Global challenges call for global strategies. This simple notion was the driving force behind the “Conference to Promote Global Health” convened in Taipei, in April 2013. Its ambitious goals were to build research capacity, stimulate transnational collaborations in the Asian and Pacific Islander (API) region, and advance scientific knowledge that would address critical issues related to substance abuse and human immunodeficiency virus (HIV) infection, two intertwined health threats that are rising in many Asian countries.
Drug abuse and addiction have being fueling the global spread of HIV from the very beginning of the AIDS epidemic. Drugs are still partly responsible for an unacceptably high number of new HIV infections (nearly 50,000/year in the United States alone). This inextricable connection is predicated on at least three major public health challenges: (1) the direct effects of contaminated injection drug use on infection rates; (2) the indirect impact of abused drugs on high-risk sex behavior and treatment adherence; and (3) the ability of drugs to worsen the neurologic complications stemming from an HIV infection.
On the positive side, exciting discoveries have recently shown that HIV prevention among drug users (which includes HIV treatment) is effective in reducing HIV prevalence and that treating substance use disorders (particularly with the aid of new and more effective medications) improves HIV treatment outcomes. A broad consensus was evident among the attendees that such findings should be parlayed into global instruments against the HIV epidemic as quickly as possible. One promising instrument that is worth highlighting in this context, referred to as the Seek, Test, Treat, and Retain (STTR) paradigm, seeks out hard-to-reach/high-risk populations, including substance abusers and those in the criminal justice system, tests them for HIV, links those who test positive to HIV treatment and other services, and provides the necessary support to ensure these individuals remain in the care system.
In addition, the scientists attending the meeting zeroed in on several additional key research topics, a global commitment to which is bound to make a real difference in the lives of millions of people. These topics include: (1) the neuroscience of HIV/hepatitis C virus (HCV) and amphetamine-type stimulants (ATS); (2) the links between ATS abuse and mental health disorders; (3) studies of HIV/HCV transmission and social networks; and (4) approaches to enhance family involvement to improve treatment adherence and recovery. To carry out this far-reaching agenda, it was agreed at this meeting that several workgroups will be established to stimulate crossnational collaborations geared towards improving our scientific understanding vis-a´ -vis all the topics identified and, ultimately, boosting clinical outcomes.
An intense and decades-long scientific effort has turned HIV into a manageable chronic disease, but benefits have lagged behind for infected substance abusers. However, recent findings on the feasibility of treating substance abusers with HIV both with antiretroviral and substance abuse treatment have shown that this improves their outcomes and reduces the spread of the disease. The increasing recognition that the treatment of HIV in substance abusers is crucial for containing the HIV epidemic globally represents a huge step forward. The Conference to Promote Global Health has now charted a credible strategy for facilitating the implementation of these advances.
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse,
National Institutes of Health,
United States of America