title: Not just the needle: the state of HIV-prevention science among substance users and future directions.
abstract: Efforts to prevent HIV transmission among substance-using populations have focused primarily among injection drug users, which have produced measurable reductions in HIV incidence and prevalence. By contrast, the majority of substances used worldwide are administered by noninjectable means, and there is a dearth of HIV prevention interventions that target noninjecting substance users. Increased surveillance of trends in substance use, especially cocaine (including crack) and methamphetamine, in addition to new and emerging substances (eg, synthetic cannabinoids, cathinones, and other amphetamine analogs) are needed to develop and scale up effective and robust interventions for populations at risk for HIV transmission via sexual behaviors related to noninjection substance use. Strategies are needed that address unique challenges to HIV prevention for substance users who are HIV infected and those who are HIV uninfected and are at high risk. We propose a research agenda that prioritizes (1) combination HIV-prevention strategies in substance users; (2) behavioral HIV prevention programs that reduce sexual transmission behaviors in nontreatment seeking individuals; (3) medical and/or behavioral treatments for substance abuse that reduce/eliminate substance-related sexual transmission behaviors; and (4) structural interventions to reduce HIV incidence.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. sshoptaw@mednet.ucla.edu
authors.forename: Steve
authors.initials: S
authors.lastname: Shoptaw
authors.forename: Brooke
authors.initials: B
authors.lastname: Montgomery
authors.forename: Chyvette T
authors.initials: CT
authors.lastname: Williams
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.forename: Apinun
authors.initials: A
authors.lastname: Aramrattana
authors.forename: Lisa
authors.initials: L
authors.lastname: Metsch
authors.forename: David S
authors.initials: DS
authors.lastname: Metzger
authors.forename: Irene
authors.initials: I
authors.lastname: Kuo
authors.forename: Francisco I
authors.initials: FI
authors.lastname: Bastos
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006293:Health Promotion / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D012106:Research; D012306:Risk; D040242:Risk Reduction Behavior; D012725:Sexual Behavior; D019966:Substance-Related Disorders / Q000150:complications* / Q000628:therapy