NIDA disburses more than $275 million annually to support research on HIV and AIDS. The mandate to ensure that this investment yields the greatest possible return in new knowledge leading to more effective treatment and prevention lies with NIDA's AIDS Research Program.
Under the direction of Dr. Jacques Normand, the AIDS Research Program oversees all the Institute's HIV-related grantmaking. Dr. Normand works with three associate directors: Dr. Lynda Erinoff is in charge of planning the basic science grant portfolio; Ms. Helen Cesari manages the social science programs; and Ms. Katherine Davenny coordinates collaborative projects with other NIH Institutes and external organizations engaged in HIV/AIDS research. Every other month, the AIDS Research Program staff convenes an AIDS workgroup consisting of 20 NIDA grantmaking staff with expertise in all science areas relevant to HIV, including representatives from four Program Divisions, three Offices, the Center for Clinical Trials Network, and the International Program. In the meetings, NIDA scientists exchange up-to-date information, identify research needs and opportunities, set priorities, and look for ways to coordinate ongoing research and new initiatives.
U.S. AIDS Epidemic Shifts. (A) The proportion of newly diagnosed AIDS cases due to injection drug use has dropped since the 1980s, and the proportion due to heterosexual contact has increased. (B) Forty-seven percent of newly diagnosed AIDS cases in 2003 were in non-Hispanic Blacks.In pursuing its mandate, the AIDS Research Program builds upon NIDA's more than 20-year history of accomplishment in HIV research. In the early 1980s, when it became apparent that injection drug use was playing a critical role in the spread of the newly recognized deadly disease, Congress identified NIDA as a key component of the Nation's response. The Institute initiated a research program that has had significant impact on the epidemic.
Along with underwriting studies leading to crucial discoveries, such as the finding that providing methadone treatment slows the spread of the disease among injection opioid abusers, NIDA has supported the development and testing of effective science-based education, outreach, and preventive interventions for drug-abusing and other at-risk populations. Partly as a result of these efforts, the number of newly diagnosed AIDS cases attributable to injection drug use in the United States dropped from 19,943 in 1995 to 6,938 in 2004.
Shifting With the Epidemic
Established in February 2005, the AIDS Research Program has come into being at a time when the character of the HIV epidemic is in transition. Since the mid-1980s, heterosexual contact—often with an injection drug user or while under the influence of drugs—has become an increasingly important route of transmission of the HIV virus. The proportion of newly diagnosed AIDS cases attributable to heterosexual contact has increased while that attributable to sexual contact among men who have sex with men and that directly attributable to injection drug use have dropped. The rise in heterosexual transmission has been especially pronounced among African-Americans and women (see graph).
A recent case highlights the AIDS Research Program's role in generating efficient responses to developments in the epidemic. In February 2005, New York City public health officials reported that a new strain of HIV had been isolated from a methamphetamine-abusing man who engaged in high-risk sex with male partners. The patient responded poorly to initial treatment and progressed rapidly from infection to AIDS. The officials, worried that such a highly virulent, treatment-resistant strain might become widespread, called for heightened monitoring of treatment-resistant HIV. The AIDS Research Program and the AIDS workgroup promptly developed a plan to promote collaborations between epidemiologists, social scientists, virologists, immunologists, and infectious disease experts. Their work aims to produce a comprehensive assessment of the potential for treatment-resistant viral strains among infected men who have sex with men and who also abuse methamphetamine.
As they realign research priorities to match the new dynamics of the epidemic, NIDA's AIDS Research Program and the AIDS workgroup members will draw on the results of NIDA's Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATH-CAP). This program's four interdisciplinary research teams are studying the patterns of viral spread from high-risk, drug-using groups to lower risk groups; for example, from drug injectors to noninjecting sexual partners, or from bisexual men to female sexual partners. Mapping these patterns will enable prevention practitioners to focus their initiatives on the social networks and activities with the most potential for containing the spread of the epidemic. SATH-CAP investigative teams are working in geographical areas where HIV is in a rapid process of bridging from one population to another. For example, one team is studying the epidemic in St. Petersburg, Russia, where the primary route of transmission is in transition from injection drug use to sexual contact.
The treatment-resistant HIV and SATH-CAP initiatives exemplify how NIDA, through the AIDS Research Program, brings the power of interdisciplinary research to bear on the intertwined problems of drug abuse and HIV/AIDS. "Interdisciplinary research among investigators with different expertise typically does not happen without coordination," says Dr. Normand. "The AIDS Research Program is the place where NIDA ensures that its research on epidemiological, biological, and behavioral aspects of the infection among drug abusers works in concert and that knowledge from the research is translated into clinical and community practice."