| Washington, D.C. -- The offices for the National Institute for Drug Addiction, or NIDA, are just outside Washington, D.C., on the red line if you travel by Metro. You might imagine the researchers there spending much of their time working on addiction issues and you' be right, mostly. But there's another issue that's eating up a lot of time for some NIDA folks; in fact, they've even got a whole division devoted to it ... AIDS.
"Early on injection drug use was one of the primary identified route of transmission," says Dr. Jacques Normand, Director of the AIDS Research Program at NIDA. He says when AIDS first came on the scene, many health pros worried about the spread of the virus by dirty heroin needles. IV drugs use is down now ...
"But one thing that people have underestimated," he says, "is the role of non-injection drug use in contributing to transmission of HIV and that will be mainly through sexual contact, including both the men who have sex with men and heterosexual transmission."
One example of this ... crack cocaine. Crack got a lot of press during the late 80's and early 90's. There was a lot in the news about the possibility of a whole generation of "crack babies" being born. People worried entire urban centers would be enveloped in the crack cocaine epidemic, and many were. Crack also affected the spread of HIV, especially among young African American women.
"What is fascinating when you compare that drug use pattern to other drug use patterns," says Normand, "is that you reach a time when your crack drug abuse, or dependent on crack, where the drug is not being, the sex is not being engaged in to get sexual gratification or pleasure, it's really, they're engaging in sex to get the drugs. Their primary drive is to get the high of the crack."
With meth the combination of sex and drugs is once again turning out to be bad news for those fighting the AIDS epidemic but for another reason entirely.
Jackie Chaisson is an outreach worker for West Alabama AIDS Outreach -- she spends much of her time traveling back roads in the Black Belt, trying to get word out about HIV/AIDS.
"Meth is very easy to make, very cheap to make and it's very cheap to buy," Chaisson says. "And also, I understand, that when people are high on meth it's very common to have multiple sex partners. It increases the sexual libido in people. It's very common to have multiple sex partners and be able to have sex for hours and hours and hours, so it's a real problem."
She says she worries the meth problem will exacerbate the AIDS epidemic. Jacques Normand shares her worries about methamphetamine.
"And as soon as this, the prevalence level reaches a threshold in the population it's gonna, it could spread like wildfire."
But University of Alabama AIDS researcher Dr. Brownwen Lichhtenstein says she's not worried about a meth-AIDS problem. Her focus is on AIDS in the Black Belt and she says the data just isn't there.
"Meth is a white drug, you know, that's not really relevant at this point for the African American community."
Rosemary asks: "Do you have any worries that that could be a problem in white parts of the state because it does lead to riskier behaviors?"
"You know I'm not very good at predicting what's going to happen, all I know is that we're not seeing that in the African American community. At all," Lichtenstein says. "In fact we see less drug use in the African American community, most people don't understand that. In the Black Belt it's pretty much all sexual; for women it's just simply their boyfriends."
It's not just Lichtenstein who isn't concerned with meth at the moment. There are a number of people who think the so-called "meth epidemic" isn't really an epidemic at all ... that it's more of a red herring than anything else. I ask Jackie Chaisson about it as we drive through Pickens County.
Rosemary asks: "There are a lot of people floating around who say this meth thing is being blown out of proportion ...
"Hmmmm, I disagree in that," says Chaisson. "In January they held a community wide meeting in Pickens County. They had guest speakers talking about the meth problem, they brought youth groups to this meeting. It was held on a Wednesday night when they knew youth groups would be meeting for churches. They met at the local DHR here in Pickens County and they had over, about 400 people who came to this meeting. It is a huge problem."
Chaisson says the sheriff called the meeting because the number of arrests he was seeing in the county involving meth had shot up in the last few years.
The number of meth labs busted statewide peaked at 419 in 2004; the good news is that last year that dropped to 296. Still, though, state officials think meth is a major issue. The Alabama Department of Public Safety has an investigative division devoted solely to the drug and meth-related crimes. The U.S. Drug Enforcement Administration calls methamphetamine the biggest drug threat to Alabama.
And while law enforcement is spending an increasing amount of its time on methamphetamine some AIDS doctors are spending more of their time with meth addicts.
"We've seen a lot of it and in our addiction services; here it's become more and more of a reason for patients to seek counseling," says Dr. Michael Kilby. Kilby is Medical Director of UAB's 1917 Clinic -- a nationally renowned AIDS facility. He says meth is a worry but the users are still a small population of AIDS patients.
"Most of the patients I see on a day to day basis live fairly sedate lives," he says. "They're not promiscuous in the usual sense of the word, the risks they may have taken that they acquire HIV may have taken place many years ago and they may be monogamous and married and productive members of society right now and yet they're living with mistakes they made many years before."
While NIDA researchers worry that meth is causing people now to make mistakes and spread HIV, there's another reason methamphetamine is getting such a close look. There's some evidence to show that meth and anti-retrovirals, the drugs used to treat HIV, interact. That meth makes the drug therapy less effective. That's not good news in an illness where the virus evolves in the body, making it more difficult to create drugs to treat it.
And, as bad as that sounds, NIDA's Jacques Normand says there's something meth and the AIDS virus do in a patient's head that may be even worse.
"So, there's certain region of the brain that are getting adversely impacted and it's reflected in an unusual growth of an area or shrinking of an area of the brain."
Basically, methamphetamine and HIV appear to change the shape of human brains. No one's quite sure how the shape change affects cognition, but researchers are certain it can't be good.
-- Rosemary Pennington, June 27, 2006