1. National Institute on Drug Abuse
Drug Abuse and HIV/AIDS
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse

2. Estimated Number of AIDS Cases and Deaths
Among Adults and Adolescents By Exposure Category
United States and Dependent Areas
The proportional distribution of AIDS cases by transmission category has shifted since the beginning of the epidemic. In 1985, male-to-male sexual contact accounted for 64% of all AIDS cases; in 2006, this transmission category accounted for 43% of all AIDS cases.
The proportion of AIDS cases attributed to injection drug use increased during 1985–1994 and then slightly decreased, accounting for 19% of cases in 2006.
The proportion of AIDS cases attributed to male-to-male sexual contact and injection drug use decreased from 9% in 1985 to 5% in 2006.
The proportion of AIDS cases attributed to high-risk heterosexual contact increased from 3% in 1985 to 32% in 2006.
The remaining AIDS cases were those attributed to hemophilia or the receipt of blood or blood products and those in persons without an identified risk factor.
The data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed.

3. Although It Has Improved in Some Places,
Injection Drug Use Remains A Significant
HIV Transmission Mode In Many Regions of the World
Estimated Number of Adults & Children Living With HIV
Oceania
Latin America and Caribbean
Asia
Middle East & North Africa
North America and W & C Europe
Sub-Saharan Africa
Eastern Europe & Central Asia 40
MSM
Hetero, IDU 35
IDU, Hetero 30
MSM, Hetero, IDU
Number of people living with HIV (millions) 25
MSM, Hetero, IDU 20
IDU 15
Hetero, IDU↑ 10 5
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year

5. Source: Des Jarlais et al AIDS, 21: 231-235, 2007.
Convergence of HIV Seroprevalence Among Injecting and Non-injecting Drug Users
Drug Treatment Program
Respondent-Driven Sampling
(n= )
(n= ) 5 10 15 20 5 10 15 20
17%
15%
CI 12-21%
13%
CI 11-19%
12%
CI 12-15%
CI 9-16%
HIV Prevalence
Current
Injectors
Non-Injectors
Current
Injectors
Non-Injectors
Source: Des Jarlais et al AIDS, 21: , 2007.

6. Drug and Alcohol Intoxication MARKEDLY Disrupt Brain Function:
Effects of alcohol intoxication on brain metabolism
sober
intoxicated (0.1 mg%)

7. In Adults, Emotional Self Regulation Is Normally
Implemented By A Neural Circuit Comprising
Various Prefrontal Regions…& Subcortical Limbic Structures
Source: Beauregard, M. et al., Journal of Neuroscience 21 RC165, 2001.
Sexual Arousal Condition
Attempted Inhibition Condition
Attempted Inhibition
Condition

8. Effects of Alcohol Intoxication on Brain Glucose Metabolism (Marker of Brain Function)
Decreases
prefrontal cortex
cingulate gyrus
Increases
amygdala
Alcohol decreases activity of areas involved with control and increases activity of areas involved with emotional reactivity

9. In the United States, Minorities are Disproportionately Affected by HIV/AIDS Infection

10. Reported AIDS Cases, By Racial/Ethnic Group Cumulative Through 2006
United States and Dependent Areas
The proportional distribution of AIDS cases among racial/ethnic groups has changed since the beginning of the epidemic. The proportion of AIDS cases in whites (not Hispanic) has decreased while the proportions in blacks (not Hispanic) and Hispanics have increased. The proportion of AIDS cases among Asians/Pacific Islanders and American Indians/Alaska Natives has remained relatively constant, at approximately 1% of all cases.
Of persons diagnosed with AIDS in the United States and dependent areas in 2006, 48% were black, 29% were white, 21% were Hispanic, 1% were Asian/Pacific Islander, and less than 1% were American Indian/Alaska Native.
The data have been adjusted for reporting delays.
Slides containing more information on HIV and AIDS in racial and ethnic minorities are available at

11. Estimated Number of Adults and Adolescents Living with AIDS By Sex
United States and Dependent Areas
This slide shows increases in the number of adults and adolescents living with AIDS in the United States and dependent areas from 1993 through The increase is due primarily to the widespread use of highly active antiretroviral therapy, introduced in 1996, which has delayed the progression of AIDS to death. At the end of 2006, an estimated 447,720 adults and adolescents were living with AIDS; of these, 77% were males and 23% were females. The data have been adjusted for reporting delays.

12. Reported AIDS Cases, By Sex and Transmission Category,
Cumulative Through 2006
United States and Dependent Areas
Of AIDS cases diagnosed in 2006 among male adults and adolescents, 59% were attributed to male-to-male sexual contact and 16% were attributed to injection drug use. Approximately 17% of cases were attributed to high-risk heterosexual contact and 7% were attributed to male-to-male sexual contact and injection drug use.
Most (73%) of the AIDS cases diagnosed in 2006 among female adults and adolescents were attributed to high-risk heterosexual contact, and 24% were attributed to injection drug use.
The data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed.

13. HIV Seroconversion at 18 Months By Receipt of Treatment
Among IDUs the Most Effective HIV/AIDS
Prevention Strategy is Drug Abuse Treatment
HIV Seroconversion at 18 Months By Receipt of Treatment 25 20
No treatment
Partial treatment
Rate of Seroconversion (%) 15
Continuous treatment 10 5
Treatment Status
Source: Metzger, D. S., Woody, G. E., McLellan, A. T., O’Brien, C. P., Druley, P., Navaline, H., De Philipps, D., Stolley, P., & Abrutyn, E. (1993). Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: An 18-month prospective follow-up. Journal of Acquired Immune Deficiency Syndromes, 6,

14. Although We Do Have Treatments That Work
We Face Some Major Challenges in Using Them
Criminal Justice System’s
Reluctance to Use
Many Countries’

15. Future Research Long-Acting Injectable Medications
Depot Naltrexone
80%
192 mg Dose
Placebo
384 mg Dose
70%
Long-Acting Injectable
Medications
(i.e. Depot Naltrexone)
Immunotherapies for
Addiction Treatment
(i.e. Vaccines)
60%
50%
% Negative Urines
40%
30%
20%
10% 0% 2 4 6 8 10 12 14 16 18
Visits (2 per week)
Comer, S.D., et al. Arch Gen Psych, 63, , 2006.

16. Since Vaccine Strategies Have Not Yet Worked
We Need to Focus More Efforts on
Prevention Strategies and their Implementation

18. Extended Back-Calculation Model,
Estimated New Human Immunodeficiency Virus (HIV) Infections by Transmission Category,
Extended Back-Calculation Model,
50 US States and the District of Columbia,
80000
70000
60000
50000
40000
30000
20000
10000
MSM
IDU
MSM/IDU
Heterosexual
Injections
1977-
1979
1980-
1981
1982-
1983
1984-
1985
1986-
1987
1988-
1990
1991-
1993
1994-
1996
1997-
1999
2000-
2002
2003-
2006
Period
Hall, H. I. et al. JAMA 2008;300:
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