Behavioral and social sciences research is playing an increasingly critical role in the Nation's public health response to the spread of AIDS, according to experts at a National Institutes of Health (NIH) symposium last summer.
Dr. James Curran, an AIDS epidemiologist and professor at Emory University in Atlanta, said that science has made significant advances in recognizing the "previously marginal" role for behavioral studies related to AIDS. He spoke at the half-day symposium, Substance Abuse and AIDS: Research from the Behavioral and Social Sciences. The meeting at the NIH campus in Bethesda, Maryland, was cosponsored by NIDA.
AIDS is still a young epidemic, said Dr. Curran, formerly head of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta. Early public responses tended to "ghettoize" those with AIDS, downplaying its spread into the general population through heterosexual contacts, he said. As a result, the public mistakenly has failed to recognize the importance of heterosexual contacts in the spread of HIV. Among women, particularly among poor and minority women, heterosexual sex is key to the currently increasing rate of HIV infections, he said. Statistics from the CDC support this view. In September, the CDC reported that the number of AIDS cases is increasing faster among women than among men and that sex with infected men has overtaken drug abuse as the leading cause of HIV infection among women. From 1991 through 1995, the number of men diagnosed with AIDS increased by 12.8 percent, versus an increase of 63 percent for women. However, many of the sex partners of these HIV-infected women are men whose own infections are drug abuse related.
Behavioral factors play an important part in these gender differences, say experts. Studies show that homosexual men, who now account for approximately 48 percent of all AIDS patients, are often well educated, aggressive about their treatment options, and responsive to prevention efforts. But many women with HIV are poor, are not well educated, and may have limited access to health care. As a result, these women may not respond as well as some men do to prevention or treatment efforts. Behavioral studies are vital to learning more about the spread of the HIV infection, agreed Dr. William Paul, former director of NIH's Office on AIDS Research. After reviewing NIH-supported AIDS research, outside experts recommended strengthening the social sciences and behavioral components of the research portfolio, advice now being heeded in NIH's AIDS research agenda, said Dr. Paul. NIDA ranks third among NIH Institutes in the level of funding it receives for AIDS studies, and much of the NIDA-supported research is already devoted to behavioral and social sciences investigations into the link between drug abuse and AIDS.
"AIDS and drug abuse are two epidemics that are totally intertwined," NIDA Director Dr. Alan I. Leshner reminded those attending the session. "It's impossible to speak about one and not the other. Behavioral and social science research is critical to gaining insights into the epidemiology of AIDS, and it helps the broader scientific community get a handle on this intersection of drug abuse and AIDS."
Studies of social and personal networks are vital to understanding HIV transmission and prevention, said Dr. Carl Latkin, a NIDA-supported researcher at Johns Hopkins University in Baltimore. "We need to look not so much at individual behavior but more at social-network aspects of behavior," he said. "We need to learn more about support networks that provide protection against HIV transmission and risk networks that actually promote high-risk behaviors."
Numerous studies have documented that significantly lower rates of HIV risk behaviors are practiced by drug abusers who are enrolled in treatment programs, said Dr. David Metzger, another NIDA-funded researcher at the University of Pennsylvania. "The consistency of these findings suggests that increasing the access to drug abuse treatment is a legitimate and absolutely necessary HIV prevention activity," he said. "Although the data [supporting the effectiveness of drug abuse treatment in preventing HIV transmission] are strongest for methadone treatment of opiate dependence, there also is growing awareness of the important role that noninjection drug use has played in the sexual transmission of HIV."
He noted that the protective effects of drug abuse treatment are not immediate and not universal. This underscores the need to investigate all modalities of treatment to document the effectiveness of each in changing behaviors to prevent HIV transmission.