RECOMMENDATION 4.

Research and epidemiologic studies on the relationships between licit and illicit drug use and HIV transmission should be greatly expanded and funding should be increased, not reduced or merely held constant.

While the definite link between HIV transmission and substance use is well-established, many questions about the relationship between substance use and HIV remain unanswered. What effect does continued substance use have on the progression of HIV disease? What behaviors place individuals at the greatest risk for transmission? Although further research is essential to help us answer and provide solutions for these and related questions, much has been learned thus far – policy makers are not in a scientific vacuum. Since the beginning of the epidemic we have learned much more about injection drug use and substance use and sexual practices which are linked to HIV. Research into these topics should not be relegated to private sponsors because of a mistaken perception that substance use and HIV are not critical national problems. Such research falls squarely under the aegis of the federal government.

There are two issues of particular concern to the Commission within the larger context of research on HIV and substance use. First, the future of projects funded through demonstration grants and second, the potential cuts in the number of federally funded investigator-initiated grants. The Commission's concern for demonstration projects is reflected in the discussion above on outreach projects. The whole concept of "demonstration" projects needs to be better defined; the evaluation process should be designed so that successful projects can be identified at an early stage. Funding can then be made available for their continuation as on-going federal projects. A consistent policy must be developed to prevent the shutdown of successful programs and the loss of trust, staff and progress.

The Commission is also concerned with proposed cuts in funding for investigator-initiated grants and the numbers of programs to be covered in the coming years. The Commission believes strongly that funding for research on HIV and substance use should be increased and is specifically concerned with the potential cuts in the numbers of grants available under ADAMHA. The Commission believes that the basic and applied research funded through this mechanism is often among the most productive and creative and holds great potential for progress in finding the answers to crucial questions around HIV and substance use. To cut these innovative programs, either in funding amount or numbers of grants, would delay once again the answers to questions which are crucial in curbing the spread of these epidemics.

Clinical trials are a key component of research and can offer both immediate and future benefits in treatment and care of HIV disease. The Commission believes strongly that those with a history of, or current, substance use problems should be actively enrolled in clinical trials. As with the provision of primary care, it may be appropriate to look to increased cooperation with treatment centers for finding participants and conducting these clinical trials.