or other medical intervention appears to be years away. In conjunction with such developments, efforts to prevent the transmission of HIV through the cessation of behaviors that contribute to it must be expanded. This requires a commitment to understanding and intervening in human behavior.
This report surveys the AIDS research programs of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and National Institute of Mental Health (NIMH). Much of the AIDS research supported by these institutes is dedicated to developing and implementing (and to a lesser extent, evaluating) HIV preventive interventions in different populations. These interventions should be driven by basic behavioral and social science research on the determinants of behavior and behavior change; and to a great extent they are. Yet much of this basic research is still in its early stages, its development inhibited by a political climate during the first decade of the epidemic that made it difficult, and on some occasions impossible, to conduct research on the very behaviors in question: drug use and sex. For example, although numerous scientific and policy reports called for a federally sponsored, national survey of sexual behavior to help determine the nature and level of risk for HIV transmission in the general population, federal and congressional restrictions did not allow it.
The absence of information about the actual sexual behaviors in which people are engaging has hampered AIDS prevention efforts during this period. Now, although the current climate is more supportive of such research, basic behavioral and social science research is having to catch up. Moreover, much-needed efforts to integrate this research with basic biomedical research to obtain a more complete understanding of the complex factors that contribute to the transmission, disease progression, and prevention of HIV/AIDS among different people are still just beginning.
Part I of this report presents an overview of findings from relevant research to date. The committee felt it was important to elucidate the status of knowledge about the substance abuse and mental health aspects of HIV/AIDS first, as a backdrop to its assessment of the specific research programs of NIAAA, NIDA, and NIMH, which appears in Part II. This was thought to be a constructive approach, as it provides a baseline for assessing contributions, gaps, and future directions for AIDS research at the institutes.