Drug Abuse

and HIV

Research Report Series

U.S. Department of Health and Human Services | National Institutes of Health

from the director:

Human immunodeficiency virus (HIV) —

the virus that causes acquired immune

deficiency syndrome (AIDS) –– has been

with us for three decades now. Today, an

entire generation of young adults has never

known a world without HIV/AIDS.

Initially characterized by relatively localized

outbreaks and then reaching pandemic

proportions, the explosive spread of HIV

is being reined in by the advent of highly

active antiretroviral therapy (HAART) and

preventative strategies. And yet, in the

United States alone, approximately 50,000

people are newly diagnosed each year —

and one in five people living with HIV are

unaware they are infected.

Scientific discoveries are moving us closer

to envisioning an AIDS-free generation as

we continue to take steps toward ending

this disease. Improving access to drug

abuse treatment; increasing condom

use and male circumcision; preventing

mother-to-child transmission; implementing

syringe-exchange programs combined with

HIV risk-reduction strategies; achieving

wider distribution of antiretroviral therapies;

and scaling up HIV screening to identify

infected people early and link them to care

are proven strategies toward reaching this

goal. New research in basic HIV biology is

also providing clues as to how we might

successfully purge the pockets of latent

virus in HIV-infected persons and thereby

achieve a true cure for the HIV/AIDS

epidemic.

This Research Report is designed to

highlight the state of the science and to

raise awareness of the link between HIV/

AIDS and drug abuse — not just injection

drug use but drug abuse in general. People

who are high on drugs or alcohol are more

likely to have unsafe sex that might expose

them to HIV and other infectious diseases.

In some populations, HIV prevalence is

converging among injection and noninjection drug users, suggesting that the

risky behavior associated with drug abuse

in general is fueling the sustained spread

of the virus. For this reason, drug abuse

treatment is HIV prevention.

As the following pages demonstrate,

NIDA’s multifaceted approach continues to

reveal more about the pivotal role of drug

abuse in the spread of HIV and to inform

effective strategies to prevent and treat it. 

Nora D. Volkow, M.D.

Director

National Institute on Drug Abuse

How Is HIV Detected?

See page 2.

What is

HIV/AIDS? 

continued inside

Human immunodeficiency virus (HIV) is the virus that causes acquired immune 

deficiency syndrome (AIDS) and is transmitted through contact with infected blood 

and bodily fluids. Such contact can occur through unprotected sex, through sharing 

of needles or other drug injection equipment, through mother-to-child transmission during 

pregnancy or breast-feeding, and through receipt of infected blood transfusions and plasma 

products during medical care in some parts of the world. There is currently no cure for HIV/

AIDS. Once an individual contracts HIV, he or she has it for life. 

HIV infects immune cells in the body called CD4 positive (CD4+) T cells, which are 

essential for fighting infections. HIV converts these cells into “factories” that produce more 

of the HIV virus to infect other healthy cells, eventually destroying the CD4+ cells. An 

infected person may look and feel fine for many years and may not even be aware of the 

infection. However, as the individual loses CD4+ cells and the immune system weakens, he 

or she becomes more vulnerable to illnesses and other infections. Physicians make an AIDS 

diagnosis when a patient has one or more of these illnesses and a CD4+ cell count of less 

than 200. Treatment for HIV typically involves highly active antiretroviral therapy, better 

known as HAART.
Research Report Series

What Is HAART?

HAART is a customized combination

of different classes of medications 

that a physician prescribes based 

on such factors as the patient’s 

viral load (how much virus is in 

the blood), the particular strain of 

the virus, the CD4+ cell count, and 

other considerations (e.g., disease 

symptoms). Because HAART 

cannot rid the body of HIV, it must 

be taken every day for life. HAART 

can control viral load, delaying or 

preventing the onset of symptoms 

or progression to AIDS, thereby 

prolonging survival in people 

infected with HIV. HAART has been 

in use since 1996 and has changed 

what was once a fatal diagnosis into 

a chronically managed disease.1

How Does Drug

Abuse Affect the

HIV Epidemic?

Drug abuse and addiction have been 

inextricably linked with HIV/AIDS 

since the beginning of the epidemic. 

While intravenous drug use is well 

known in this regard, less recognized 

is the role that drug abuse plays more 

generally in the spread of HIV by 

increasing the likelihood of highrisk sex with infected partners.3

 The

intoxicating effects of many drugs 

can alter judgment and inhibition and 

lead people to engage in impulsive 

and unsafe behaviors. Also, people 

who are abusing or addicted to 

drugs may engage in sexually risky 

behaviors to obtain drugs or money 

for drugs. Nearly one-quarter of 

How Is HIV Detected?

When a person contracts HIV, his or her immune system produces

antibodies, which are proteins that recognize the virus. The most

commonly used HIV tests detect the presence of these antibodies.

There are rapid tests that can provide results in 20 minutes2

, but

it usually takes 6–8 weeks after someone has been exposed to

the virus for enough HIV antibodies to accumulate for accurate

detection through testing (although improved HIV tests are now

reducing this window to 2 weeks). This period represents one of the

most dangerous for HIV transmission, since a person can receive a

negative test result and yet be highly infectious, capable of rapidly

spreading the virus through unsafe behaviors. The Centers for

Disease Control and Prevention (CDC) now recommends that HIV

testing be provided to anyone 13–64 years old as part of routine

medical care and that this screening be performed annually for

anyone at high risk for HIV infection (e.g., drug abusers, men who

have sex with men, and sex workers). NIDA is collaborating with

the Substance Abuse and Mental Health Services Administration

(SAMHSA) and others to expand rapid HIV testing to drug

treatment facilities to better identify HIV infections and to more

efficiently engage patients in comprehensive treatment for both

drug addiction and HIV infection.

Estimated Persons Living with HIV Infection (Diagnosed and

Undiagnosed)†

 and Estimated AIDS Deaths Among Adults

and Adolescents — United States, 1981–2008

*Estimates were obtained by statistically adjusting the national HIV surveillance data reported through June

2010 for reporting delays, but not for incomplete reporting.

†

HIV prevalence were estimated based on national HIV surveillance data for adults and adolescents (aged

≥13 years at diagnosis) reported through June 2010 using extended back-calculation.

Source: Centers for Disease Control and Prevention

2 NIDA Research Report Series

Drug Abuse

and HIV
AIDS cases stem from intravenous 

drug use, and one in four people

living with HIV/AIDS in the period 

of 2005–2009 reported use of alcohol

or drugs to an extent that required 

treatment.4

Drug abuse and addiction can 

also worsen the progression of HIV 

and its consequences, especially in 

the brain. For example, in animal 

studies, methamphetamine increased 

the amount of HIV virus present in 

the brain;5 and in human studies, 

HIV caused greater neuronal 

injury and cognitive impairment in 

methamphetamine abusers compared 

to non-drug users.6, 7

What Is the

Scope of HIV

in the United

States?

The Centers for Disease Control and

Prevention (CDC) estimates that 1.2

million people are infected with HIV

in the United States and that 1 in 5

(20 percent) are unaware that they

are infected. In 2010, over 47,000

people were newly diagnosed with

HIV, the majority of whom were men.

HIV infection is over-represented in

the African-American community:

African-Americans make up almost

one-half of the newly diagnosed

cases, followed by Whites and

Hispanics. 

Effective treatments have

dramatically decreased the number

of deaths from AIDS since the peak

years of the epidemic (1993–1998);

however, more than 17,000 people

still died from AIDS-related illnesses

in 2009. In fact, even among those

diagnosed with HIV, a substantial

proportion do not receive proper care

or remain in treatment (see figure).8

 

Additionally, the trend of people

living longer with HIV presents new,

long-term healthcare challenges for

this population.

How Has the

HIV Epidemic

Changed Over the

Past 30 Years?

CDC data reveal notable shifts in the

HIV epidemic in the United States,

with a higher proportion of new

infections today occurring among

young men who have sex with men

(MSM), racial/ethnic minorities,

and women. Early in the HIV/AIDS

epidemic, infections emerged mainly

among White, urban MSM, or male

injection drug users (IDUs). However,

over the past 30 years, the boundaries

between groups at greater and lesser

risk for contracting the virus have

been dissolving. From 2005 to 2008,

estimated HIV diagnoses increased

approximately 17 percent among

MSM, particularly minority MSM.

Risky sexual behavior linked to

substance abuse exacerbates this

trend, a specific example being the 

link between risky sexual behavior

and methamphetamine abuse.9

Number and Percentage of HIV-infected Persons 

Engaged at Each Stage of HIV Care

Source: Centers for Disease Control and Prevention, MMWR 2011, 60(47):1618-1623.

How Drug Abuse

Contributes to

HIV Transmission:

•	 Injection drug use: sharing

needles or other equipment

with an infected person.

•	 Sexual Contact:

–	 Unprotected sex due		

to intoxication, which		

can impair judgment		

and decisionmaking		

and reduce inhibitions

–	 Unprotected sex with		

an infected IDU

–	 Transactional sex to		

obtain drugs or money		

for drugs

NIDA Research Report Series NIDA	Research	Report	Series 3
(e.g., unprotected sex with an infected

partner) could be exposed to HIV

infection. However, while all groups

are affected by HIV, some are more

vulnerable than others, as summarized

below.

Men Who Have Sex with Men

Gay or bisexual MSM are the most

severely affected population. MSM

account for just a small fraction (2

percent) of the total U.S. population,

yet nearly two-thirds of all new

infections occurred within this

group in 2009, and one-half of all

people living with HIV in 2008 were

MSM. MSM within ethnic minority

populations are at greatest risk (see

“Ethnic Minorities,” page 5).

Injection Drug Users 

Injection drug use has long been

associated directly or indirectly with

approximately one-third of AIDS

cases in the United States. The fact

that IDUs made up only 8 percent of

new HIV infections in 2010 versus 23

percent in 1994–2000 demonstrates

the progress made in HIV prevention

 Although HAART has transformed the face of HIV/AIDS in this

country and around the world, it has

also altered the consequences of HIV

infection. While new diagnoses of

HIV-associated infections and some

neurological complications, such

as HIV dementia, have decreased

since the treatment’s introduction,1

other medical complications have

increased. For example, individuals

receiving HAART therapy are more

vulnerable to developing diabetes,

hypertension, and chronic kidney

disease.10 HIV+ patients also have

lower bone mineral density,11 which

HAART can amplify by contributing

to bone loss, resulting in fractures.

Some individual medications that

are included in HAART can be

toxic to the liver, especially in older

individuals, for whom liver function

may already be declining due to the

natural aging process; this can lead to

liver disease.12

Another unintended consequence

of effective HAART therapy is

the development of complacency.

Because HAART reduces viral load,

some patients mistakenly believe that

they do not need to adhere strictly

to the treatment regimen or that

reduced viral load means elimination

of transmission risk.13-15 This belief

can, in turn, lead to a resumption of

unsafe sex and drug abuse practices.16

These and other unhealthy behaviors,

such as smoking cigarettes, diminish

the benefit achieved with HAART 

therapy. For example, cigarette

smoking among HIV+ individuals

is 2–3 times higher than in the

general population. HIV-infected

smokers are unusually susceptible to

respiratory complications, chronic

obstructive pulmonary disease, lung

cancer, cardiovascular disease, and

suppressed immune function.17

Who Is at Risk

for HIV Infection

and Which

Populations Are

Most Affected?

Anyone can contract HIV, and while

IDUs are at great risk because of

practices related to their drug use,

anyone who engages in unsafe sex

Diagnosis of HIV Infection amoung Adults and 

Adolescents, by Transmission Category (2010)*

*These transmission categories do not distinguish infections resulting from non-injection drug use (e.g.,

sexual behavior resulting from drug or alcohol intoxication).

Source: Centers for Disease Control and Prevention

4 NIDA Research Report Series
and treatment within this population.

Still, much work remains; while there

may be fewer new infections among

IDUs, in 2009, nearly one-half of

those who were HIV+ were unaware

they were infected.18 

Women

Heterosexual contact with an HIV+

partner accounted for over onequarter of all new infections in 2010

and is the main way that women

contract the virus (see figure), 

especially within ethnic minority

communities. Regional variations

of HIV incidence in women have

changed over time. In the early years

of the epidemic, incidence in women

predominated in the Northeast, but

infection rates and mortality have

been steadily increasing in the

southern United States.19 Although

injection drug use has declined as

a means of HIV transmission over

recent years, it is still responsible

for 14 percent of HIV diagnoses in

women. A recent study conducted

by the Massachusetts Department of

Public Health reported 40 percent

of White women contracted HIV

through injection drug use.20 Another

factor contributing to HIV disease in

women is trauma. Trauma resulting

from sexual or physical abuse

experienced during childhood or

adulthood is increasingly associated

with rising prevalence of HIV

infection and poor health outcomes

in HIV+ women.21 Comprehensive

HIV treatment regimens that include

mental health services are critical for

this population.

Ethnic Minorities

HIV surveillance data show that

the rates of new HIV infection are

disproportionately highest within

ethnic minority populations. AfricanAmericans account for a higher

proportion of HIV infections than any

other population at all stages of the

disease from initial infection to death

(see text box, page 6). Moreover, 

specific minority subgroups are at 

Diagnosis of HIV Infection amoung Adults and Adolescents,

by Sex and Transmission Category (2010)

Source: Centers for Disease Control and Prevention

Hepatitis C and 

Co-Infection

with HIV

Hepatitis C virus (HCV), a leading 

cause of liver disease, is highly 

prevalent among injection drug 

users and often co-occurs with HIV. 

In the United States, an estimated 

3.2 million people are chronically 

infected with HCV,22 with injection 

drug use being the main driver. 

Nearly one-quarter of HIV patients 

and over one-half (50–80 percent) of 

IDUs are infected with both viruses. 

Chronic HCV and HIV co-infection 

results in an accelerated progression 

to end-stage liver disease, with HCV 

infection being a leading cause of 

non–AIDS-related deaths among 

HIV+ individuals.

Injection drug use, HIV, and HCV 

create a complicated tapestry of 

ailments that present a variety of 

challenges to healthcare providers. 

Although HAART medications can 

effectively treat people infected with 

HIV, HAART provides only modest 

benefit for co-occurring HCV. HCV 

infection, like HIV infection, 

can be successfully managed if 

detected early. The newer HCV 

medications boceprevir and 

telaprevir — approved by the U.S. 

Food and Drug Administration

(FDA) in 2011 — increase cure rates 

and decrease treatment length 

when combined with standard HCV 

drug regimens,23 but they must be 

carefully coordinated with HAART for 

those co-infected. The added burden 

of drug addiction further complicates 

treatment regimens. 

NIDA Research Report Series 5
Source: Centers for Disease Control and Prevention

The Differential HIV Experience

of African-Americans

While African-Americans make up 12 percent of the U.S. population, 

they accounted for 46 percent of new HIV infections in 2010,

substantially higher than the rate for Whites or Hispanics. The

majority of these were men (70 percent); however, African-American

women also have a high rate of HIV diagnosis –– nearly 20 times 

that of White women (see figure). More disheartening is that 1 in 

16 African-American men and 1 in 32 African-American women will 

eventually be diagnosed with HIV.

The causes of this HIV health disparity are complex. HIV infection 

prevalence is higher and more broadly represented in the AfricanAmerican community compared to the White population; thus 

African-Americans are at increased risk of infection simply by 

choosing intimate partners within their own ethnic communities.24

Additionally, African-American communities experience high 

rates of other sexually transmitted infections, and some of these 

infections can significantly increase the risk of contracting HIV. 

African-Americans also tend to be diagnosed at later stages in the 

disease and therefore begin therapy later, increasing the length of 

time of their infectivity. Once engaged in HAART, African-Americans

are more likely to discontinue therapy prematurely,25 risking 

resurgence of HIV infectivity and further health complications. 

To address these disparities, NIDA is encouraging research that 

expands and coordinates prevention and treatment strategies 

across Federal agencies and within communities to more effectively 

identify persons at risk and link them to the help they need. 

Additional efforts are being made to promote healthy lifestyle 

choices, safe sexual practices, and HIV and substance abuse 

treatment adherence in a way that is culturally relevant for the 

African-American community.

particular risk. Nearly two-thirds

(64 percent) of new HIV infections

among MSM occurred in minority

men (Black/African-American,

Hispanic/Latino, Asian/Pacific 

Islanders, and Native American/

Hawaiian). In addition, young

minority men (13–24 years old) had

the greatest increase (53 percent) of

HIV infections of all groups studied

between the years 2006 and 2009,

occurring predominantly in the South.

The Hispanic population

accounted for 1 in 5 new HIV

infections in the United States in 

2009 — a rate 3 times that of the

White community. A number of

factors contribute to the high levels of

HIV infection within this community,

including the country of birth. For

example, there is a substantially

larger proportion of HIV infections

attributed to injection drug use for

Hispanic men born in Puerto Rico

than anywhere else. Such differences

underscore the need for interventions

that are socially and culturally tailored

for specific populations.

Youth

Young people are also at risk for

HIV infection. Approximately 9,800

people aged 13–24 were diagnosed

with HIV in 2010, representing 20

percent of newly diagnosed cases,

0 20 40 60 80 100 120 140

Diagnosis Rate (per 100,000 population)

41.7

9.2

2.1

Female

White

Hispanic

Black

Estimated Rate of HIV Diagnosis by Gender and Race/Ethnicity (2010)

116

44.7

15.3

Male

White

Hispanic

Black

0 20 40 60 80 100 120 140

6 NIDA Research Report Series
with the highest rate occurring among

those aged 20–24. Particular HIV

risk behaviors within this age group

include sexual experimentation

and drug abuse, which are often

influenced by strong peer group 

relationships. Compounding this

vulnerability is “generational 

forgetting”: Studies show that today’s 

youth may be less likely to perceive 

the dangers associated with HIV than

are older Americans, who witnessed a

higher AIDS mortality rate associated 

with the rapid progression from HIV

to AIDS in the early years of the 

epidemic.

Older People

Sixteen (16) percent of new diagnoses

of HIV infection in the United States

in 2010 occurred among individuals

over the age of 50, and this number

has been increasing for the past 11

years.26 Some older persons do not

believe they are at risk and thus 

engage in unsafe sexual practices.

The problem is further exacerbated

by healthcare professionals who 

underestimate the vulnerability of this 

population.

The growing number of people

contracting HIV later in life,

combined with the prolonged survival

made possible by HAART, has 

contributed to an increasing number

of people over the age of 50 living

with HIV. This trend will continue,

and by 2015, the over-50 population 

is predicted to represent one-half 

of all HIV/AIDS cases.27 The aging

population presents a variety of 

treatment challenges. Older adults

progress more rapidly to AIDS, 

have a greater number of age-related 

comorbidities (e.g., cardiovascular

disease, limited mobility), and report 

smaller support networks than their

younger counterparts.28

Criminal Justice System

The criminal justice system 

is burdened with a significant 

population of HIV-infected 

individuals that can be 2 to 5 times

larger than that in the surrounding

community.29 An estimated 1 in

7 HIV+ individuals living in the

United States passes through this

system each year.30 The criminal

justice system is also burdened with 

significant substance abuse, with 

about one-half of Federal and State 

prisoners meeting the criteria for

drug dependence or abuse.31 Yet, few

offenders are screened for HIV,32

or receive treatment for substance

abuse and other mental illness

while incarcerated. This situation

is further exacerbated upon reentry 

when released offenders often lack

health insurance and fail to be linked

to continuing treatment programs

within the community. NIDA is 

helping to address these challenges by 

researching the best ways to identify 

and help prisoners get treatment for

both drug addiction and HIV while

incarcerated and in the community 

after release.

How Can HIV

Be Prevented

and Treated

in Drug-Using

Populations?

Cumulative research has shown

that drug addiction treatment,

community-based outreach, testing, 

and linkage to care for HIV and other

infections are the most effective

ways to reduce HIV transmission 

among drug-abusing individuals. 

Combined pharmacological and

behavioral treatments for drug abuse

have a demonstrated impact on HIV

risk behaviors and incidence of HIV

infection.33 For example, recent 

research showed that when behavioral

therapies were combined with

methadone treatment, approximately 

one-half of study participants who 

reported injection drug use at the

outset of the study reported no such 

use at the end of the study, and over 

Young people

are also at

risk for HIV

infection.

NIDA Research Report Series 7
their chaotic lifestyles has resulted in

delays in delivering HIV treatments

to drug abusing populations, or even

withholding of those treatments —

dramatically compromising the quality

of life for these individuals and their

partners (see figure). This further 

burdens the healthcare community,

leaving unchecked illness within this

population.35 These misperceptions 

have been refuted by a recent study

showing no difference in survival

between IDUs and non-IDUs

receiving HAART.36

Moreover, treatment of drug addiction

may actually improve adherence to

HIV treatment. Studies show, for 

example, that treating opioid addiction

with buprenorphine or methadone

improves both adherence to HAART 

and the quality of care in HIV+

individuals with a history of opioid

abuse.37,38 These studies confirm that 

drug addiction should not be a barrier

90 percent of all participants reported

no needle sharing.34 Drug treatment

programs also serve an important role

in providing current information on

HIV and related diseases, counseling

and testing services, and referrals for

medical and social services.

NIDA is also investing in research to

identify the most effective strategies

to treat HIV among drug users. The 

mistaken belief that IDUs are unlikely

to benefit from HAART because of 

to HIV treatment and that treatment

of both conditions is both necessary

and effective. 

NIDA-funded research is also

investigating new technologies

to make adherence easier, more

accessible, and relevant to targeted

audiences. For example, textmessaging and other smartphone

applications are being tested to help

HIV+ youth improve adherence

to HAART treatment. Culturally 

sensitive and gender-specific Web 

sites are also under development,

designed to provide information to

vulnerable populations to help modify

risky behaviors, prevent infection,

and build social support networks.

Finally, since treatment of 

co-occurring drug addiction and

HIV infection may involve the use

of multiple medications, there can be

a risk of drug interactions that can

HIV+ IDUs Are Less Likely to Receive

HAART Treatment than Non-IDUs

Opportunities

to Improve HIV

Prevention and

Treatment:

•	 Make HIV testing	a	routine

part of healthcare.

•	 Initiate HAART therapy early

to decrease HIV viral load and

reduce infectivity.

•	 Establish	a	continuum of

care to improve linkage to

substance abuse and HIV

treatment within the criminal

justice system and upon

prisoner reentry.

•	 Improve rates of testing and

treatment among AfricanAmericans, MSM, and other

groups disproportionately

impacted by the epidemic.

8 NIDA	Research	Report	Series
decrease the effectiveness of either or

both treatments. For instance, when

methadone is administered to treat

heroin and other opioid addictions

along with certain antiretroviral

medications (ARVs) that are

components of HAART therapy, the

concentration of methadone in the

blood is significantly decreased,39

potentially compromising its

effectiveness. Newer medications are

now available to address these issues.

Specifically, buprenorphine — a 

medication approved for the treatment

of opioid addiction in 2002 — does 

not display the same cross-reactivity

with the majority of ARVs and is thus

a better choice for HIV+ patients who

require treatment for both. 40, 41

How Do We

Implement HIV

Prevention on a

Broad Scale?

Early detection and treatment

prevents transmission of HIV and

improves health outcomes for those

infected. Research indicates that

routine HIV screening in healthcare

settings among populations with a

prevalence rate as low as 1 percent is

as cost effective as screening for other

conditions such as breast cancer and

high blood pressure. These findings 

suggest that HIV screening can lower

healthcare costs by preventing highrisk practices and decreasing virus

transmission.42 

More recently, scientists

demonstrated43 that providing

early HAART therapy to the HIVinfected partner of a heterosexual

couple was 96 percent successful in

preventing the spread of the virus

to the uninfected partner. In fact,

early initiation of HAART has been

shown to be pivotal in reducing

viral load and HIV incidence at the

population level.44, 45 Capitalizing on

these and other findings, researchers 

and clinicians have been testing and

promoting the Seek, Test, Treat, and

Retain approach to identify highrisk populations (Seek) including

substance abusers and those in the

criminal justice system; test them

NIDA-funded research is also

investigating new technologies to make

adherence easier, more accessible,

and relevant to targeted audiences.

for HIV (Test); initiate HAART for

those who test positive (Treat); and

provide the necessary support to help

these individuals remain in treatment

(Retain, e.g., linking criminal offenders

to treatment upon their return to the

community). These findings show great 

promise for preventing the spread of

HIV and improving outcomes for those

already infected, but studies are now

needed to determine the most effective

ways to scale up these interventions,

especially in the most vulnerable

populations.

Summary

While the need continues for more

research, the scientific and medical 

communities are poised to move forward in developing and disseminating

effective HIV prevention and treatment approaches. Three key principles

underlie NIDA’s strategy: (1) drug

abuse and HIV are linked in ways that

extend beyond injection drug use; (2)

drug abuse and HIV remain intertwined

epidemics in the United States and

around the world — therefore, drug 

abuse treatment is HIV prevention; and

(3) the Seek, Test, Treat, and Retain

approach, especially when implemented in high-risk populations or settings,

stands to decrease viral load and HIV

incidence at a population level, improving outcomes for all. Our mission now

is to implement these evidence-based

strategies so that we can attain our goal

of an “AIDS-free generation.” 

NIDA Research Report Series 9
Glossary

Acquired Immune Deficiency Syndrome (AIDS): 

The most severe manifestation of infection with HIV.

An AIDS diagnosis is based on the presence of clinical

symptoms, a patient’s HIV viral load, and a CD4+ T

cell count at or below 200 cells per microliter in the

presence of HIV infection. Persons living with AIDS

often have infections of the lungs, brain, eyes, and

other organs, and they frequently suffer debilitating

weight loss, diarrhea, and a type of cancer called

Kaposi’s sarcoma.

Addiction: A chronic, relapsing disease characterized

by compulsive drug seeking and abuse despite

adverse consequences. It is associated with longlasting changes in the brain.

Antiretroviral Drugs: Medications used to kill or

inhibit the multiplication of retroviruses such as HIV.

Behavioral Treatments: A set of treatments that focus

on modifying thinking, motivation, coping mechanisms,

and choices made by individuals.

CD4+ T Cells: A type of cell involved in protecting

against viral, fungal, and protozoal infections. These

cells normally stimulate the immune response,

signaling other cells in the immune system to perform

their special functions. Also known as helper T cells,

they are destroyed or disabled during HIV infection.

Cultural Relevancy: The ability of an intended

audience to view an intervention as applicable to their

life circumstances.

Generational Forgetting: Term to describe when

knowledge of adverse consequences experienced

by a particular generation or population is lost by

a younger cohort. In this report, it refers to the

diminished view of the dangers of HIV/AIDS among

those ages 25 and younger.

Highly Active Antiretroviral Therapy (HAART): A

combination of three or more antiretroviral drugs used

in the treatment of HIV infection and AIDS.

Hepatitis C Virus (HCV): A virus that causes liver

inflammation and disease. Hepatitis is a general term 

for liver damage and hepatitis C is the most common

type of hepatitis found among those with HIV.

Human Immunodeficiency Virus (HIV): The virus

that causes AIDS.

Injection Drug Use (IDU): Act of administering drugs

directly into a vein using a hypodermic needle and

syringe. Injection drug users (IDUs) are individuals that

abuse drugs in this way.

Opioid: A compound or drug that binds to receptors

in the brain involved in the control of pain and

other functions (e.g., morphine, heroin, oxycodone,

hydrocodone).

Pharmacological Treatment: Treatment using

medications.

Seek, Test, Treat, and Retain (STTR): A researchbased model of care that aims to expand HIV testing

and reduce viral load and HIV transmission through

initiating HAART therapy in HIV+ individuals. This

approach reaches out to high-risk groups who have

not been recently tested (Seek), engages them in HIV

testing (Test), initiates and monitors HAART for those

testing positive (Treat), and retains patients in care

(Retain).

Viral Load: The quantity of HIV RNA (ribonucleic acid)

in the blood. Research indicates that viral load is a

better predictor of the risk of HIV disease progression

than the CD4+ cell count. The lower the viral load, the

longer the time to AIDS diagnosis and the longer the

survival time. Viral load testing for HIV infection is used

to determine when to initiate or change therapy.

10 NIDA Research Report Series
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NIDA Research Report Series 11
NIH Publication Number 12-5760

Printed March 2006, Revised July 2012.

Feel free to reprint this publication.

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12 NIDA Research Report Series