The National Impact of Alcohol and Drug Problems and HIV Infection and AIDS Among the Poor and Underserved

21 Presentation THE NATIONAL IMPACT OF ALCOHOL AND DRUG PROBLEMS AND HIV INFECTION AND AIDS AMONG THE POOR AND UNDERSERVED RICHARD A. MILLSTEIN Acting Director National Institute on Drug Abuse Alcohol, Drug Abuse, and Mental Health Administration U.S. Department of Health and Human Services Rockville, MD 20857 Every individual IN this country has the right to good emotional, mental, and physical health. One of the highest priorities of the National Institute on Drug Abuse (NIDA), as an agency of the U.S. Department of Health and Human Services, is to ensure that substance abuse and any health problem it may spawn or intensify is, if not prevented, certainly greatly lessened. The critical relationship of substance abuse—particularly, but not solely, injection drug abuse—to the spread of HIV infection and AIDS is an urgent and major immediate challenge to this goal. I am particularly pleased with the title and focus of this conference, because of the recognition that lives affected by alcohol and other drug abuse can be changed through research and treatment. When we speak of alcohol and other drug abuse, we are speaking of primary care, infant mortality, tuberculosis, hepatitis, and sexually transmitted diseases. Although NID A's mission involves research, our Agency is one whose projects and programs emphasize helping people, and we never lose sight of the fact that our research has meaning because its findings lead directly to more effective prevention and treatment approaches. As a research institute, NIDA supports and conducts most of our nation's research into the incidence and prevalence of drug abuse, its causes and Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 22____________________Drugs, HIV, and AIDS consequences, and improved approaches to prevention and treatment. NIDA's epidemiological research has monitored steady, and in many cases significant, declines since the late 1970s in overall substance abuse throughout the United States, as well as increases in public awareness of the harmful aspects of substance abuse. Our social norms have steadily changed toward the view that substance abuse is socially unacceptable. As encouraging as these trends are, however, we are well aware that this country is far from homogenous and, in fact, contains several very special populations. Many of these—some minorities, adolescents, young mothers, homeless people, those in the inner cities as well as rural areas—represent the poor, underserved, hidden, often hard-to-reach Americans this conference is addressing. All efforts toward improving outreach and services, including education, to the poor and underserved need to be upgraded, better targeted, and better coordinated among federal as well as state and local governments; between departments of government; and among government and privatesector community organizations. Overview of substance use and HIV/AIDS trends In recent years, NIDA has assumed responsibility for conducting research on the role of substance abuse as a contributing factor in the spread of HIV and AIDS. Drug use fosters the spread of HIV in a number of ways that we need to keep uppermost in our minds, because some may not be as obvious as others: • through injection drug use, by the sharing of needles or other drug paraphernalia; • through high-risk sexual behavior, which may include sex for drugs, or sex for money to buy drugs; • through the disinhibiting effects of drugs and alcohol, which can impair a user's judgment and result in high-risk behavior; and • through the potentially weakening effects of drugs on the immune system, possibly making a user more susceptible to infection. NIDA monitors emerging trends in substance abuse through surveys on extent and nature; NIDA and others, such as the Centers for Disease Control (CDC), also monitor the spread of HIV infection and AIDS. The resulting epidemiological data are important for planning research programs and prevention and treatment strategies for reducing the incidence and impact of both diseases—substance abuse and AIDS. It is important to understand the nature and scope of the problem, and I would like to share with you some of the Millstein 23 highlights of these epidemiological findings, particularly as they relate to poor and underserved Americans. Trends in substance abuse. As I have mentioned, the overall trend in substance use...