Enrollment of drug abusers in HIV clinical trials: a public health imperative for communities of color.

There is an increasing appreciation of the impact of drug abuse on AIDS in the United States because of the pivotal role of injecting drug use in the prevalence of total AIDS cases and case reporting among ethnic/racial minorities, women, and children. While the participation of injecting drug users (IDUs) in HIV clinical trails has increased steadily, the IDU accrual rate lags unacceptably behind the IDU proportion of AIDS cases. The stigma of drug abuse, issues related to poverty, and the underrepresentation of communities of color are the major obstacles to IDU participation in HIV clinical research. It is critical to overcome these obstacles as the spectrum of HIV disease in IDUs requires the development of an IDU-relevant scientific agenda for HIV clinical trials. This, in turn, is crucial to the development of effective therapies for the treatment of HIV disease in IDUs. To the extent that these endeavors are successful, more relevant therapies to communities of color will be developed, as injecting drug use is disproportionately more prevalent in these communities.