HIV/AIDS, Hepatitis, and Other Contagious Diseases

Since the beginning of the HIV/AIDS epidemic, injection drug use and needle sharing have been associated with the spread of HIV.  What is less recognized is the connection between drug abuse and addiction in general and the spread of both HIV and other contagious diseases.  Various methods of drug administration can increase an individual’s risk of contracting HIV.  In addition, drug abuse often leads to dangerous sexual behaviors that can also contribute to the spread of HIV.  For these reasons, the National Institute on Drug Abuse (NIDA) recognizes that HIV/AIDS can be prevented through treating and preventing drug abuse.

What are HIV and AIDS?

HIV is the abbreviation for human immunodeficiency virus, the virus that causes AIDS by attacking the immune system.  This virus is transmitted through contact with bodily fluids; an infected person may spread the virus when their blood or other bodily fluids come into contact with another person’s mucous membranes, blood, or broken skin.  Infected women can also pass on the virus to their children through pregnancy, delivery, and breastfeeding.  People can become infected with HIV and not know it for many years.  They may look and feel normal until their immune system becomes so weak that they develop AIDS, acquired immune deficiency syndrome.  There is no cure for AIDS currently although HIV-infected people can be effectively treated through a combination of medications called highly active antiretroviral therapy (HAART).  Approximately one million Americans are currently infected with HIV.

How are drug abuse and HIV/AIDS linked?

            Intravenous drug use.  The most well-known link between HIV/AIDS and drug use, intravenous drug users may pass along HIV when they share infected needles and/or other injection paraphernalia.  In fact, injection drug use accounts for as many as 30% of HIV infections around the world outside of sub-Saharan Africa.  Heroin, cocaine, and amphetamines are the drugs most frequently injected.  Drug users often choose to inject drugs rather than smoking, drinking, rubbing, or snorting them because it is a cheap method that takes rapid effect.  In addition, none of the drug is dissipated in smoke.  Many drug users share used needles when sterile syringes are unavailable.

            Crack use.  Although crack cocaine is generally smoked rather than injected, crack smokers often develop blisters, burns, and cuts inside their mouths and on their lips.  Blood from these sores can taint smoking devices and infect other smokers.  These sores can also put crack smokers at an increased risk for contracting HIV through oral sex with an infected person.  Snorting and rubbing cocaine can also cause sores that can lead to HIV infections.

            Risky sexual behaviors. All drugs interfere with a person’s judgment and inhibitions, increasing the likelihood that an intoxicated person will engage in unsafe sexual practices and potentially contract HIV/AIDS.  Some drugs are taken specifically because they increase sexual arousal and lower inhibitions.  Methamphetamine in particular is a stimulant linked to the increased spread of HIV among both gay men and heterosexual users.  Men who have sex with men and use methamphetamine tend to engage in more unprotected sex and have a greater number of partners.  They are also more likely to exchange money or sex for drugs, use intravenous drugs, and have a history of STDs—all of which are risk factors for HIV.  In one survey of young urban gay men, as many as 20% stated that they had used methamphetamine within the last 6 months.  

            Like methamphetamine, ecstasy is another drug that increases sexual arousal and enhances feelings of touch.  Frequently associated with the club scene, ecstasy can give users a burst of long-lasting energy, but it also increases their likelihood of engaging in unsafe sex and becoming infected with a wide variety of sexually transmitted diseases.  Ketamine (often called Special K) and poppers (amyl and butyl nitrite) are other drugs that are used to intensify sexual experiences and often influence users to engage in risky sexual practices.  In addition, some users have been known to combine drugs like meth and ecstasy with Viagra, which is also potentially very dangerous.

            Trading sex for money and drugs.  Another grave link between drug abuse and HIV is the intersection between those who use drugs and sell sex.  Drug addicts can be driven to transactional sex in order to purchase drugs.  In one study of women who smoked crack in South Florida, 48% of them reported having traded sex for money and drugs.  54% of those who both smoked crack and injected drugs had sold sex.  At other times, sex workers may be driven to abuse drugs.  In either case, these marginalized individuals are at an extremely high risk for HIV/AIDS.

How does drug abuse complicate the progression and treatment of HIV?

Drug abuse can aggravate AIDS and complicate treatment.  For example, HIV-infected people who also abuse methamphetamine experience greater brain damage and cognitive impairment than those who do not use drugs.  Some recreational drugs as well as methadone, a drug used to treat opioid addictions, can interact with HAART therapies, decreasing the efficacy of both treatments.  It can also be difficult for HIV-positive drug users, who often have chaotic lifestyles, to follow the strict treatment regimens required for HAART therapy. 

What other contagious diseases are associated with drug use?

Hepatitis C is an extremely contagious virus that causes liver disease.  According to NIDA, most intravenous drug users become infected with hepatitis C within three years.  As many as 90% of intravenous drug users who have HIV/AIDS are also infected with this virus.  Left untreated, the co-occurrence of hepatitis C and HIV/AIDS rapidly leads to liver failure. 

Other contagious diseases frequently linked with drug use include hepatitis B and tuberculosis, in addition to a wide variety of STDs, such as syphilis, gonorrhea, and herpes.  Intravenous drug users are also at a great risk for infections at the injection site.

What can be done?

Sterile needle programs can help to prevent the spread of HIV and other contagious diseases among drug users.  Education about safe sex practices and health care and counseling for those who are infected are also necessary.  But the most effective way to break this vicious connection between drug use and the rapid spread of HIV/AIDS and other devastating contagious diseases is to treat and prevent drug use and addiction.