Yale researchers are about to tackle the nation’s biggest HIV epidemic.
A research team at the School of Medicine recently received a $4.2 million grant from the National Institute on Drug Abuse to study HIV treatment among drug users in Washington D.C.’s criminal justice system. Principal investigator Frederick L. Altice, a professor at the medical school, will be offering a replacement medication, the semi-synthetic opioid buprenorphine, to drug users in treatment with the goal of decreasing the rate of transmission in the D.C. area.
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“We’re looking at people almost at the time of arrest,” Altice said. “The level of health care is low among these people, and the question is how we can engage them in health care more effectively.”
Altice and his team will use the grant to treat injecting drug users entering the criminal justice system with buprenorphine and track the effectiveness of this treatment, while monitoring the spread of HIV within the system. Hypothetically, a smaller population of injecting drug users will slow the rate of HIV transmission both within the criminal justice system and in the greater community.
Around 3 percent of the city’s population and 6 percent of the criminal justice system is infected with the chronic disease, Altice said. The research team, which consists of researchers from Yale, George Mason and Howard universities, chose D.C. for its high HIV prevalence in order to more efficiently study the effects of the drug on a larger epidemic.
The epidemic in D.C. is also an interesting case study due to its disproportionate effect on racial and ethnic minorities, particularly among people of color, co-principal investigator William Lawson, of Howard University, said.
Altice’s study is the first of its kind, said Faye Taxman, one of the study’s researchers from George Mason University, because it is typically difficult to research this section of the criminal justice system.
“This study is designed to answer critical questions about helping to motivate offenders to become interested in their outcomes to reduce criminal justice involvement,” Taxman said in an email. “It also provides an opportunity to assess how providing medically assisted treatments can improve offender outcomes, and since medications are infrequently used in the criminal justice system, it is important to empirically demonstrate their value.”
Altice said that the use of buprenorphine to wean drug users off opioids will be unique to this project. The method has received negative responses from the American public, Altice said, with people believing this type of opioid replacement treatment just switches one drug for another.
Previously, the norm for treating drug users in the criminal justice system was strict abstinence. But evidence has shown that offering a replacement medication like buprenorphine is much more effective in treating addiction, Altice said.
And while this study will certainly answer some key questions about the HIV epidemic, it will likely offer key insights on other issues as well. Taxman said they hope to learn how improvements in health care can affect negative social behaviors like crime and overall HIV transmission.
“It’s really very community-oriented,” Altice said. “You’re taking people who are at high risk of transmitting HIV into the community and you’re staging an intervention.”
The study may also influence public policy in several important areas, Altice said, adding that he hopes the study will, eventually, result in more effective HIV treatment overall, particularly using the method of replacement medication.
Student HIV/AIDS activists at Yale agree that the study could have wide-reaching ramifications.
“This study is important because HIV infections and AIDS prevalence has been statistically much higher among prisoners than among the general population in the United States,” co-director of AIDS Walk New Haven Sheila Enamandram ’13 said. “Yet, these same people are unlikely to seek treatment on their own while out of prison. This study therefore provides the opportunity to treat illness and prevent infection in this neglected part of society.”
The Centers for Disease Control estimates that around 1.1 million people are living with HIV in the United States.