Drug Abuse and AIDS: Intertwined Epidemics

---

Adult and Adolescent AIDS cases, by exposure category, through June 1998, United States

n=657,077 (98.8% of all cases)
Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1998:10(1)

n=8,280 (1.2% of total cases)
Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1998:10(1)

n=104,028 (15.6% of total cases)
Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1998:10(1)

HIV infection is not limited to drug injectors and their sex partners. In poor inner city communities young smokers of crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection, exhibiting HIV prevalence rates as high as 30%. While the proportion of new HIV cases attributed to injection drug use has steadily increased up to 50% in 1996, a significant proportion (up to 25%) of new HIV cases may also be drug abuse-related through exposure associated with other drug abuse or through heterosexual contact with an injection or intravenous drug user (IDU).

NIDA has responded by building a multiple disciplinary program of research which comprehensively addresses the AIDs and drug abuse problem. The focus of the program has been to develop improved strategies to reduce drug-abuse related behaviors that are linked to the transmission of HIV. These strategies include drug abuse treatment and outreach strategies to drug abusers not in treatment. In support of this effort, NIDA's program also includes epidemiologic studies of seroincidence, seroprevalence, and progression to disease among drug users (in and out of treatment), their sexual partners, and their children; and studies of the effects of drugs of abuse on the immune system.

NIDA has expanded its research on ways to improve drug abuse treatment, as a means of reducing levels of HIV infection by reducing overall levels of drug use, particularly drug injecting. NIDA research has demonstrated that drug abusers in drug treatment are at lower risk for seroconversion than those not in treatment. One recent study found a six fold difference in the rate of seroconversion between injecting drug users in methadone maintenance treatment (3.5%) and those who stayed out of treatment (22%). NIDA will continue to support research to improve existing treatment approaches and to develop new pharmacologic and behavioral therapies to improve drug abuse treatment as an AIDS prevention strategy.

NIDA has established large scale studies to reach drug abusers not currently in treatment. Through such community outreach studies, NIDA has assessed strategies to inform and counsel drug abusers about AIDS, to encourage them to seek treatment for their drug abusing behaviors, and to educate them on methods to reduce their risk of transmitting and contracting HIV. NIDA also conducts research on other community based strategies to reduce HIV infection, such as needle exchange programs. About 85% of the chronic drug abusers (primarily hardcore cocaine and heroin users) are not in drug treatment. Out-of-treatment drug abusers have higher rates of high risk behaviors, greater seroprevalence, and higher rates of seroincidence than in-treatment populations. Significantly, these studies have shown that even relatively small amounts of education and counseling can help many drug users modify their HIV risk behaviors, even without achieving total abstinence from drugs. NIDA will continue to conduct research to improve educational and behavioral strategies to reduce HIV transmission among drug abusers, and have begun new initiatives focussing on gender and cultural issues, drug-using networks, and pediatric AIDS.

To support these efforts and to enhance the knowledge base about HIV infection and AIDS in drug abusers, NIDA has also supported natural history studies of drug abusers, studies of drugs of abuse as cofactors in HIV disease, studies of behavior change and abuse as cofactors in HIV disease, studies of behavior change and relapse prevention, and basic and clinical research on the effects of drugs of abuse on the immune system. These studies have provided critically important information on the epidemiology of the AIDS epidemic among drug users, on the role of drug abuse in risky behaviors, on the role of drugs of abuse in infection and progression to AIDS, and on the effects on the immune system.

Drug abuse treatment and prevention programs that change high risk behaviors can most effectively reduce the drug abuse-related transmission of HIV. Consequently, NIDA has and plans to continue to develop and enhance effective methods for treating and preventing drug abuse-related risky behaviors. The continuation and strengthening of this research is central to the Nation's hopes for developing effective HIV/AIDS prevention strategies.

[Center on AIDS and Other Medical Consequences of Drug Abuse Home]

NIDA Home | Site Map | Search | FAQs | Accessibility | Privacy | FOIA (NIH) | Employment | Print Version _ The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. Last updated on Monday, January 22, 2001.