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HIV, AIDS, and Substance Use

Substance use disorders commonly occur with other disorders, like HIV. Certain types of drug use—specifically intravenous drug use—present a high risk of contracting HIV. Drug and alcohol use can also contribute to engaging in other behaviors, like unprotected sex, which also carry a risk of sexually transmitted infection (STI), viral hepatitis, and HIV.

Factors That Increase HIV Risk​

Injection drug use can be a direct route for HIV transmission, because people sometimes share needles, syringes, and other materials that may be contaminated with HIV and other blood-borne diseases. Many people don’t realize that human immunodeficiency virus can survive in these types of drug paraphernalia for up to 42 days.  

As substances can lower inhibitions and impede judgment, it is more likely for someone inebriated to have unprotected sex and/or sex with multiple partners. These behaviors are associated with a greater risk of contracting HIV and other STIs, like hepatitis B and C. 


Substances That Increase HIV Risk

Certain substances are associated with a higher risk of contracting or transmitting HIV due to the behaviors (injection and/or less safe sex) listed above. These substances include:

  • Alcohol
  • Opioids, like heroin
  • Inhalants, like poppers (amyl nitrate)
  • Stimulants:
    • Methamphetamine
    • Cocaine
    • Crack cocaine


HIV Infection

More than 1.2 million Americans live with HIV, or are “HIV-positive.” HIV stands for human immunodeficiency virus and is the virus that can lead to AIDS (acquired immune deficiency syndrome). 

According to the Centers for Disease Control and Prevention (CDC), HIV is transmitted through body fluids of a person with a detectable HIV viral load. These body fluids include:

  • blood
  • semen
  • pre-seminal fluid
  • rectal fluids
  • vaginal fluids
  • breast milk

For a person to contract HIV, these bodily fluids must interact with a mucous membrane (the moist inner lining of body cavities), damaged tissue, or be directly injected into the bloodstream. The parts of the body that have mucous membranes are the nose, mouth, lungs, stomach, rectum, vagina, and penis.

The main ways HIV is transmitted are:

  • oral sex
  • unprotected penetrative sex
  • protected penetrative sex in which the barrier method (e.g. condom) fails
  • intercourse where vaginal fluid and menstrual blood are exchanged
  • workplace accident: nurses and doctors may be pricked with a contaminated needle or a bodily fluid 
  • drug use, sharing needles, syringes, and other drug equipment
  • pre-chewed food
  • biting
  • deep open-mouth kissing
  • tattoos and body piercings
  • breastfeeding


Lowering HIV Risk (HIV Prevention)

Behaviors that lower the risk of contracting HIV include:

  • not having sex while intoxicated
  • practicing safer sex and using barriers including condoms, dental dams, and gloves 
  • using new, clean syringes and injection equipment every time you inject substances
  • taking PrEP (pre-exposure prophylaxis), which is medicine people who are at risk take to prevent contracting HIV
  • in an emergency, taking PEP (post-exposure prophylaxis) within 72 hours after a possible exposure to HIV

People living with HIV/AIDS normally manage their condition with the use of multiple antiretroviral drugs to lower their chances of transmitting HIV. There are several classes of antiretroviral agents that act on different stages of the HIV life cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART).

The National Institutes of Health (NIH) confirm that people living with HIV who achieve and maintain an undetectable viral load through their use of antiretroviral therapy (ART) cannot sexually transmit the virus to others. This concept is sometimes referred to as “U=U” or “Undetectable = Untransmittable.”  


Ways HIV is Not Transmitted

There are many common misconceptions and fears about HIV. However, HIV doesn’t survive for long outside the human body. For example, it cannot reproduce outside of a human host. 

HIV is not transmitted through mosquitos, saliva, hugging, or shaking hands. You cannot catch it from sharing a toilet or eating off the same dishes. Closed-mouth kissing or kissing on the cheek is not a way that HIV is transmitted. It is a blood-borne virus and is transmitted through the blood and bodily fluids, so you cannot transmit/contract it through the air.


Related Substance Use Concerns

Addiction & Viral Hepatitis 

Substance use and engaging in risky behavior increase a person’s risk of contracting other blood-borne diseases, like viral hepatitis. Hepatitis is an inflammation of the liver that can be caused by a number of autoimmune conditions, viruses, and drug use. Hepatitis B and hepatitis C are the most common viral hepatitis infections passed between people who use drugs.

According to the National Institute on Drug Abuse (NIDA), 2.4 million Americans live with chronic hepatitis. NIDA states that this number has grown rapidly since 2010, which they say is linked to injection drug use. 

COVID-19 & Substance Abuse

The COVID-19 pandemic has exacerbated substance use. The National Institute on Drug Abuse reports that there have been both increases in substance use and drug overdoses during the pandemic. People who use substances are also at a greater risk of poor outcomes if they contract COVID-19.

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