November 25, 2011
NIDA Director, Dr. Nora D. Volkow

On Nov. 8th, the NIH had the honor of hosting Secretary of State Hillary Rodham Clinton as she presented a vision for "Creating an AIDS-Free Generation," calling for a combination of proven strategies - including HIV treatment as HIV prevention - to achieve this worthy goal. As the December 1 Federal World AIDS Day approaches, her speech is a perfect complement to the many activities and opportunities this Day brings. It also reminds us that HIV/AIDS is still a threat here and globally. In the United States, approximately 1 million people live with HIV, with 56,000 new cases diagnosed each year, an incidence rate that has held steady for the past 10 years. Internationally, the pandemic has been devastating - in 2010, an estimated 34 million people were living with HIV, and about 1.8 million people died from AIDS.

Secretary Clinton's "combination prevention strategy" comprises approaches with proven success in reducing HIV transmission. One involves getting HIV+ mothers started on appropriate treatment before their babies are born, thus reducing their viral load and the chances of passing HIV on to their infants; another is to encourage voluntary, medical male circumcision, shown to reduce women-to-men transmission by up to 60 percent; and a third is to scale up effective treatment interventions so that more people are identified early in the course of HIV infection and are started on antiretroviral medications, especially the most vulnerable populations, which are also typically the most difficult to reach.

In this country, several groups are especially vulnerable, including drug users, and people involved in the criminal justice system, where both HIV and drug use disorders are overrepresented. Indeed, from the time it began, the HIV/AIDS epidemic has been closely linked with drug abuse and addiction. That is why improved access both to proven drug abuse treatments and to highly active antiretroviral therapy (HAART) along with more aggressive screening for HIV in substance abusing populations stands to have a major health impact. Clinical trials and population studies have demonstrated that starting HAART early in the course of the HIV infection gives infected individuals the best chance of survival while also reducing the risk of their infecting others.

NIDA is therefore actively pursuing research to optimize the implementation of the seek, test, treat, and retain (STTR) strategy to seek out high-risk, hard-to-reach substance abusers, test them for HIV, begin treatment for those who test positive, and retain them in treatment and monitor their care. NIDA is testing the STTR model in diverse settings, including the criminal justice system and substance abuse treatment centers, as well as in regions with high injection drug use and in international settings where drug abuse is a prominent vector of HIV transmission (e.g., Central Asia, Eastern Europe).

A concerted effort is needed to achieve Senator Clinton's vision of an "AIDS-free generation," and World AIDS Day is the ideal time for helping to make this vision a reality.  

Nora D. Volkow, M.D.

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