Letter from the Director

Human immunodeficiency virus (HIV) — the virus that causes acquired immune deficiency syndrome (AIDS) — has been with us for three decades now. Today, an entire generation of young adults has never known a world without HIV/AIDS.

Initially characterized by relatively localized outbreaks and then reaching pandemic proportions, the explosive spread of HIV is being reined in by the advent of highly active antiretroviral therapy (HAART) and preventative strategies. And yet, in the United States alone, approximately 50,000 people are newly diagnosed each year — and one in five people living with HIV are unaware they are infected.

Scientific discoveries are moving us closer to envisioning an AIDS-free generation as we continue to take steps toward ending this disease. Improving access to drug abuse treatment; increasing condom use and male circumcision; preventing mother-to-child transmission; implementing syringe-exchange programs combined with HIV risk-reduction strategies; achieving wider distribution of antiretroviral therapies; and scaling up HIV screening to identify infected people early and link them to care are proven strategies toward reaching this goal. New research in basic HIV biology is also providing clues as to how we might successfully purge the pockets of latent virus in HIV-infected persons and thereby achieve a true cure for the HIV/AIDS epidemic.

This Research Report is designed to highlight the state of the science and to raise awareness of the link between HIV/AIDS and drug abuse — not just injection drug use but drug abuse in general. People who are high on drugs or alcohol are more likely to have unsafe sex that might expose them to HIV and other infectious diseases. In some populations, HIV prevalence is converging among injection and noninjection drug users, suggesting that the risky behavior associated with drug abuse in general is fueling the sustained spread of the virus. For this reason, drug abuse treatment is HIV prevention.

As the following pages demonstrate, NIDA’s multifaceted approach continues to reveal more about the pivotal role of drug abuse in the spread of HIV and to inform effective strategies to prevent and treat it.

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