vaginal sex for both men and women was greater for those who did not exchange sex for drugs and/or money. The number of persons already infected with HIV was substantial. Many reported histories of other sexually transmitted diseases which were generally higher among men. Future research should investigate the relationship between gender and other factors (e.g., ethnicity, geographic location) associated with HIV risk.
    Women & Health 02/1998; 27(1-2):177-89. DOI:10.1300/J013v27n01_11 · 1.05 Impact Factor
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    ABSTRACT: In the US, the number of women diagnosed with AIDS continues to increase. In this study, women in New York City (East Harlem) and Miami, two sites with high rates of drug use and HIV infection, were first compared on sociodemographic variables and risk behaviors. Logistic regression analyses were used to identify significant, independent predictors of HIV infection in each city. In comparing women from the two cities, several differences in sociodemographic characteristics and drug use were observed. In both cities, ever exchanging sex for drugs and/or money was predictive of HIV infection; and in East Harlem only, other lifetime risk variables independently predicted HIV infection: drug injection, having a sexually transmitted disease, and not having graduated from high school. Results suggest that intervention efforts with women who exchange sex should be intensified in both cities. Also, further comparisons of women drug users in AIDS epicenter cities are necessary to provide information on similarities and differences in sociodemographic characteristics and individual risk behaviors. More research attention should be focused on examining the social context of HIV risk in order to develop innovative intervention strategies which focus on the link between contextual factors and HIV infection.
    Women & Health 02/1998; 27(1-2):191-204. DOI:10.1300/J013v27n01_12 · 1.05 Impact Factor
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    ABSTRACT: Crack use has been associated with increased risk for HIV seropositivity. This study was undertaken to examine HIV-related risk behaviors among crack users in East Harlem, New York and Philadelphia, Pennsylvania, two northeastern communities which have reported extensive crack use. Crack users recruited in East Harlem (n = 1434) and Philadelphia (n = 694) were compared on demographics, drug and sex-related risk behaviors, health-related behaviors, and HIV serostatus. Many significant differences were found, and seropositivity was higher in the New York sample (25% vs. 11%, chi 2 = 36.28, p < .001). Being a recent drug injector was a significant predictors of seropositivity in both communities, and differences between communities were found in additional predictors of serostatus. Results suggest that tailored HIV interventions may be needed for different communities. In addition, aggregate data across communities, even those that may be in geographical proximity, may obfuscate differences important to incorporate in developing prevention/intervention efforts.
    The American Journal of Drug and Alcohol Abuse 11/1997; 23(4):555-67. DOI:10.3109/00952999709016895 · 1.78 Impact Factor
  • W R Davis · S Deren · M Beardsley · J Wenston · S Tortu ·
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    ABSTRACT: Gender, health, HIV risk, and demographic factors were examined with chi-square and logistic regression analyses to assess which of these factors are most predictive of active injection drug users' (IDUs') getting tested for HIV. Analyses were based on 36,898 IDUs recruited to participate in a nationwide multisite HIV prevention project. Women IDUs were recently tested (prior 6 months) more than men IDUs. Health factors, particularly for women IDUs, predicted who got tested for HIV more than risk or demographic factors. HIV testing usually occurred when disease symptomatology developed, after a long period of being capable of transmitting HIV to others, and when the benefits of AZT and other interventions may be reduced. Preventive interventions with IDUs are needed that emphasize the possible benefits of HIV testing and that encourage testing before symptoms develop.
    AIDS Education and Prevention 09/1997; 9(4):342-58. · 1.59 Impact Factor
  • S Deren · J Sanchez · M Shedlin · W R Davis · M Beardsley · D Des Jarlais · K Miller ·
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    ABSTRACT: Latina women are overrepresented among AIDS cases in the United States. To assist in developing appropriate prevention and intervention programs, information regarding HIV risk behaviors is needed on the many diverse Latina subgroups. This study examined sociodemographic characteristics and HIV risk behaviors of Dominican female prostitutes, comparing those who worked primarily in brothels with those who were street workers. A total of 77 Dominican prostitutes (54 brothel; 23 street) were recruited in New York City to participate in a structured interview and were offered HIV testing. Ethnographic interviews were conducted with a subscale. Results indicated that there were many significant differences in demographics and risk behaviors between the two groups, and those working in brothels engaged in lower levels of risk behaviors. In addition, those working in brothels had closer ties to the Dominican and Spanish cultures. Implications for AIDS prevention efforts are discussed.
    AIDS Education and Prevention 11/1996; 8(5):444-56. · 1.59 Impact Factor
  • S Deren · M Shedlin · M Beardsley ·
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    ABSTRACT: Hispanic women whose sexual partners have other sexual partners may be at risk for HIV. A structured interview was administered to 106 Dominican and Puerto Rican women who reported that they knew or suspected that their partner had other partners. A subsample participated in qualitative interviews. The study assessed concern about HIV and predictors of condom use. The majority of women reported that they worried about getting HIV and almost half had been HIV-tested. Most of the women discussed HIV/AIDS concerns with their partners, and one-third reported some condom use. Predictors of condom use were: born in the Dominican Republic/Puerto Rico, having talked with their partner about being tested, and belief that he used condoms with others. Although the women were concerned about HIV, condom use was infrequent. Results suggested methods to address this discrepancy: introducing condoms early in the relationship, developing women-controlled methods, and directly influencing men's behavior.
    AIDS Education and Prevention 09/1996; 8(4):335-42. · 1.59 Impact Factor
  • S. Tortu · S. Deren · M. Beardsley · R. Hamid ·
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    ABSTRACT: The research reported in this paper focused on out-of-treatment injection drug users recruited from the streets of East Harlem, New York City. Drug use was verified by urinalysis and HIV testing was offered. The research compared self-reported users and non-users of needle exchange programs (NEPs) on sociodemographic variables, HIV-related risk behaviors, and selected health variables. Results indicated that being White and having been incarcerated were the sociodemographic variables most strongly associated with NEP use. Other findings include the following: (1) compared to other groups, Puerto Ricans were most likely to be non-users of NEPs ; (2) there were no significant differences between NEP users and non-users in reported injection risks, but NEP users reported significantly less unprotected sex; and (3) health data indicated that almost 50% of those tested were HIV infected and many had histories of sexually transmitted diseases and hepatitis.
  • Kristine Ziek · Mark Beardsley · Sherry Deren · Stephanie Tortu ·
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    ABSTRACT: The study identifies factors associated with completing a follow-up interview in an AIDS out-reach/intervention research project targeting out-of-treatment crack smokers. Information on clients less likely to return for follow-up is important to determine generalizability of findings and to develop methods to increase follow-up rates. A street-based targeted sampling plan was used to recruit out-of-treatment crack cocaine users in East Harlem, NYC. Structured baseline (n = 409) and 6 month follow-up interviews (n = 288) were administered. Analyses comparing those followed-up and not followed-up indicated that clients less likely to be located for a follow-up were younger, male, using crack more frequently at baseline, and living on the streets or in shelters. This study demonstrated that street based AIDS prevention projects requiring follow-up can access hard to reach subjects such as crack users. Methods to enhance follow-up rates are discussed.
    Evaluation and Program Planning 08/1996; 19(3-19):219-224. DOI:10.1016/0149-7189(96)00014-6 · 0.90 Impact Factor