HIV and Substance Abuse: A Closer Look

Table of Contents

Did you know that, in 2019, around 34,800 new Human Immunodeficiency Virus (HIV) infections occurred in just the United States? Even with research and new treatments to prevent the spread of HIV, this disease can be devastating and life-altering for many people it affects.

HIV is not uncommon for individuals fighting against substance abuse issues. Almost 50 percent of individuals with HIV report current and past histories with drug or alcohol disorders. What’s the relationship between HIV and substance abuse? Keep reading, and we’ll explore how the two connect in this guide to HIV and drug use.

What is HIV?

Human Immunodeficiency Virus is a condition that infects the immune system or T-cells of the body. The role of T-cells in the body is to fight off infection and viruses. For example, T-cells are important in fighting off COVID.

When an individual has HIV, the disease destroys your T-cells. This reduces the amount of disease-fighting cells you have in your body.

What does this mean? A person without HIV is better equipped to fight off diseases such as pneumonia. While the various illnesses can take their toll on an individual’s body, typically, the person’s immune system will be up to the job as long as there are no other factors.

In a person with HIV, that same level of pneumonia can be much more serious, if not deadly. Unfortunately, HIV doesn’t always stop at HIV. As it progresses, the person can go from HIV positive to AIDS, or Acquired Immune Deficiency Syndrome.

When HIV progresses to AIDS, it means that the person no longer has the ability to fight off infections or other illnesses. The determination of HIV versus AIDS comes down to the T-cell count.

In a person who is healthy, you will see a T-cell count that falls between 500 and 1,600. In those living with HIV, their T-cell count begins to decrease. Medical professionals determine an AIDS diagnosis when the T-cell count falls to 200 or less.

History of HIV

HIV is believed to have originated in Kinshasa, which is in the Democratic Republic of Congo. HIV was passed from chimpanzees to humans around 1920.

However, until the 1980s HIV and AIDS were largely unknown. Individuals with HIV or AIDS are at higher risk for a lung infection called Pneumocystis Carinii Pneumonia (PCP).

While this infection can occur in others with low immune systems, it is a rare condition. As the public became more and more aware of HIV and AIDS, it spurred a lot of stigma against gay men when the disease seemingly targeted that population. Today, we know HIV does not discriminate.

Fueling the stigma is the fact that there were 270 cases reported of severe immune deficiency among gay men in 1981, and 121 of these men died. The disease PCP was also found in five previously healthy gay men in Los Angeles at the same time.

The growth of this disease in gay men in Southern California continued to spur the belief that the nature of the transmission of HIV was sexual. The initial name of HIV was gay-related immune deficiency or GRID. The first cases of PCP in individuals who inject drugs were reported in December of 1981.

In 1983, more women were diagnosed with HIV. This began to change the knowledge that was present about the transmission of HIV. By September of 1983, the CDC was able to define all the major routes of transmission.

However, a lot of stigmas had already been created, and harm had been done. While treatments were evolving around 1984, blood banks did not begin screening for HIV until 1985. This means that HIV was spreading through blood transfusions as well. While there continues to be a lot of progress and growth in knowledge surrounding HIV and AIDS, it has been a long and storied history.

How Do You Get HIV?

HIV is a viral infection. The transmission of HIV occurs through blood and other bodily fluids. There are over 1.2 million Americans living with HIV today.

There are several ways you can contract this disease. One method of transmission is through contaminated drug paraphernalia. This could be through sharing needles or accidental contact with contaminated devices.

Another method of transmission is through sexual contact. Unprotected sex is one of the most common methods of transmission. An additional method of transmission includes an open wound coming into contact with bodily fluids.

It’s important to note that the risk of HIV does not stop with you. For women, if you’re pregnant, you can pass the disease to your child. You can also pass HIV through breastfeeding.

The early stages of HIV are especially dangerous. This is because you may not know you are infected and can unwittingly spread the disease.

How Do You Get HIV?

HIV is a viral infection. The transmission of HIV occurs through blood and other bodily fluids. There are over 1.2 million Americans living with HIV today.

There are several ways you can contract this disease. One method of transmission is through contaminated drug paraphernalia. This could be through sharing needles or accidental contact with contaminated devices.

Another method of transmission is through sexual contact. Unprotected sex is one of the most common methods of transmission. An additional method of transmission includes an open wound coming into contact with bodily fluids.

It’s important to note that the risk of HIV does not stop with you. For women, if you’re pregnant, you can pass the disease to your child. You can also pass HIV through breastfeeding.

The early stages of HIV are especially dangerous. This is because you may not know you are infected and can unwittingly spread the disease.

Who Is At Risk?

Anyone who engages in the activities above is at risk for HIV. However, we’re going to really break down the numbers for you.

In 2019, seven percent of new infections were in people who inject drugs. Men accounted for four percent of that, and women accounted for the other three percent.

The majority of new infections (69 percent) were in men engaging in unprotected sexual activity with other men.

Another two percent of new diagnoses in 2018 were accounted for by transgender individuals. Finally, 23 percent of new diagnoses were accounted for by heterosexual couples.

While anyone can get HIV, Black and Hispanic communities are disproportionately affected. The Black community accounted for 44 percent of new diagnoses in 2019. Hispanics accounted for 30 percent.

HIV Treatment

HIV used to be an eventual death sentence however the diagnosis and treatment of HIV have changed and patients are living longer lives.

Just because you are diagnosed with HIV doesn’t mean you will progress to the point of AIDS. However, timing and treatment are important.

Antiretroviral therapy or ART can slow HIV and stop it from progressing to AIDS. Around 13 percent of individuals living with HIV do not know it.

While there is no cure for HIV, most people living with the disease are able to get it under control in around six months and become undetectable.

HIV and Substance Abuse

There are obviously inherent risks and dangers of drug use however when it comes to HIV and substance use, they are connected in a few ways.

One of these risks includes the transmission of HIV. If you are thinking “I don’t inject drugs” — don’t stop reading; you are still at risk.

There are many substances that are not injected that can still put you at risk for HIV. Each of these drugs will affect you and put you at risk in various ways.

Alcohol

The use of alcohol creates a risk factor for getting HIV, especially when excessively or binge drinking. 

Through studies done with individuals with STIs, it has been discovered that binge drinking, especially in women, is likely to lead to risky sexual behavior. As the alcohol lowers your inhibitions, you are more likely to have unprotected sex. 

Opioids

This is a class of drugs typically utilized for pain treatment. Opioids include prescription drugs and heroin.

The risk for HIV with opioids comes in two forms. First, this type of drug is the most common to be injected. Sharing needles or using dirty needles increases the risk of the transmission of HIV.

Second, individuals who utilize opioids also have a higher incidence of engaging in risky sexual behaviors.

Crystal Meth and Cocaine

Other drugs such as methamphetamines, crack cocaine, and inhalants are also linked to riskier sexual behavior. Meth is another example of a drug that can be injected.

Any time you are consuming a substance that affects your decision-making skills, you put yourself at a higher risk for HIV and other sexually transmitted diseases.

Other Risks

You may believe you’re safe if you are not sharing your needles. However, what about the “cookers”, paraphernalia, and other preparation equipment?

Any equipment you utilize for injecting drugs is at risk of passing infection. HIV can live up to 42 days in a syringe, depending on temperature and other factors.

Harm Reduction Clinics

Harm reduction clinics are a path that could help to significantly reduce the risk of HIV transmission, drug misuse, and overdose. This can be scary for a community that has grown used to needing to hide using for fear of legal repercussions.

In 2019, the California Harm Reduction Initiative was established. This includes 15.2 million dollars dedicated to supporting programs that provide clean syringes and responses for substance abuse disorders.

Services like this can help reduce the risk; however, they do not entirely eliminate the dangers.

STDs and Substance Abuse

There is evidence that HIV infection, genital ulcer disease, and substance use are associated with trading sex for money or drugs among heterosexual members of minority groups in urban areas.

For example, in Houston, crack cocaine use was significantly associated with syphilis, HIV infection, female sex, and African American race.

According to 16 studies, the abuse of various substances was related to the increasing rates of sexually transmitted diseases and HIV infection.
Oftentimes it was reported that individuals were exchanging drugs/money for sex and vice versa which was also related to STDs.

If you struggle with substance abuse and contract HIV, you may believe that life doesn’t matter anymore. However, there is hope with current treatments to thrive – as long as you stay sober.

Continued use of drugs can impact your health and how your body responds to HIV. It is imperative that you seek help for substance abuse issues when you are living with HIV.

Risk of Infections

Those living with HIV still have significantly weakened immune systems, which means that they are less likely to have the ability to fight off disease and infection. For example, sharing/using dirty needles is dangerous because it increases your risk for infection.

Masking Symptoms

Using drugs can also mask the symptoms of HIV that you may have. When these symptoms get masked, it will take longer to get diagnosed.

Because diagnosis gets delayed, treatment gets delayed. To prevent HIV from becoming AIDS, early treatment is crucial.

Weakened Immune System

With HIV, your immune system is further weakened. To compound, the issue, continued abuse of drugs also weakens your immune system.

If you are using drugs and not treating your HIV, the ability of HIV to enter your brain increases. This can lead to nerve cell injury.

Nerve cell injury can cause cognitive impairment, memory problems and affect decision-making skills.

Liver Issues

Misuse of drugs and alcohol damages your liver. For individuals with HIV, fighting off liver infections can be even more difficult because of this factor. This also makes it more difficult to fight off liver cancers.

Spreading the Disease

Finally, after infection, you can continue to spread the infection to others. If you don’t know or don’t take steps towards treatment, you put the people around you at risk for contracting HIV as well.

The Importance of Early HIV Treatment

Early treatment is key for individuals with HIV or even individuals who believe they may have possibly used/shared a needle or had unprotected sex with an individual with HIV.

There are a few things you can do to help prevent the transmission of HIV. However, keep in mind, the safest way to prevent the transmission is through safe sexual practices and not sharing injection equipment.

PEP

PEP stands for Post-Exposure Prophylaxis. This is when you take antiretroviral medicine to prevent infection after exposure to HIV. The key to this is it must get used in the first 72 hours after exposure.

This type of treatment should only be used in the case of an emergency.

PrEP

PrEP stands for Pre-Exposure Prophylaxis. This is a medication that can be taken daily. They are HIV medications that can help prevent HIV, especially for people who abuse drugs.

Harm Reduction

There are centers for harm reduction in LA. Finding a center near you can help to reduce the risk of HIV.

Early Treatment

Early antiretroviral treatment of HIV lowers your risks. One study showed that early treatment reduced the risk of a serious AIDS-related event by 72 percent.

It also showed that the risk of serious non-AIDS events was reduced by 39 percent.

Treatment for Substance Abuse and HIV

Treatment for substance abuse and HIV presents a unique challenge. If you add in a mental health/co-occurring condition, you are looking at even higher levels of complication.

This is referred to as a triple diagnosis. Unfortunately, individuals with HIV tend to underutilize treatment for substance abuse.

Triple Diagnosis

When you look at individuals with HIV, around 10 to 28 percent have co-occurring mental health and substance abuse disorders. Mood disorders are the most common among this population.

This dual-diagnosis of mental health and substance abuse can keep individuals with HIV from seeking treatment. Mood disorders are also connected to lower medication adherence in individuals with HIV.

Appropriate treatment can help to improve outcomes and medication adherence.

Treatment Challenges

There are several challenges you can encounter when you look at treatment for individuals with HIV and a substance use disorder. These challenges come at a variety of levels.

Factors that can affect substance abuse in individuals with HIV include:

  • Lower-income levels
  • Lower educational levels
  • Ethnicity
  • Sexual orientation
  • Social networks
  • Mental health
  • Homelessness
  • Trauma history


Oftentimes, a diagnosis of HIV can even spur individuals to use more drugs to cope with the emotions surrounding their diagnosis.

Cost

HIV disproportionately affects individuals with a lower socioeconomic status. When it comes to treatment, it can be difficult for these individuals to receive care and support for their addiction because of the cost.

If they do not have insurance or the money to pay for rehab, the ability to get treatment can be quite difficult. Low-cost and no-cost options such as 12-step programs and self-help programs are the most commonly utilized methods of treatment by individuals with HIV.

Barriers

There are many barriers that prevent individuals with HIV from seeking substance abuse treatment. These barriers can include things such as transportation, stigma, or denial.

Awareness

The number of people in drug rehab with a diagnosis of HIV is in the minority. However, part of this is due to the fact that many with HIV do not know they have it.

Provider Conversations

Did you know that patient-provider conversations surrounding substance abuse are associated with a higher incidence of entering treatment? Despite this, less than 50 percent of individuals report talking to their doctors about substance abuse.

These are conversations that medical providers need to be trained in.

Caregiving Issues

While the threat of a loss of custody can motivate women to seek treatment, caregiving issues can also present a unique challenge to getting treatment. Parents with substance abuse issues need ways to attend treatment and have their children cared for.

Substance Abuse Management

Proper addiction treatment will allow you to address the substance abuse piece of a triple diagnosis. Some substance abuse management services that can get included are:

  • Detox
  • Relapse prevention
  • Harm reduction
  • Medication-assisted treatment
  • Aftercare
  • Risk monitoring
  • Inpatient or outpatient rehab
  • 12 step programs or other recovery support groups


These services are important in helping obtain and maintain sobriety for individuals with HIV to prevent a worsening of the condition.

Getting Treatment

Getting treatment as an individual with a substance abuse disorder, HIV, and mental health concerns is imperative. However, providers need to take a holistic approach and treat mind, body, and spirit in the treatment of a triple diagnosis.

HIV/Medical Management

Early and consistent treatment of HIV is important, as discussed above. When you look at medical management, the following factors are getting addressed:

  • Monitoring symptoms
  • Labs and other medical tests
  • Medication adherence
  • Management of other health conditions


This treatment allows the physical health base to help them as they begin addressing substance abuse and mental health.

Below is a list of resources for HIV treatment and programs:

Psychiatric Management

Psychiatric management will look at the mental health component of a triple diagnosis.

For individuals with HIV, this is extremely important. Some psychiatric treatments you may see implemented include:

  • Therapy
  • Medication
  • Risk monitoring


Managing a mental health disorder is as important as managing HIV. As mental health disorders are addressed, you will begin to see increased medication adherence.

Get Help Today

Living with HIV and substance abuse disorder is difficult. However, there are many treatments available to help individuals with these diseases l live a full and long life.

No Matter What Recovery wants to be your lifeline to wellness. Our goal is to treat your mind, body, and spirit so that you can live a healthier life.

If you have questions or need treatment, reach out to us today. We want to support you on your journey.

Sources

  1. Academic.oup.com. (n.d.). Retrieved from https://academic.oup.com/cid/article/31/4/920/376265
  2. Centers for Disease Control and Prevention. (2021, August 9). HIV in the United States and dependent areas. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/hiv/statistics/overview/ataglance.html
  3. Centers for Disease Control and Prevention. (2021, May 20). Treatment. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html
  4. Centers for Disease Control and Prevention. (2021, September 29). HIV among people who inject drugs. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/hiv/group/hiv-idu.html
  5. Cusick Director, J., et al. (2011, May 12). Protecting and advancing health care for transgender adult communities. Center for American Progress. Retrieved from https://americanprogress.org/article/protecting-advancing-health-care-transgender-adult-communities/
  6. Durvasula, R., & Miller, T. R. (2014). Substance abuse treatment in persons with HIV/AIDS: Challenges in managing triple diagnosis. Behavioral medicine (Washington, D.C.). Retrieved from https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3999248/
  7. History of HIV and AIDS overview. Avert. (2019, October 10). Retrieved from https://www.avert.org/professionals/history-hiv-aids/overview
  8. Joy_Website_Admin. (2020, August 31). CA harm reduction initiative. National Harm Reduction Coalition. Retrieved from https://harmreduction.org/our-work/action/california-harm-reduction-initiative-chri/
  9. Marx R;Aral SO;Rolfs RT;Sterk CE;Kahn JG; (n.d.). Crack, sex, and std. Sexually transmitted diseases. Retrieved from https://pubmed.ncbi.nlm.nih.gov/1862466/
  10. Our programs: Homeless health care Los Angeles (HHCLA). HHCLA. (n.d.). Retrieved from https://www.hhcla.org/programs
  11. Published: Jun 07, 2021. (2021, June 7). The HIV/AIDS epidemic in the United States: The basics. KFF. Retrieved from https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-basics/
  12. SAMHSA, C. for B. H. S. and Q. (n.d.). Key substance use and mental health indicators in the United States:results from the 2019 National Survey on Drug Use and health. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm
  13. ScienceDaily. (2008, September 15). Women who binge drink at greater risk of unsafe sex and sexually transmitted disease. ScienceDaily. Retrieved from https://www.sciencedaily.com/releases/2008/09/080904215613.htm
  14. U.S. Department of Health and Human Services. (2016, April 1). Benefits of early antiretroviral therapy in HIV infection. National Institutes of Health. Retrieved from https://www.nih.gov/news-events/nih-research-matters/benefits-early-antiretroviral-therapy-hiv-infection