Volume 10, Number 3
AIDS Brings Greater Research Obligation, More Potential for Results
By Dr. Alan I. Leshner, NIDA Director
In 1994, the Centers for Disease Control and Prevention (CDC) received 80,691 new reports of Americans with AIDS. This 1-year toll is almost one-fifth of all U.S. AIDS cases ever reported.
While the epidemic continues its spread, it is also evolving, targeting different population groups. We have clear evidence that drug-related transmission of HIV, the AIDS virus, is increasing significantly. Analysis of new CDC data suggests a majority of new HIV cases last year involved drug abusers - heroin and crack addicts - and their sexual partners. While new cases among homosexual and bisexual men are decreasing, heterosexual transmission of HIV is increasing. In fact, the fastest-growing subgroup of patients with AIDS over the last several years has been heterosexual men and women, most of whom are linked sexually to drug users.
The changing nature of the AIDS epidemic, especially its growing association with drug abuse, increases the Institute's responsibilities in fulfilling its public health mission. When you consider how closely drug abuse is linked to the spread of AIDS, it should be no surprise that NIDA allocates one-third of its budget to AIDS-related aspects of drug abuse.
NIDA has supported and will continue to support research aimed at developing strategies to reduce drug abuse as an important contribution to AIDS prevention efforts. NIDA-supported researchers have shown that drug abuse treatment and street outreach to drug abusers not in treatment can be effective in changing high-risk sexual and drug-use behaviors associated with contracting and transmitting HIV. Scientists have shown that it is possible to get addicts to change these high-risk behaviors even while they are still using drugs.
Over the years, NIDA-funded researchers have also probed drug-related aspects of AIDS in the areas of epidemiology, disease origin and progression, immunology, and neurobiology. They have shed new light on treatment, interactions between disease medications and those for drug abuse, health care services delivery, and transmission of HIV from mothers to their infants.
While some NIDA-funded researchers have been learning how to teach street addicts to modify high-risk drug-related behaviors, other investigators have been conducting cellular and molecular studies of the connections between drugs of abuse and the body's disease-fighting immune system.
Beyond research in the streets and the laboratories, NIDA has supported research training programs to increase the ranks of researchers qualified to deal with the scientific and medical aspects of AIDS. In past years, NIDA provided training in AIDS and related drug abuse issues to thousands of treatment counselors and administrators and helped 35 States develop training programs on AIDS and drug abuse. In addition, the Institute has mounted a number of informational and public education initiatives to warn people about the links between drug abuse and AIDS. These initiatives have included, for example, nationwide TV campaigns aimed at young people.
NIDA is committed to building on its previous research. That means the Institute is calling on researchers, in turn, to expand their horizons in designing future investigations, to consider AIDS- and HIV-related issues in the design of new experiments. We encourage scientists to develop and submit their own investigator-originated funding requests for drug-abuse-related AIDS research.
Some 14 years into the AIDS epidemic, NIDA is still broadening the scope of its AIDS research, building on progress. We must learn more about how to improve drug abuse treatment and outreach programs to reduce high-risk behaviors associated with drug use and sexual practices, how to prevent relapses to high-risk behaviors, and how to improve clinical management of HIV-positive drug abusers. We must develop more research-based responses to the special AIDS risks and needs of minorities, women, infants, and children. We must probe the enigmatic connection between drugs of abuse and the immune system. And we must ensure that HIV risk-reduction strategies are incorporated into all appropriate NIDA-funded research strategies.
In short, we must further demonstrate to the public that preventing the spread of AIDS means, in large part, preventing drug abuse.
In broadening the scope of our research, we are not lessening our commitment to drug abuse research. By mounting an enhanced, research-based response to the AIDS epidemic, NIDA is also tapping new opportunities for scientific advancement that extend beyond AIDS. The Institute's AIDS research helps us learn more about how drugs of abuse work in the central nervous system, how disease spreads among at-risk subgroups of drug abusers, how drug-related cellular and molecular mechanisms modulate the progress of disease, and how the immune system functions to protect the human body from invading microorganisms.
NIDA's broadened research agenda will help us learn how to devise innovative therapies and responses effective not only against AIDS but also against drug abuse.
From NIDA NOTES, May/June 1995
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