ENTANGLED EPIDEMICS - COCAINE USE AND HIV DISEASE

Over the past decade, two epidemics have had a severe impact on public health in this country. These health problems involve cocaine abuse a nd AIDS (or HIV disease). The processes of these two conditions are cl early not independent of each other and may be quite complex. Understa nding of this relationship has been hampered by a myriad of social, bi ological and behavioral variables that are entangled with the basic co caine-HIV association. This article presents a paradigm for discussion of the interaction between cocaine exposure and HIV disease based on three mechanisms: the relationship between cocaine exposure and increa sed opportunity for HIV exposure, the direct role that cocaine plays i n altering susceptibility to HIV infection, and the influence that coc aine use has on the progression of HIV disease. The goal of this struc tured approach is to enhance conceptual understanding of the cocaine-H IV relationship while recognizing the complexity of the issue and the limitations of current research efforts. This model will serve as a fr amework for the discussion of implications for future research, clinic al practice, and public policy.