HIV/AIDS

How Can We Counter These Trends?

Scientific knowledge is the best tool we have to address the disease of addiction and its consequences, including HIV. Research has taught us that drug abuse is preventable and that addiction is treatable. Promising prevention and treatment strategies continue to emerge to address this devastating disease, yet much remains to be done.

The increase in HIV infections associated with heterosexual contact requires additional research to better unravel the dynamics behind how drug abuse may be contributing to these new infections. We know that substance abuse may affect judgment and decision-making and lead to high-risk sexual encounters and that sexually active drug abusers increase the likelihood of HIV transmission. However, we have not yet identified all of the behavioral, biological, and environmental processes involved in the sexual transmission of HIV among drug abusers. We now need to establish how an individual's peers, relationships, social networks, and environment influence both drug abuse and sexual risk taking. Linkages to drug diffusion, drug abuse practices, and HIV risk behaviors are of particular interest.

Next Steps

Research is also needed to understand the factors leading to disparities in HIV infection and survival rates among racial and ethnic minorities, particularly among African-Americans. We can begin with research that characterizes the extent and nature of disparities in the rates of HIV infection and the occurrence of co-infections and other conditions among drug-abusing minorities, taking into account age, gender, education, sexual identity, geographic region, and socioeconomic status. Studies are also needed to characterize risk and protective factors so as to develop culturally sensitive prevention interventions.

Research on HIV disease progression and its relationship to the use and availability of treatment services will help us develop better interventions. Finally, research is needed to investigate the transmission of treatment-resistant HIV strains among drug abusers and to explore the extent to which drug abuse may contribute to the development of resistant viral infections.

Summary

While calls for more research continue, important discoveries made possible by NIDA and others have positioned the field to move forward in developing effective prevention and treatment approaches. Three key findings inform our approach, linking the interactions of drug abuse and HIV/AIDS in ways that extend far beyond injection drug use. First, drug abuse impairs judgment and good decisionmaking, leaving people more prone to engage in HIV risk behaviors, including risky sexual behavior and nonadherence to HIV treatment. Second, drug abuse adversely affects health and may exacerbate disease progression. Third, and most important, because of these linkages, we must recognize that drug abuse treatment is HIV prevention.