Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

CHAPTER 19HIV/AIDS and Substance Use DisordersCHERYL ANN KENNEDYJAMES M. HILLSTEVEN J. SCHLEIFERSince its appearance in 1981, the human immunodeficiency virus/acquiredimmune deficiency syndrome (HIV/AIDS) pandemic has been the focus ofglobal attention and remains a serious public health threat throughout theworld. By the end of 2004, over 40 million people worldwide, including 2.5 millionchildren under age 15, were living with HIV/AIDS, mostly in Africa andAsia (UNAIDS, 2004). Showing a decrease from prior years, 22% of the 43,171new cases of HIV/AIDS reported in the United States in 2003 had injectiondrug use (IDU) as the major risk factor for transmission. The majority of thosewith HIV/AIDS in the United States are minorities: African Americans andLatinos (Centers for Disease Control and Prevention, 2003). Among noninjectingdrug users (NIDUs) there are clear links between substance abuse andhigh-risk behaviors in both men and women, especially those who use crackcocaine (Astemborski, Vhalov, Warren, Solomon, & Nelson, 1994; De Souza,Diaz, Sutmoller, & Bastos, 2002; Edlin et al., 1994). Use of mind-altering substances,such as alcohol, other sedatives, stimulants, and club drugs, plays anincreasing, albeit less direct, role in HIV risk and disease progression. Impairedstates induced by alcohol and other drugs can influence sexual behavior andlead to risky, unsafe sexual practices that increase risk of HIV exposure (Kennedyet al., 1993; National Institute of Drug Abuse, 2002). HIV infectionamong IDUs has been reported in nearly 180 countries worldwide and presentsthe risk of spreading to 40 more. Once the virus has been introduced into alocal community of IDUs, spread is ordinarily rapid. Drug-using populations are411