USIS Washington File - December 6, 2005
Todd Bullock, Washington File Staff Writer

The finding comes at a time when several world regions are experiencing soaring HIV prevalence rates due to intravenous drug abuse.

Intravenous drug use is propelling HIV epidemics in countries such as Iran, Libya, Pakistan, Spain, Ukraine and Uruguay, according to international research.

ôDrug abuse prevention is HIV prevention," said Dr. Nora Volkow, director of NIDA, one of the National Institutes of Health. She was speaking at a November 29 conference entitled Linked Epidemics: Drug Abuse and HIV/AIDS.

"Because illicit drug use encourages risky behaviors that can promote HIV transmission, NIDA views drug abuse treatment as essential HIV prevention," she said.

"Drug abuse and addiction can also worsen the progression of HIV and its consequences, especially in the brain," Volkow said, adding that the combination of HIV with cocaine "dramatically accelerates HIV-degeneration of neural cells."

Additionally, Volkow said, drug abuse can interfere with the efficacy of highly active antiretroviral therapy (HAART), a treatment that can greatly extend the lives of people infected with HIV.

Established in 1974, NIDA is part of the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services. NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction and conducts public health and prevention campaigns.

Other research has shown HIV can continue to replicate in people who abuse methamphetamine, despite HAART treatment, which works to reduce the level of virus in the system of most patients.

Addressing HIV prevention among current intravenous drug users (IVUs), NIDA-supported research also shows that drug abuse treatment programs can reduce the risk of HIV transmission by promoting abstinence from drug use and reducing risk behaviors, such as unprotected sex, that are known to promote HIV transmission, Volkow said.

Numerous studies also show that methadone therapy for IVUs is an effective strategy for decreasing HIV transmission, she said, adding that a reduction in use was accompanied by a significant drop in HIV risk -- mainly the result of fewer sexual partners and less unprotected sex.

In addition to methadone treatment, she also cited sterile syringe access programs as effective in reducing the further spread of HIV among IVUs, as well as their sexual partners.

According to the U.S. Center for Disease Control (CDC), for injection drug users who cannot or will not stop injecting drugs, using sterile needles and syringes remains the safest, most effective approach for limiting HIV transmission.

"They must be advised to always use sterile injection equipment; warned never to reuse needles, syringes, and other injection equipment; and told that using syringes that have been cleaned with bleach or other disinfectants is not as safe as using new, sterile syringes," a CDC fact sheet said.

For example, international investigators found that in 29 cities with established sterile syringe access programs HIV infections among IVUs decreased an average of 5.8 percent per year but increased an average of 5.9 percent per year in cities without such programs.

NIDA'S DUAL PREVENTION STRATEGY

As the data mounts on the significance of drug users in the spread of the AIDS epidemic, NIDA released its latest public awareness campaign, Drug Abuse and HIV: Learn the Link, which includes a public service announcement targeting youth audiences.

"Research has shown that a significant proportion of young people are not concerned about becoming infected with HIV," Volkow said.

The announcement will be shown on all major U.S. television networks, including popular networks such as MTV.

In addition to the media campaign, NIDA and other U.S. nonprofit organizations are working together to develop "peer based" HIV-drug abuse prevention campaigns which will target youth audiences.

Volkow also cited NIDA efforts to develop school/community-based HIV prevention programs designed for urban underprivileged youth, considered highly vulnerable to drug abuse and HIV exposure. These programs can be effective in reducing high-risk behaviors, including drug abuse and risky sexual practices that can lead to HIV infection, she said.

GLOBAL TRENDS

"This trend is resulting in an explosion of HIV infections among IVUs throughout the world," says Steffanie Strathdee, a professor of infectious disease epidemiology at the University of California at San Diego.

Strathdee cited the November 2005 report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) showing that 40.3 million adults and children are living with HIV. (See related article.)

Across Asia, especially in India, Indonesia and Vietnam, combinations of intravenous drug use and commercial sex propel HIV infections. IVUs account for 43.9 percent of HIV infections in China, according to Strathdee. HIV positive drug users are then transmitting the virus more widely into the society.

"It is often women with little or no income who are most at risk," Strathdee said. "Widespread inequalities including political, social, cultural and human security factors also exacerbate the situation for women and girls."

According to Strathdee, 85 percent of IVUs in Indonesia and Iran are HIV positive. Comprehensive prevention strategies that include elements such as condom distribution and methadone therapy for drug addicts need to be scaled up urgently, Strathdee said.

Strathdee touted Brazil as a model for providing treatment and prevention for drug addicts other developing nations but noted a lack of access to antiretroviral treatment for IVUs in regions, such as Eastern Europe, Central Asia and East Asia where infection rates are the highest and are continuing to soar.

In the Eastern Europe and Russia, the number of people living with HIV has increased by one quarter (to 1.6 million) since 2003. The number of AIDS deaths almost doubled (to 62,000) in the same period, she said, adding that in East Asia, the number of people living with HIV in 2005 increased by one-?fth (to 870 000), compared with two years earlier.

For additional information on efforts to fight the disease worldwide, see HIV/AIDS.

The NIDA's new public service announcement and more information on HIV prevention are available on the NIDA Web site.

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