Salaam Semaan - Academia.edu (original) (raw)
Papers by Salaam Semaan
American Journal of Public Health, 2015
We explored how variance in HIV infection is distributed across multiple geographical scales amon... more We explored how variance in HIV infection is distributed across multiple geographical scales among people who inject drugs (PWID) in the United States, overall and within racial/ethnic groups. People who inject drugs (n = 9077) were recruited via respondent-driven sampling from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance system. We used multilevel modeling to determine the percentage of variance in HIV infection explained by zip codes, counties, and MSAs where PWID lived, overall and for specific racial/ethnic groups. Collectively, zip codes, counties, and MSAs explained 29% of variance in HIV infection. Within specific racial/ethnic groups, all 3 scales explained variance in HIV infection among non-Hispanic/Latino White PWID (4.3%, 0.2%, and 7.5%, respectively), MSAs explained variance among Hispanic/Latino PWID (10.1%), and counties explained variance among non-Hispanic/Latino Black PWID (6.9%). Exposure to potential determinants of HIV infection at zip codes, counties, and MSAs may vary for different racial/ethnic groups of PWID, and may reveal opportunities to identify and ameliorate intraracial inequities in exposure to determinants of HIV infection at these geographical scales. (Am J Public Health. Published online ahead of print October 15, 2015: e1-e9. doi:10.2105/AJPH.2015.302861).
In 2006 the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening in... more In 2006 the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening in health care settings of all patients aged 13 to 64 years, irrespective of lifestyle or perceived risk behaviors . As part of those recommendations, the CDC stated that separate signed informed consent and prevention counseling should not be required for HIV-screening programs in health care settings. Depending on the policy of the individual setting, patients would be provided with verbal or written information about HIV testing, told that testing was recommended as part of routine care, and afforded the opportunity to decline-"opt-out." Those recommendations represented a shift from previous policies that had encouraged testing only for persons at high risk for HIV infection or in health care settings with high prevalence of HIV. Previous testing policies usually required separate written consent and preand post-test prevention counseling .
Objectives: Examine relationships between herpes-simplex virus type 2 (HSV-2, a biomarker for sex... more Objectives: Examine relationships between herpes-simplex virus type 2 (HSV-2, a biomarker for sexual risk), and hepatitis C virus (HCV, a biomarker for injecting risk), with HIV among injecting drug users who began injecting after large-scale expansion of syringe exchange programs in New York City. Methods: 337 heroin and cocaine users who began injecting in 1995 or later were recruited from persons entering drug detoxification. A structured interview covering drug use and HIV risk behavior was administered and serum samples collected for HIV, HCV and HSV-2 testing. Results: HIV prevalence was 8%, HSV-2 39%, and HCV 55%. There was a significant association between HSV-2 and HIV (OR = 7.9, 95% CI 2.9-21.4), and no association between HCV and HIV (OR = 1.14, 95% CI 0.5-2.6). African-American IDUs had the highest prevalence of HSV-2 (76%) and HIV (24%) but the lowest prevalence of HCV (34%). Conclusions: The strong association between HSV-2 and HIV and the lack of an association betwee...
Human rights protections include national and international responsibilities for health protectio... more Human rights protections include national and international responsibilities for health protection using evidence-based public health strategies. The HIV/AIDS epidemic has played a significant role in bringing human rights and public health together. We focus on how human rights considerations apply to the health of persons who use illicit drugs in the context of HIV prevention and treatment. There are about 16 million injection drug users in 148 countries, of whom 10 million live in developing and transitional countries, and 3 million are infected with HIV. We examine three relevant aspects of drug use: prevention and treatment of drug dependence, prevention and control of HIV infection among drug users, and drug use and incarceration. The right to optimal health includes prevention and treatment for drug dependence, including prevention of initiation of drug use, addressing social determinants of drug use, opioid substitution therapy, cognitive behavioral therapy, contingency mana...
Public Health Reports
In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultati... more In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.
Background: Adolescent drug users, 11-17 years old, are at risk for bloodborne and sexually trans... more Background: Adolescent drug users, 11-17 years old, are at risk for bloodborne and sexually transmitted infections. Including adolescent drug users in behavioral and social research is important for developing prevention and treatment interventions. More than 90% of studies with drug users report a mean age of mid-to-late 30s with lower age limits of 18 years. Findings from these studies may not be applicable to adolescent drug users. Methods: We reviewed the scientific, ethical, and regulatory literature of the past 15 years to shed light on barriers and strategies to increase studies with adolescent drug users. Results: Many adolescents are classified as children by federal regulations for protecting research participants. This classification depends on state and local laws which vary by state according to its definition of age of majority or legal age of adulthood. Regulatory requirements for study participation include consent or assent of adolescents depending on the regulatory...
International Journal of Drug Policy, 2015
Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID)... more Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.
Background: Developing interventions for early detection and treatment of diseases among high-ris... more Background: Developing interventions for early detection and treatment of diseases among high-risk groups, such as migrants,immigrants, and refugees requires high-quality data on prevalence of behaviors, health conditions, and health outcomes. Projects that use probability sampling methods, such as household surveys of these populations are important.Probabilitysampling of these populations is challenging;unknown sampling frames and distributions. Time-space sampling (TSS) (also known as time-location sampling or as venue-based sampling) is a probability-based sampling method of defined populations congregating at specific locations and times. Methods: We describe TSS in terms of procedures, advantages, and disadvantages of TSS and build on the collective TSS experience with hidden non-migrant populations, particularly persons at risk for infection with blood-borne pathogens and sexually transmitted infections. We highlight factors that can enhance successful application of TSS in t...
Women & Health
This study presents the results of a needs assessment survey conducted with 66 incarcerated women... more This study presents the results of a needs assessment survey conducted with 66 incarcerated women in a large Philadelphia county jail during the winter of 1993. Results indicated that prior to incarceration, these women engaged in very high risk sexual and drug use behaviors, and had experienced a myriad of other problems that may contribute to their risk for HIV infection. Of the 66 women who participated in the study, over three-fourths had used crack cocaine, nearly one-half had traded sex for drugs and money in the six months prior to incarceration, one-third reported a prior history of injection drug use, and one-half report sexual contact with a male partner who injected drugs. In addition, one-fourth of the study sample had been homeless during the year prior to incarceration, one-half reported a prior history of sexual abuse, three-fourths had been physically beaten by a boyfriend or spouse, and nearly one-half had a prior history of syphilis. Although limited in scope, the ...
MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control
The virtual mentor : VM, 2009
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estima... more Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
Public health reports (Washington, D.C. : 1974)
In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultati... more In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.
AIDS reviews
Although sampling is a crucial component of research methodology, it has received little attentio... more Although sampling is a crucial component of research methodology, it has received little attention in intervention research with populations at risk for HIV infection. We review the challenges involved in sampling these populations for evaluating behavioral and social interventions. We assess the four strategies used for street and network sampling that have been reported in the HIV-intervention research literature and used because traditional probability sampling was not possible. The sampling strategies are: 1) targeted, 2) stratified, (3) time-space, and (4) respondent-driven. Although each has strengths and limitations in terms of its ability to produce valid results that enhance generalizability, the choice of a particular strategy depends on the goal of the study, characteristics of the target population, and the availability of resources and time for collecting and analyzing sampling-related data. Continued efforts are needed to improve the sampling strategies used in evaluat...
Social Science & Medicine, 2007
We conducted spatial regression analysis to account for spatial clustering of sexually transmitte... more We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15-34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs. r (S. Semaan), msternberg@cdc.gov (M. Sternberg), azaidi@cdc.gov (A. Zaidi), saral@cdc.gov (S.O. Aral).
International Journal of Drug Policy, 2009
Sexually Transmitted Diseases, 2010
Objective: To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) ... more Objective: To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) infection and HIV infection among never-injecting heroin and cocaine drug users (NIDUs) in New York City.
Image: the Journal of Nursing Scholarship, 1993
American Journal of Public Health, 2015
We explored how variance in HIV infection is distributed across multiple geographical scales amon... more We explored how variance in HIV infection is distributed across multiple geographical scales among people who inject drugs (PWID) in the United States, overall and within racial/ethnic groups. People who inject drugs (n = 9077) were recruited via respondent-driven sampling from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance system. We used multilevel modeling to determine the percentage of variance in HIV infection explained by zip codes, counties, and MSAs where PWID lived, overall and for specific racial/ethnic groups. Collectively, zip codes, counties, and MSAs explained 29% of variance in HIV infection. Within specific racial/ethnic groups, all 3 scales explained variance in HIV infection among non-Hispanic/Latino White PWID (4.3%, 0.2%, and 7.5%, respectively), MSAs explained variance among Hispanic/Latino PWID (10.1%), and counties explained variance among non-Hispanic/Latino Black PWID (6.9%). Exposure to potential determinants of HIV infection at zip codes, counties, and MSAs may vary for different racial/ethnic groups of PWID, and may reveal opportunities to identify and ameliorate intraracial inequities in exposure to determinants of HIV infection at these geographical scales. (Am J Public Health. Published online ahead of print October 15, 2015: e1-e9. doi:10.2105/AJPH.2015.302861).
In 2006 the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening in... more In 2006 the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening in health care settings of all patients aged 13 to 64 years, irrespective of lifestyle or perceived risk behaviors . As part of those recommendations, the CDC stated that separate signed informed consent and prevention counseling should not be required for HIV-screening programs in health care settings. Depending on the policy of the individual setting, patients would be provided with verbal or written information about HIV testing, told that testing was recommended as part of routine care, and afforded the opportunity to decline-"opt-out." Those recommendations represented a shift from previous policies that had encouraged testing only for persons at high risk for HIV infection or in health care settings with high prevalence of HIV. Previous testing policies usually required separate written consent and preand post-test prevention counseling .
Objectives: Examine relationships between herpes-simplex virus type 2 (HSV-2, a biomarker for sex... more Objectives: Examine relationships between herpes-simplex virus type 2 (HSV-2, a biomarker for sexual risk), and hepatitis C virus (HCV, a biomarker for injecting risk), with HIV among injecting drug users who began injecting after large-scale expansion of syringe exchange programs in New York City. Methods: 337 heroin and cocaine users who began injecting in 1995 or later were recruited from persons entering drug detoxification. A structured interview covering drug use and HIV risk behavior was administered and serum samples collected for HIV, HCV and HSV-2 testing. Results: HIV prevalence was 8%, HSV-2 39%, and HCV 55%. There was a significant association between HSV-2 and HIV (OR = 7.9, 95% CI 2.9-21.4), and no association between HCV and HIV (OR = 1.14, 95% CI 0.5-2.6). African-American IDUs had the highest prevalence of HSV-2 (76%) and HIV (24%) but the lowest prevalence of HCV (34%). Conclusions: The strong association between HSV-2 and HIV and the lack of an association betwee...
Human rights protections include national and international responsibilities for health protectio... more Human rights protections include national and international responsibilities for health protection using evidence-based public health strategies. The HIV/AIDS epidemic has played a significant role in bringing human rights and public health together. We focus on how human rights considerations apply to the health of persons who use illicit drugs in the context of HIV prevention and treatment. There are about 16 million injection drug users in 148 countries, of whom 10 million live in developing and transitional countries, and 3 million are infected with HIV. We examine three relevant aspects of drug use: prevention and treatment of drug dependence, prevention and control of HIV infection among drug users, and drug use and incarceration. The right to optimal health includes prevention and treatment for drug dependence, including prevention of initiation of drug use, addressing social determinants of drug use, opioid substitution therapy, cognitive behavioral therapy, contingency mana...
Public Health Reports
In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultati... more In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.
Background: Adolescent drug users, 11-17 years old, are at risk for bloodborne and sexually trans... more Background: Adolescent drug users, 11-17 years old, are at risk for bloodborne and sexually transmitted infections. Including adolescent drug users in behavioral and social research is important for developing prevention and treatment interventions. More than 90% of studies with drug users report a mean age of mid-to-late 30s with lower age limits of 18 years. Findings from these studies may not be applicable to adolescent drug users. Methods: We reviewed the scientific, ethical, and regulatory literature of the past 15 years to shed light on barriers and strategies to increase studies with adolescent drug users. Results: Many adolescents are classified as children by federal regulations for protecting research participants. This classification depends on state and local laws which vary by state according to its definition of age of majority or legal age of adulthood. Regulatory requirements for study participation include consent or assent of adolescents depending on the regulatory...
International Journal of Drug Policy, 2015
Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID)... more Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.
Background: Developing interventions for early detection and treatment of diseases among high-ris... more Background: Developing interventions for early detection and treatment of diseases among high-risk groups, such as migrants,immigrants, and refugees requires high-quality data on prevalence of behaviors, health conditions, and health outcomes. Projects that use probability sampling methods, such as household surveys of these populations are important.Probabilitysampling of these populations is challenging;unknown sampling frames and distributions. Time-space sampling (TSS) (also known as time-location sampling or as venue-based sampling) is a probability-based sampling method of defined populations congregating at specific locations and times. Methods: We describe TSS in terms of procedures, advantages, and disadvantages of TSS and build on the collective TSS experience with hidden non-migrant populations, particularly persons at risk for infection with blood-borne pathogens and sexually transmitted infections. We highlight factors that can enhance successful application of TSS in t...
Women & Health
This study presents the results of a needs assessment survey conducted with 66 incarcerated women... more This study presents the results of a needs assessment survey conducted with 66 incarcerated women in a large Philadelphia county jail during the winter of 1993. Results indicated that prior to incarceration, these women engaged in very high risk sexual and drug use behaviors, and had experienced a myriad of other problems that may contribute to their risk for HIV infection. Of the 66 women who participated in the study, over three-fourths had used crack cocaine, nearly one-half had traded sex for drugs and money in the six months prior to incarceration, one-third reported a prior history of injection drug use, and one-half report sexual contact with a male partner who injected drugs. In addition, one-fourth of the study sample had been homeless during the year prior to incarceration, one-half reported a prior history of sexual abuse, three-fourths had been physically beaten by a boyfriend or spouse, and nearly one-half had a prior history of syphilis. Although limited in scope, the ...
MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control
The virtual mentor : VM, 2009
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estima... more Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
Public health reports (Washington, D.C. : 1974)
In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultati... more In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.
AIDS reviews
Although sampling is a crucial component of research methodology, it has received little attentio... more Although sampling is a crucial component of research methodology, it has received little attention in intervention research with populations at risk for HIV infection. We review the challenges involved in sampling these populations for evaluating behavioral and social interventions. We assess the four strategies used for street and network sampling that have been reported in the HIV-intervention research literature and used because traditional probability sampling was not possible. The sampling strategies are: 1) targeted, 2) stratified, (3) time-space, and (4) respondent-driven. Although each has strengths and limitations in terms of its ability to produce valid results that enhance generalizability, the choice of a particular strategy depends on the goal of the study, characteristics of the target population, and the availability of resources and time for collecting and analyzing sampling-related data. Continued efforts are needed to improve the sampling strategies used in evaluat...
Social Science & Medicine, 2007
We conducted spatial regression analysis to account for spatial clustering of sexually transmitte... more We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15-34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs. r (S. Semaan), msternberg@cdc.gov (M. Sternberg), azaidi@cdc.gov (A. Zaidi), saral@cdc.gov (S.O. Aral).
International Journal of Drug Policy, 2009
Sexually Transmitted Diseases, 2010
Objective: To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) ... more Objective: To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) infection and HIV infection among never-injecting heroin and cocaine drug users (NIDUs) in New York City.
Image: the Journal of Nursing Scholarship, 1993