INTRODUCTION

Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse

The 2007 Drug Abuse and Risky Behaviors: The Evolving Dynamics of HIV/AIDS meeting responded to deep concern about the continuing spread of HIV/AIDS in the United States and abroad and invited the scientific community to engage in a dialog to further our understanding of the problem and how it is changing. It provided a timely forum to explore our growing knowledge of the behavioral and social factors that affect HIV infection rates among various populations, including the multiple influences of drug abuse and addiction on HIV risk. It underscored how research could inform public health policy and identified emerging opportunities to address this evolving pandemic.

Sponsored by NIDA in collaboration with multiple NIH Institutes and the Centers for Disease Control and Prevention, this meeting highlighted the drug abuse-HIV link. Speakers addressed a variety of related topics, including how drugs of abuse alter brain function and impair decisionmaking, how substance abuse affects HIV/AIDS risk in diverse demographics, how and to what extent substance abuse influences sexual risk behaviors, and how testing and counseling can be incorporated as key components of HIV prevention strategies for different drug-abusing populations.

HIV/AIDS in 2007: A Brief Overview
Anthony S. Fauci, M.D.
Director
National Institute of Allergy and Infectious Diseases

[Abstract Not Available]

NeuroAIDS in Drug Users

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Drug Abuse Treatment in HIV Prevention and Care: Past Successes and Future Challenges

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Drug Abuse Treatment in HIV Prevention and Care: Past Successes and Future Challenges
David S. Metzger, Ph.D.

Injection and noninjection drug use have been well documented as risk factors for HIV infection. They have also been shown to inhibit access to HIV care and to negatively affect adherence to HIV treatment regimens. Although most research has been focused on injection drug users, there is a growing awareness of the significant role of noninjection drug use in sexual transmission among the populations of both heterosexuals and men having sex with men. Substantial data exist on the potential for effective drug abuse treatments, particularly those with pharmacologic adjuncts, to have significant effects in preventing the transmission of HIV infections and in increasing the access to HIV care among those already infected. Although there are several limitations to past HIV research focusing on the impact of drug abuse treatments (with most studies having been focused on opiate-dependent injectors, the absence of randomized controlled trials, and short-term followup intervals), it is clear that drug treatments can play a major role in HIV prevention and care in domestic and international communities where drug use is propelling the epidemic. Yet to maximize their impact, these treatments need to be accessible, acceptable, and affordable to the populations at the highest risk of HIV infection. Research must continue to be focused on the development of more effective pharmacologic agents, counseling strategies, and delivery mechanisms with public health relevance.

The Role of Drug Abuse in the Evolving HIV Epidemic

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The Role of Drug Abuse in the Evolving HIV Epidemic
Steffanie A. Strathdee, Ph.D.

According to the National Institute on Drug Abuse’s International Program, there is "no greater public health goal for addiction researchers than to help stem the continued spread of the intertwined epidemics of HIV and drug abuse." More than 15 million people have been diagnosed with drug use disorders worldwide. There are an estimated 13.2 million injection drug users (IDUs) in 130 countries. Although 10 percent of the world’s HIV infections are directly attributed to needle-sharing among IDUs, outside of Africa this percentage rises to 30 percent. In the United States, of the nearly 14,000 HIV infections associated with injection drug use diagnosed in 2005, 45 percent and 24 percent were heterosexual males and female IDUs, respectively; 16 percent were attributed to men who have sex with men (MSM)-IDUs; 15 percent were heterosexual partners of IDUs; and less than 1 percent were children of IDU parents.* Explosive HIV epidemics among IDUs have occurred in both developed and developing countries, including such recent examples as Ukraine, the Russian Federation, Vietnam, Iran, and China, with emerging epidemics in Pakistan, Tajikistan, Afghanistan, and northwestern Mexico. In mature HIV epidemics in developed and developing countries, diffusion from IDUs to non-IDU populations has been documented, with growing attention needed on bridging the populations (e.g., sex worker-IDUs, MSM-IDUs, paid blood donors). Examples of successful interventions to reduce HIV among drug users have been reported at the levels of the individual, social network, and community. In a recent meta-analysis of behavioral IDU interventions, the most successful strategies focused on both injection and sexual risks, but only 50 percent of the interventions were based on behavioral theory and only 6 percent had more than one followup visit. Only 12 percent were conducted outside the United States, even though 78 percent of IDUs reside in developing countries. Despite the heterogeneity of IDU-associated HIV epidemics between and even within countries, lessons from HIV prevention stories among drug users worldwide suggest that HIV risk environments are socially produced, and thus, prevention is a shared responsibility.

*The percentages listed are rounded and may not equal 100 percent.