The HIV/AIDS epidemic has always been a moving target for health and prevention planners, with infection rates rising in some population groups as they level off or fall in others. Recently, the disease has spread most rapidly among women, minorities, lower income groups, and young men who have sex with men (MSM). Of particular concern to NIDA are the heavy burden of HIV among African-Americans and the growing importance of heterosexual activity associated with drug use as a source of viral transmission. To elucidate the current dynamics, NIDA has developed two new initiatives: Health Disparities in HIV/AIDS: Focus on African Americans (PA-06-069) and Non-injection Drug Abuse and HIV/AIDS (PAS-06-054).

AFRICAN-AMERICANS: HIGHER PREVALENCE, WORSE PROGNOSIS

People from all racial and cultural backgrounds contract HIV/AIDS, but in the United States, African-Americans carry a disproportionate burden of the disease. Although they make up only 12 percent of the U.S. population, African-Americans accounted for half of the new AIDS cases diagnosed in 2003. Of persons diagnosed with AIDS since 1995, a smaller percentage of African-Americans (60 percent) than Whites (70 percent) were alive 9 years after diagnosis. NIDA-supported investigators have identified some contributing factors:

• A higher likelihood that a particular episode of sexual activity or injection drug abuse will result in HIV transmission among African-Americans than other ethnic groups: The elevated prevalence of HIV in the African-American community raises the chances that a sexual or needle-sharing partner will have the virus.
• Lack of awareness of HIV status: African-Americans account for more than half of those receiving an AIDS diagnosis within 1 year of testing positive for HIV, an indication that the infection went undiagnosed for a long time. A related finding suggests that as many as 90 percent of African-American HIV-positive MSM do not know they are infected.

NIDA's African-American initiative will support research to further illuminate the causes of the HIV disparities affecting African-Americans, as well as research on:

• Access to HIV treatment and services available to drug-abusing African-Americans;
• Connections between HIV/AIDS and criminal justice involvement;
• Mental health issues that influence HIV high-risk behaviors; and
• Sociocultural factors that enhance, sustain, or perpetuate health disparities.

NONINJECTION DRUG USE AND HIV/AIDS

Since the early years of the epidemic, NIDA-supported research contributed to a decline in the proportion of HIV/AIDS cases attributable to injection drug use. Now, NIDA is also focusing attention on ways that noninjection drug use—more prevalent by far—may contribute to new HIV infections. We know that drug abuse affects judgment and may lead to high-risk sexual encounters that increase transmission rates. There also is evidence that, regardless of the route of exposure, drugs have immunological effects that may increase the risk of HIV transmission and disease sequelae. To further advance scientific understanding of the relationships, we support studies that help explain how, where, why, and among whom HIV/AIDS is spreading through noninjection drug use and associated high-risk sexual behavior; and studies that develop effective prevention and treatment interventions.

Volume 20, Number 6 (July 2006)