After nearly three decades, the HIV/AIDS epidemic in the United States continues to evolve, and although much progress has been made, the number of new infections annually has remained stable and unacceptably high since the late 1990s. Substance abuse and addiction continue to fuel the spread of HIV/AIDS in the United States and worldwide. The following sections provide a brief overview of HIV/AIDS surveillance data, the links between drug abuse and HIV/AIDS, and NIDA's efforts to address the epidemic.
Global HIV/AIDS Pandemic
HIV/AIDS remains an unrelenting public health problem in the United States, disproportionately affecting certain racial and ethnic populations, men who have sex with men (MSM), women of color, and young adults. In the United States, more than a million people are infected with HIV. The Centers for Disease Control and Prevention (CDC) has released statistics showing that the number of annual new infections actually was higher than previously estimated, and the incidence of new infections has not declined for more than a decade. CDC's latest estimates suggest that more than 56,000 Americans become infected each year - one person every 90 minutes.
AIDS knows no borders; it is an international public health crisis. The most recent data available from UNAIDS reports that in 2008:
- More than 33.4 million people were estimated to be living with HIV/AIDS;
- 2.7 million people were newly infected; and
- 2.0 million people died of AIDS-related illnesses.
The majority of people infected with HIV live in developing countries. Africa has been disproportionately affected, and sub-Saharan Africa remains the most affected region globally. In 2008, 67 percent of all people living with HIV resided in sub-Saharan Africa.
In many regions of the world, both injection and non-injection drug use continue to significantly contribute to the spread of HIV. Injection drug users (IDUs) have some of the highest HIV prevalence of any population in Asia. UNAIDS reports that between 2001 and 2008, the number of people living with HIV in Eastern Europe and Central Asia increased by 67 percent. Epidemics in these regions are primarily driven by transmission during injection drug use. UNAIDS also estimates the HIV prevention coverage rate for IDUs to be only 8 percent, with access to care and treatment coverage lagging even further behind.
Intertwined Epidemics of HIV/AIDS and Drug Abuse
Drug use has been linked to 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 IDUs in treatment, have contributed to reducing the number of AIDS cases associated with injection drug use. The proportion of new HIV infections attributable to injection drug use has shown a continuing three-decade decline in the United States, thanks in part to comprehensive prevention efforts, including drug abuse treatment. However, as the epidemic has evolved, it has become apparent that focusing 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.
NIDA’s Multifaceted Response to the HIV/AIDS Epidemic
The NIDA AIDS Research Program (ARP) seeks to achieve an integrated vision for HIV/AIDS research throughout NIDA. ARP's 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 HHS agencies. The AIDS Research Program 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. The AIDS Workgroup helps ARP facilitate and coordinate HIV/AIDS activities within NIDA. As noted in NIDA's strategic plan, NIDA supports a broad range of research to diminish the spread of HIV among drug abusers and their partners and to minimize the associated health and social consequences of the disease.
NIDA’s HIV/AIDS priorities include:
- Supporting research to better understand the etiology, pathogenesis, and spread of HIV/AIDS among drug-abusing populations;
- Preventing the acquisition (primary prevention) and transmission (secondary prevention) of HIV among drug abusers and their partners;
- Decreasing the health disparities associated with HIV/AIDS;
- Supporting international research on the intertwined epidemics of drug abuse and HIV/AIDS; and
- Improving HIV treatment and outcomes of drug abusers through a better understanding of interactions with drugs of abuse, HIV/AIDS disease processes, and the medications used to treat both.
To attract innovative scientists, NIDA created the Avant-Garde Award for high-impact research, potentially transformative research that is likely to open new areas of HIV/AIDS research and/or lead to new avenues for the prevention and treatment of HIV/AIDS in drug abusers. This annual award has attracted outstanding investigators who are pursuing diverse approaches to addressing HIV/AIDS. To facilitate the entry of newly independent and early career investigators into research on the intersection of drug abuse and HIV/AIDS, NIDA developed the AIDS-Science Track Award for Research Transition (A-START) mechanism.
I hope that this brief overview has been helpful, and that you will continue to access the ARP Web site for information on drug abuse research on HIV/AIDS including up-to-date information on funding opportunities. I look forward to continuing to work with you on research to improve the lives of people living with HIV and to prevent transmission of new infections.
Jacques Normand, Ph.D.