By NIDA Acting Director Glen R. Hanson, Ph.D., D.D.S.
In the 20 years since AIDS was first identified, the disease has killed 25 million people. From the beginning of the epidemic, drug abuse has played an important role in transmitting HIV, the virus that causes AIDS. Injection drug use has accounted for approximately 35 percent of the 774,467 AIDS cases reported in the United States through 2000 and is now the predominant mode of HIV transmission in many areas of the world.
Injecting drug users (IDUs) can acquire and transmit HIV when they share syringes and other paraphernalia for preparing and injecting drugs. Injecting and non-injecting drug users also are at increased risk for engaging in unprotected sexual activity, which, in turn, can result in acquisition or transmission of HIV. Finally, women who abuse drugs or have sexual contact with drug abusers have elevated rates of HIV and so are more likely than women who don't engage in these behaviors to give birth to HIV-infected infants.
NIDA-supported research on drug abuse has greatly increased our understanding of the complex role drug abuse plays in the HIV/AIDS epidemic, fueled the development of a broad range of HIV prevention and treatment approaches for drug abusers and their sexual partners, and helped reduce the spread of HIV/AIDS in the United States. In the past few years NIDA also increased its response to the global spread of HIV by expanding its efforts to foster international research and exchange scientific findings on drug abuse-related HIV/AIDS with other nations.
| Research has shown that drug abuse treatment
is one of the most effective ways to curtail the spread of HIV and
its health consequences.
Research has shown that drug abuse treatment is one of the most effective ways to curtail the spread of HIV and its health consequences. For example, one recent study found that IDUs in methadone treatment contracted HIV at one-sixth the rate of IDUs who were not in treatment.
Unfortunately, approximately 85 percent of chronic drug abusers are not in treatment, so strategies to reach this population are also extremely important. Two major NIDA-supported HIV prevention research studies have shown that comprehensive community-based outreach programs for out-of-treatment drug abusers can be doubly beneficial in reducing HIV transmission -- they recruit drug abusers into treatment programs and they help to reduce AIDS-related risk behaviors even among those who do not have access to or are not ready to begin treatment. Over 15 years, 60,000 IDUs and their sex partners in communities across the Nation participated in the research that produced these results.
To facilitate the widespread application of research-based HIV-prevention information, NIDA recently issued The NIDA Community-Based Outreach Model: A Manual To Reduce the Risk of HIV and Other Blood-Borne Infections Among Drug Users. Initially developed for IDUs, the model has been adapted successfully for crack cocaine users, tailored to specific at-risk groups, and found to be effective with drug-using populations regardless of race, ethnicity, gender, and HIV status. In 2002, NIDA plans to publish another manual detailing the essential research-based principles of HIV prevention for out-of-treatment drug abusers.
NIDA-supported research also has improved our understanding of the clinical course of HIV/AIDS in drug users. For example, a study that followed more than 200 IDUs for 10 years after they became HIV-positive found that women develop AIDS as swiftly as men despite having much lower levels of the virus in their blood during the early years of HIV infection. Such findings help shape HIV treatment for drug users and inform guidelines used by clinicians to provide women with potent antiretroviral medications and other medical care to retard AIDS' deadly advance.
While progress in the fight against AIDS has been significant, the constantly evolving dynamics of the epidemic continue to pose challenges for drug abuse research. NIDA's Center on AIDS and Other Medical Consequences of Drug Abuse, which coordinates NIDA's AIDS research, has identified several areas for increased emphasis. These include developing approaches to preventing and treating drug abuse and its medical consequences among women, including those who are pregnant, and the prevention and treatment of other blood-borne and sexually transmitted diseases, such as hepatitis B and C, which are prevalent in drug users and their sexual partners. The same behaviors spread hepatitis and HIV among drug abusers and it is more difficult to treat patients who suffer from both diseases.
| NIDA supports efforts to develop effective HIV
prevention and treatment approaches with scientists and public health
officials around the world.
Also receiving increased emphasis will be HIV prevention in adolescents
and other populations at risk for drug abuse and for acquiring or transmitting
the virus. Findings from HIV-related research will be disseminated widely
for use by practitioners and the general public. For example, NIDA recently
launched a series of public service announcements to increase awareness
among young people that drug use can lead to risky sex that can transmit
HIV/AIDS. The announcements reinforced the theme of World AIDS Day 2001:
"Youth and AIDS in the 21st Century." (See "PSAs
Warn Young Adults: Drug Use Can Impair Judgment, Result in Health Problems.")
In contrast to the progress we have made against AIDS in the United States, the global epidemic continues to escalate. More than 40 million people worldwide now are estimated to be living with HIV/AIDS with 5 million new infections occurring in 2001. NIDA has responded by collaborating with other NIH institutes, the World Health Organization, and other agencies to support efforts to develop effective HIV prevention and treatment approaches with scientists and public health officials around the world.
In July 2000, NIDA cosponsored a conference in Durban, South Africa, on the relationship between drug abuse, HIV/AIDS, and poverty, where researchers from both countries shared strategies for HIV prevention, treatment, and future research. In October 2001, NIDA cosponsored the fourth annual meeting of the Global Research Network (GRN) on HIV Prevention in Drug-Using Populations in Melbourne, Australia. As one of the founding organizations of the GRN, NIDA helps support its critically important efforts to exchange scientific information and develop collaborative research on international HIV trends and prevention strategies.
In the years ahead, developing and implementing effective HIV prevention and treatment for drug abusers and their sexual partners is likely to offer the greatest opportunity for making further progress against AIDS and other blood-borne infectious diseases around the world. As it has to date, NIDA's multidisciplinary AIDS research program -- in partnership with other medical, governmental, and private initiatives -- will continue to be a formidable force in reducing the ravages of drug abuse and HIV/AIDS.
Volume 17, Number 1 (April 2002)