in which the likelihood of HIV infection is greatly increased for anyone having unprotected sexual intercourse or using needles for drug injection.

Social settings and networks are also implicated in efforts to reduce HIV risk. In a recent study of injection drug users in Brooklyn, consistent condom use was shown to be a characteristic of social relationships rather than an individual attribute (Friedman et al., 1994). Condom use by an individual varied from relationship to relationship. Relationship characteristics, as well as peer norms, influenced the extent of consistent condom use. Overall, condoms were consistently used in about two-thirds of the relationships between HIV positive injection drug users and their non-drug using partners.

The HIV epidemic is tightly linked to a complex set of diseases whose prevalence in the community will change over time. The progression of the other, concurrent epidemics—infectious disease epidemics such as STDs and behavioral epidemics such as drug use—can be expected to influence either the incidence and prevalence of HIV infection or the course of HIV disease. Several examples may serve to highlight this process.

New drug use epidemics can alter the patterns of needle use or sexual behavior, increasing the prevalence of risk behavior in the community. An increase in the number of people practicing risky behaviors implies an increase in the risk for spread of infection. The crack epidemic has demonstrated the increased spread of HIV infection through the confluence of new epidemics. As discussed earlier, the risk for HIV infection among crack users is thought to be attributable to the widespread practice of risky sex-for-drugs exchanges.

Some diseases will influence the course of HIV disease, rather than the spread of new infections. HIV-infected people are more likely to move rapidly from tuberculosis infection to active tuberculosis disease. The prognosis for tuberculosis in the HIV-infected person appears to be poor and requires early diagnosis and aggressive treatment. Thus, infection with tuberculosis may shorten the course of HIV disease for those dually infected.

The AIDS epidemic in the United States, while still predominantly affecting the gay male community, has spread through sexual contact and injection drug use to other communities and populations.

FRONT MATTER (R1-R18)

EXECUTIVE SUMMARY (1-38)

1 INTRODUCTION (39-44)

PART I RESEARCH FINDINGS AND OPPORTUNITIES (45-46)

2 UNDERSTANDING HIV TRANSMISSION (47-77)

3 UNDERSTANDING THE DETERMINANTS OF HIV RISK BEHAVIOR (78-123)

4 DISEASE PROGRESSION AND INTERVENTION (124-154)

PART II MANAGING THE AIDS RESEARCH PROGRAMS AT NIAAA, NIDA, AND NIMH (155-156)

5 THE CONTEXT OF AIDS PROGRAMS AT NIAAA, NIDA, AND NIMH (157-185)

6 RESEARCH FUNDING, PROGRAMS, AND PRIORITIES AT NIAAA, NIDA, AND NIMH (186-239)

7 LINKAGES BETWEEN RESEARCH AND SERVICES (240-256)

BIBLIOGRAPHY AND REFERENCES (257-296)

APPENDIXES (297-298)

A Grants Analysis Methodology (299-304)

B Abbreviations and Acronyms (305-308)

C Acknowledgments (309-314)

D Contributors (315-326)

INDEX (327-338)