HIV/AIDS

How Does Treating Drug Abuse Affect the HIV/AIDS Epidemic?

Since the late 1980s, research has shown that drug abuse treatment is effective HIV prevention. Drug abusers in treatment stop or reduce their drug use and related risk behaviors, including risky injection practices and unsafe sex.²⁰ Drug treatment programs also serve an important role in providing current information on HIV/AIDS and related diseases, counseling and testing services, and referrals for medical and social services.

Combined pharmacological and behavioral treatments for drug abuse have a demonstrated impact on HIV risk behaviors and incidence of HIV infection.²⁰ For example, recent research showed that when behavioral therapies were combined with methadone treatment, approximately half of study participants who reported injection drug use at intake reported no such use at study exit, and over 90 percent of all participants reported no needle sharing at study exit.²¹ While these findings show great promise for achieving reductions in sexual and drug-related risk behaviors, studies are now needed to determine the long-term effectiveness of such interventions.

Moreover, drug treatment has also been shown to decrease cocaine use from an average of 10 days per month at baseline to 1 day per month at 6-month followup among noninjection cocaine abusers. Reduction in cocaine use was associated with an average 40 percent decrease in HIV risk across gender and ethnic groups, mainly as a result of fewer sexual partners and less unprotected sex.⁵ Among gay and bisexual men who abused methamphetamine, comprehensive behavioral treatment reduced sexual risk behaviors and sustained those reductions for at least 1 year following substance abuse treatment.²²

Behavioral treatments have also shown promise for enhancing adherence to antiretroviral therapy. Interventions aimed at increasing HIV treatment adherence are crucial to treatment success, but usually require dramatic lifestyle changes. Effective treatment often includes providing a consistent medical regimen to counter the often irregular lifestyle created by drug abuse and addiction.

Which HIV/AIDS Prevention Programs Work Best?

Cumulative research has shown that comprehensive HIV prevention -- drug addiction treatment, community-based outreach, and testing and counseling for HIV and other infections -- is the most effective way to reduce risk of bloodborne infections among drug-abusing individuals. NIDA's extensive prevention research portfolio, begun in the 1980s, shows that comprehensive HIV prevention strategies can be cost-effective and reliable in preventing new HIV infections among diverse populations of drug abusers and their communities.²³ Recent research confirms these findings, demonstrating that school- and community-based prevention programs designed for inner-city African-American boys can be effective in reducing high-risk behaviors, including drug abuse and risky sexual practices that can lead to HIV infection.²⁴ This research also underscores the importance of ensuring cultural relevancy for specific populations.

Early detection of HIV is another approach for preventing HIV transmission. Research indicates that routine HIV screening in healthcare settings among populations with a prevalence rate as low as 1 percent is as cost-effective as screening for other conditions such as breast cancer and high blood pressure. These findings suggest that HIV screening can lower healthcare costs by preventing high-risk practices and decreasing virus transmission.^25,26

How Has the HIV/AIDS Epidemic Changed Over the Past 25 Years?

CDC surveillance data reveal a notable shift in the HIV/AIDS epidemic in the United States, with a higher proportion of new diagnoses today occurring among women, racial/ethnic minorities, low-income groups, and young MSM. Early in the HIV/AIDS epidemic, infections were mainly seen among White, urban, MSM or male IDUs. However, over the past 25 years, the boundaries between groups at greater and lesser risk for contracting the virus have been dissolving, with the diversity of those potentially at risk rapidly increasing. Heterosexual sex has now become a major transmission route for HIV and is a leading cause of infection among women, especially within minority communities. In fact, the heterosexual transmission rate has increased sixfold since 1993, from 5 percent to 31 percent.

Emerging trends in HIV infection include an increase in new infections among MSM, after years of decline. This increase has been associated with a resurgence of risky sexual behavior linked to use of methamphetamine and other club drugs. While the link between HIV infection and methamphetamine abuse is not established for heterosexuals, data show an association between methamphetamine use and risky sexual behavior.

Proportion of AIDS Cases Among Adults and Adolescents, by Transmission Category and Year of Diagnosis, 1985-2003 -- United States