Four decades after the initial HIV case was reported, strategies for treating and preventing the disease continue to advance. In the United States, the HIV epidemic continues to disproportionately affect people who are Black or Hispanic, men who have sex with men, people who are transgender, and individuals who use illicit drugs. HIV is increasingly diagnosed in older adults, and one-fourth of HIV-positive people will be older than 65 years by 2030. One creative mechanism that has been developed to foster collaboration is the multidisciplinary AIDS research center. Much of the needed behavioral and social research on AIDS prevention requires large, multidisciplinary teams of scientists with close working relationships with many of the different communities in which interventions must be conducted.

The committee recommends the use of PHS fellowship programs and Intergovernmental Personnel Appointments (IPAs) as an interim means for rapidly enlarging the cadre of senior behavioral and social scientists working on AIDS programs at CDC and other PHS agencies. The remedy for this problem is to establish a singly constituted group in which to assess treatment effects. To be included in the group, a person must satisfy the criteria for inclusion in the program. Then, a subset of that one group is randomly chosen to receive the intervention, thus producing two comparable subgroups that are not identical but are as alike as two random samples drawn from the same population. Since AIDS was first recognized, there has been growing appreciation of the critical role played by IV drug use in the spread of HIV infection. As of November 14, 1988, 20,752 cases of AIDS—approximately one quarter of all cases—had been diagnosed in individuals who reported using IV drugs.

What factors affect HIV treatment in children and adolescents?

Direct estimates are based on surveys (e.g., the National Household Survey on Drug Abuse, conducted by NIDA), on back-extrapolation methods, or on dual-systems estimates. Several factors can make medication adherence iv drug use difficult for children and adolescents with HIV. The use of HIV medicines and other strategies have helped to lower the rate of perinatal transmission of HIV to 1% or less in the United States and Europe.

Given the high relapse rates of drug users after they leave drug treatment programs and the ineffectiveness of currently available treatment for some injectable drugs, the complete elimination of injection behavior is not a realistic goal. Moving toward a more moderate, more realistic set of goals will broaden the possible approaches to risk reduction programs; these efforts should include mechanisms to prevent relapse. The committee recommends that high priority be given to research that will lead to improved drug-use treatment, including studies of relapse prevention and of treatment for cocaine dependence. The AIDS epidemic and the role of IV drug use in the transmission of HIV have also focused the nation’s attention on the prevention of drug use and the efficacy of drug treatment programs. These issues are of great concern to the Academy complex1 and to the nation; yet it is not possible to review the extensive literatures of these topics here.

Investigating Risk-Associated Drug Behaviors

Gerstein (1976) also distinguishes between different types of IV drug users, ranging from the hard-core “strung-out” users who inject frequently to situational users who inject only occasionally. There has been much less research on initiation into the injection of other illicit drugs (e.g., cocaine or amphetamines) than on initiation into heroin use. As is the case with most mathematical models, models of heroin consumption could benefit from further elaboration and the use of other mechanisms to improve their predictive powers.

Women who are financially dependent on men or who exchange sex for money or other necessities of life may face the dilemma of choosing between economic survival and unsafe sex (Worth, 1988). In cities with relatively few IV drug users, the equivalent of a shooting gallery may be the dealer’s apartment, a rented room, or a hotel room in which the dealer makes “house works” available to inject drugs at the time of purchase. The house works are borrowed, used to inject the drugs, and returned to the dealer for the next user—again, often without adequate cleaning or sterilization.

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They also vary across cultures and geographic locations, as well as by age, race, gender, and ethnicity. These variations have important implications for the spread of HIV that cannot be captured by or understood through cross-sectional studies that provide only a “snapshot” view of evolutionary and variable behaviors. It will be necessary to make a long-term commitment to a diversified behavioral research portfolio on IV drug use with sufficient support to sustain these efforts.