From the Director of the AIDS Research Program

It is hard to believe, but an entire generation of young adults has never known a world without AIDS. The human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic has been with us for a quarter of a century.

Drug use has been linked with HIV/AIDS since the beginning of the epidemic. Early in the epidemic, the role of injection drug use in HIV transmission was recognized. Research on outreach and other preventive interventions to reduce needle and drug paraphernalia sharing, as well as engaging out-of-treatment injection drug users in treatment have contributed to reducing the number of AIDS cases associated with injection drug use. However, as the epidemic has evolved, it has become apparent that focusing solely on injection drug use significantly underestimates the impact of drug use on the transmission of HIV/AIDS.

Drug and alcohol intoxication is associated with high-risk sexual behavior, including having unprotected sex or sex with a high-risk partner such as an injection drug user. Drug use and risky sexual behavior are associated with increased prevalence of sexually transmitted infections (STIs), which in turn increase the risk of contracting and/or transmitting HIV. Furthermore, drug use affects many pharmacological and physiological processes including stress systems and immune function, which may affect HIV transmission and/or disease progression. Long-term drug use can alter the function of brain regions associated with risk-taking and decision-making. In addition, drug use may interact with contextual or environmental factors and facilitate HIV transmission (e.g., bringing people together in high-risk venues such as circuit parties).

Currently, an estimated one million people in the United States are living with HIV/AIDS. Annual reported AIDS cases peaked in the mid-1980s, declined steadily between 1993 and 1998, and then leveled off. An incidence rate of approximately 40,000 new AIDS cases has been reported annually. The annual rate of HIV infections has remained at approximately 40,000 over the past 15 years. AIDS knows no borders; it is an international as well as a U.S. public health threat. HIV/AIDS has now become a pandemic; worldwide more than 25 million people have already died. More than 40 million people are estimated to be living with HIV/AIDS. While AIDS is a global phenomenon, the nature of the epidemic varies geographically, and risk factors vary within and across populations.

NIDA's response to the ongoing epidemic of HIV/AIDS is multifaceted. We support research from basic research projects to behavioral HIV prevention research trials. The common thread in this research is to elucidate the pivotal role of drug use and abuse in the transmission and progression of HIV. Research has demonstrated that pharmacological and behavioral drug use treatments are as effective as HIV prevention interventions. Drug treatment programs can also serve an important role by providing current information on HIV/AIDS, counseling and testing services, and other medical and social services.

The NIDA AIDS Research Program (ARP) seeks to achieve an integrated vision for HIV/AIDS research throughout NIDA. Our mission is to support the development, planning, and coordination of HIV/AIDS research priorities within NIDA's intramural and extramural programs and to coordinate activities with other NIH Institutes and DHHS agencies. With the help of NIDA's AIDS Workgroup, ARP provides direction and leadership for the development of research that addresses the unique dimensions of drug use and abuse as they relate to HIV/AIDS. Furthermore, the AIDS Workgroup assists ARP in facilitating and coordinating HIV/AIDS activities within NIDA. An External Scientific Workgroup with broad-based membership has also been formed to chart the future direction of NIDA's AIDS Research Program.

I welcome the opportunity to work with you in increasing the knowledge base essential to preventing the spread of HIV and developing effective treatments for drug users with HIV/AIDS and other comorbid conditions.

Jacques Normand, Ph.D.