Substance abuse can play a role in contracting HIV, complicating its treatment and speeding up the progression from HIV to AIDS.
How HIV Spreads With Needles
HIV lives in body fluids (blood, semen, vaginal fluids and breast milk) and is most commonly spread through blood. According to the Centers for Disease Control and Prevention (CDC), if certain variables like temperature are just right, the HIV virus can survive as long as 42 days on a used needle. What causes HIV risk in people who shoot illicit drugs like heroin, morphine, cocaine and meth is the use of shared needles. People who inject drugs account for one in 10 HIV diagnoses, the CDC reports, and for every 10,000 exposures to an HIV-infected shared needle, 63 result in contraction of the virus. According to data from 22 cities where HIV is rampant:
- Only one in four people who use syringes to inject drugs obtain syringes from sterile sources.
- People who don’t use sterile needle sources such as needle exchange programs for all their syringes are 41% more likely to share needles than those who don’t (13%).
- Younger people are more likely to share syringes.
- Caucasians are more likely than people of color to share syringes: 46% of white people versus 32% of Hispanics/Latinos and 28% of black people.
Between 2008 and 2014 annual HIV diagnoses among people who inject drugs with needles were reduced by about one-half for Hispanic/Latinos and black people, but only dropped by 28% for white people. The CDC attributes this to the higher likelihood of white people to share needles. Gender differences also exist in HIV and drug use by needles. One large cross-sectional study of 1111 IV-drug users in an alcohol and drug detox center found HIV more prevalent in women than men: 66% versus 58%.
Harm Reduction: HIV and Drug Use
The first government sanctioned needle exchange programs were established in the Netherlands during the early 1980s. Countries like the United States soon followed suit after HIV and AIDs cases began to reach epidemic numbers. Today, there are around 200 needle exchange programs in the US. Recently, the idea of safe injection sites has joined the national conversation of initiatives to curb HIV and drug use. Another controversial harm reduction method, these sites also known as fix rooms, supervised injection sites (SIS) and drug consumption facilities (DCF) offer a handful of services like providing sterile syringes as well as the drug Naloxone, which reverses the effects of opioid overdoses. As of yet, there are no legally sanctioned safe injection sites in the United States, but a handful of cities are putting the wheels in motion to make them a reality.
Addiction’s Indirect Link to HIV
Unprotected sex is a large risk factor for HIV. When people abuse alcohol and drugs, their judgement can be clouded and they feel less inhibited. Not surprisingly, studies have confirmed the link between substance abuse and unprotected sex. For instance, a review and meta-analysis of 12 studies linking blood alcohol content (BAC) to sex without a condom found the intent to participate in unsafe sex increased along with the amount of alcohol. The likelihood of having risky sex rose by 5% for every 0.1 milligram per milliliter increase in BAC. Another study followed 2226 Colombian teens for two years and found drug use was tied to more sexual partners and higher instances of unprotected sex and unplanned pregnancies. Bugchasing, a phenomenon that gained media attention in the early 2000’s is also indirectly linked to drugs and alcohol. “Bugchasers” are HIV-negative homosexual men who desire to have sex with HIV-positive men for a variety of reasons: social acceptance within the HIV-positive gay community, despair/slow suicide, sexual excitement, access to social services obtainable with HIV status, and “the ultimate intimacy” are a handful of given motives. Bugchasers often hold “HIV parties” with several HIV-positive men whose purpose is to have unprotected sex with those hoping to contract the virus. These parties have a reputation for including copious amounts of drugs and alcohol to lower inhibitions.
What Causes AIDS and the Role of Addiction
In short, HIV is what causes AIDS. The human immunodeficiency virus (HIV) attacks the body’s immune system, and without treatment, may result in acquired immunodeficiency syndrome (AIDS). How HIV spreads in the body and progresses into AIDS involves:
HIV is contracted through practices like unprotected sex and needle sharing or transmitted from mother to child during pregnancy or breastfeeding.
2. Acute HIV Infection
Within two to four weeks after contracting HIV, people may experience flu-like symptoms as the virus rapidly multiplies and attacks CD4 cells, which are the immune system’s infection-fighting agents.
3. Chronic HIV Infection
This stage is also known as asymptomatic HIV infection or clinical latency. During the chronic HIV infection stage, people with HIV may not experience symptoms, but are still contagious. The virus multiplies at a slower rate. Without treatment, the chronic HIV stage can last seven to 10 years or more before it progresses to full-blown AIDs, but may take significantly less time. The duration of the asymptomatic phase is highly dependent on the individual.
4. AIDS or Advanced HIV
The final and most severe stage of HIV, when AIDS develops, people’s immune systems are exponentially weakened. Their CD4 cell numbers are ravaged by the virus, no longer able to defend the body against infections and illnesses. People may survive up to three years with AIDS without treatment. What causes AIDS’ deaths are opportunistic infections that take advantage of a weakened immune system like viral hepatitis, non-Hodgkin’s lymphoma, cancer (unrelated to AIDS or hepatitis), bacterial infections and cardiovascular disease. There’s no cure for HIV, though its progression can be drastically slowed by antiretrovirals (ARVs) medication as well as healthy practices like good nutrition, exercise, plenty of sleep and sobriety. Substance abuse complicates these good practices and HIV treatment in a number of ways.
Medications used to treat HIV are hard on the liver. Alcohol and certain drugs also take their toll on the liver. Abusing substances while taking HIV medications makes the liver work overtime. It’s more difficult for the liver to rid the body of waste from the HIV medication. Substance abuse may decrease the effectiveness of the HIV meds.
Depleted immune system
The immune system can take a beating from alcohol abuse. Because HIV also impacts the immune system, drinking makes it even more difficult to fight off infection and illness. A weaker immune system can also increase the side effects of the HIV medication.
Decreased medication adherence
Research shows that not only does alcohol play a role in depleting the immune system, but also makes it less likely that the HIV-infected individual will adhere to the medication regime that keeps AIDS at bay.
Increased risk for some illnesses
Smoking cigarettes and pot can irritate the lungs and put people with HIV at greater risk for some of the opportunistic infections associated with AIDS and advanced HIV like pneumonia.
Some research has found that drugs like meth cause more neurological deficits in HIV positive people than those without the disease.
Lack of self-care
People who abuse drugs and alcohol are often more focused on substances than engaging in practices that support health and the immune system such as proper nutrition and exercise.
Treatment for HIV and Drug Use
Mental health and drug rehab for people struggling with HIV and drug use and alcohol use disorders must address all co-occurring issues. It’s not uncommon for addiction, mental health disorders and HIV-positive status to occur together, making treatment particularly complex. Important issues to address include:
- Sexual risk
- Medication adherence
- Psychosocial and biological factors
- Mood disorders/symptoms
- Physical/medical symptoms
Research on this triple-diagnosis is still new, but approaches like cognitive behavioral therapy, motivational interviewing, social support and relapse prevention have shown to be effective.