to curb transmission of HIV
Yale and the University of Connecticut have received $6 million in grants to study ways of reducing the spread of HIV among drug users and others with HIV infection.
One study will recruit HIV positive drug users to counsel their fellow addicts and coax them into treatment for HIV/AIDS. The other study will draw on the relationship between drug users and others with HIV and their physicians as a means of reducing HIV transmission behavior.
"There is a tremendous disparity of resources for people with AIDS," says Dr. Gerald Friedland, director of the AIDS Program at Yale and co-investigator on the studies with the University of Connecticut. "Our goal is to make HIV therapeutics as readily available to drug addicts and other vulnerable populations as anyone else in this affluent society."
Friedland says five years ago there were about 40 patients at Yale-New Haven Hospital hospitalized with AIDS on any given day. Today, that number is closer to 10 to 12 AIDS patients.
"This is all because of potent anti-retroviral therapies," he says. "We can keep people healthy and alive in a way no one would have imagined a decade ago. The morbidity and mortality has declined by 70% in the last four years. The disease has changed. It has become a chronic disease in this country."
Friedland says one shortcoming of the new drug therapies is that AIDS replicates itself quickly and therefore becomes resistant to treatment unless the combination of drugs is varied. The drugs also must be taken on a rigid schedule and for the remainder of the patient's life. The new longevity creates additional problems.
"Because resistance develops and people with HIV now feel well, some still engage in risky behaviors, so we are continuing to see new infections but now with a virus that is more resistant to drugs," he says.
It is estimated that half of the people with AIDS are receiving medical care while the remainder are either unaware that they are infected, or are unable or unwilling to receive medical treatment, he says.
One of the two studies -- the Peer-Driven Intervention program -- is funded by the National Institute on Drug Abuse and is designed to bring active and recovering drug users who are HIV-positive into treatment for drug abuse and HIV/AIDS. Only 10% to 15% of drug users are in drug treatment at any given time, Friedland says.
The researchers will recruit and randomly assign 300 HIV-positive active and recovering drug users. Half will be enrolled in the peer intervention program and the other half will be assigned to an existing program. Over time, the researchers will compare the two groups as to enrollment and retention in primary care services, adherence to HIV therapeutics, entry and retention in drug treatment, reduction of HIV risk behaviors, and increase in medical knowledge.
The second study attempts to reduce risky behavior among HIV positive drug users and others with HIV infection by making use of the doctor-patient relationship. The study will be conducted at two comparable HIV clinics that together treat more than 1,800 adults who are HIV positive. The intervention process will be used with patients at one clinic. Patients at the second clinic will receive current standard of care prevention services.
Friedland says the goal of the second study is to design, implement and evaluate "a conceptually based, easily disseminated, clinician-delivered intervention to promote HIV risk reduction among HIV positive adults receiving care in HIV treatment settings.
"This population is at risk for transmitting HIV to others who are HIV negative and for acquiring other pathogens themselves, and it is a population for whom few effective HIV risk reduction interventions have been designed and evaluated," he adds.
The second study is funded by the National Institute of Mental Health and will be carried out at Yale-New Haven Hospital, Yale University, Hartford Hospital and the University of Connecticut at Storrs.
Friedland is co-principal investigator on the peer intervention study with Dr. Rick Altice and Dr. Patrick O'Connor, both from the Yale AIDS Program. The principal investigator is Robert Brodhead, a sociologist at the University of Connecticut.
Friedland is co-principal investigator on the second study, along with William Fisher of the University of Western Ontario. University of Connecticut psychologist Jeffrey Fisher is principal investigator on the study. Dr. Jack Ross of Hartford Hospital, is investigator.
-- By Jacqueline Weaver
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