Closing the Implementation Gap to Stop HIV/AIDS

Levine: Can people addicted to drugs be treated for AIDS in spite of their struggle against two diseases? For Dr. Julio Montaner the answer is unequivocally yes. And he says it's crucial to controlling the epidemic.

Dr. Montaner: Why are we not doing what we're supposed to be doing which is to offer treatment to the people who need treatment?

Levine: Montaner heads the International AIDS Society and serves as clinical director of a major AIDS research and treatment program in Vancouver, Canada. Much of Montaner's work is supported by the Canadian government as well as the National Institute on Drug Abuse at NIH. Montaner makes the case for what he calls the "treatment as prevention" approach. He points out how his studies of Vancouver patients along with other research shows the value of treating patients many think are likely to fail.

Dr. Mantaner: We have been able to show as a result first decreased morbidity and mortality related to AIDS, among these populations which are extremely important. But secondly, we showed that the clinical benefit that they derive is the same as the non-drug user. And thirdly, a societal benefit that is equally important is that we saw a fifty percent decrease in new HIV infections among drug users. So, the treatment is working better for the patients and it's working better for society.

Levine: Montaner emphasizes that his results clearly show that, when it comes to HIV/AIDS, treatment means prevention.

Dr. Mantaner: The data is all in; the mathematics are sound; the cost effectiveness is a no-brainer; the benefit to the individual is absolute. Listen, let's be clear. I'm not talking here about treating people who do not have a medical indication for treatment. I am specifically saying that we need to make our treatments accessible to 100 percent of those who have a medial indication for treatment. If we don't address the epidemic in these minorities, whether it's sex trade workers or substance users or homosexual minorities or racial minorities, we will not be able to address the epidemic.

Levine: Montaner says he will work with NIDA Director Dr. Nora Volkow and others to press the case for expanding HIV treatment to drug abusers worldwide at the International AIDS Conference in Vienna this July. He spoke recently at a lecture on the NIH campus. For more information on drug addiction, visit www.nida.nih.gov; and for details on AIDS research, visit www.niaid.nih.gov. This is Jeff Levine, National Institutes of Health, Bethesda, Maryland.