DrugFacts: HIV/AIDS and Drug Abuse: Intertwined Epidemics

Revised May 2012

Drug abuse and addiction have been inextricably linked with HIV/AIDS since the beginning of the epidemic. The link has to do with heightened risk—both of contracting and transmitting HIV and of worsening its consequences.

No vaccine yet exists to protect a person from getting HIV, and there is no cure. However, HIV can be prevented and its transmission curtailed. Drug abuse treatment fosters both of these goals. HIV medications also help prevent HIV transmission and the progression of HIV to AIDS, greatly prolonging lives.

What Exactly Is HIV/AIDS?

HIV stands for human immunodeficiency virus. This virus severely damages the immune system and causes acquired immune deficiency syndrome, or AIDS, a condition that defeats the body’s ability to protect itself against disease.

HIV inflicts this damage by infecting immune cells in our bodies called CD4 positive (CD4+) T cells—essential for fighting infections. HIV converts the CD4+ T cells into “factories” that produce more of the HIV virus to infect other healthy cells, eventually destroying the CD4+ T cells.

As CD4+ T cells are lost and the immune system weakens, a person becomes more prone to illnesses and common infections. AIDS is diagnosed when a person has one or more of these infections and a CD4+ cell count of less than 200.

More than 16,000 people died from AIDS in 2008.

How Is HIV Spread?

HIV is transmitted by contact with the blood or other body fluids of an infected person. This can occur during unprotected sex or through sharing injecting drug-use equipment. In addition, untreated infected women can pass HIV to their infants during pregnancy, delivery, and breastfeeding.

How Do Drugs Affect HIV?

Most people know that intravenous drug use and needle-sharing can transmit HIV; less known is the role that drug abuse in general plays. A person under the influence of certain drugs is more likely to engage in risky behaviors such as having unsafe sex with an infected partner. Indeed, the most common (but not only) way of contracting HIV is through unsafe sex. This includes “transactional” sex—trading sex for drugs or money.

Drug abuse and addiction can also worsen HIV symptoms, causing greater neuronal injury and cognitive impairment, for example.

Because of the strong link between drug abuse and the spread of HIV, drug abuse treatment can be an effective way to prevent the latter. People in drug abuse treatment, which often includes HIV risk reduction counseling, stop or reduce their drug use and related risk behaviors, including risky injection practices and unsafe sex.

Can Anyone Get HIV/AIDS?

Yes, anyone is vulnerable to contracting HIV. Although injecting and other drug users are at elevated risk, anyone who has unprotected sex could be exposed to the infection. In 2010, nearly 47,000 people were diagnosed with HIV. Among those newly diagnosed, nearly two-thirds occurred in men who have sex with men (MSM). One-half of all people living with HIV in 2008 were MSM.

Pie chart showing new HIV Diagnoses in 2010. Men who have sex with men, 61%. Heterosexual contact, 28%. Injecting drug users, 8%. MSM/ IDU, 3%. Source: Centers for Disease Control and Prevention. Men who have sex with men made up the majority of new HIV Diagnoses in 2010 Men who have sex with men, 61%. Heterosexual contact, 28%. Injecting drug users, 8%. MSM/ IDU, 3%. Source: Centers for Disease Control and Prevention.

HIV infection is also disproportionately represented in the African American community. Over one-half of all newly diagnosed cases in the United States are in African Americans, followed by the White and Hispanic populations.

How Is HIV Treated?

From the beginning of the HIV/AIDS epidemic in the early 1980s until the mid-1990s, HIV infection was almost guaranteed to result in death from AIDS. The number of deaths declined after 1996, when effective treatments were introduced.

Graph showing that when HAART was introduced in 1995, the number of HIV related deaths decreased by nearly 30,000 over a two year period and remained steady through 2007, while the number of those living with HIV steadily increased by nearly 400,000 over the same period of time. With the Advent of HAART, More People Are Living with HIV Infection as Rates of AIDS-Related Deaths Decline

HAART—highly active antiretroviral therapy—is a customized combination of different classes of medications that a physician prescribes to treat HIV. Although it cannot rid the body of the virus, HAART can control the amount of virus in the bloodstream (viral load), helping to delay the onset of symptoms and progression to AIDS, prolonging survival in people with HIV.

Why Is HIV Testing So Important?

A person infected with HIV may look and feel fine for many years and may not even be aware of the infection. In fact, the Centers for Disease Control and Prevention estimates that 1.2 million people are infected with HIV in the United States and that one in five people infected are unaware of it. HIV testing is critical and can help prevent spread of the infection—among those most at risk (e.g., people who abuse drugs) and in general. Getting tested is not complicated. Some tests can even provide results in 20 minutes, although testing is not accurate until about 6–8 weeks after exposure to HIV. That time is needed for HIV antibodies to form in amounts detectable by a standard HIV test.

Research shows that seeking out and testing high-risk populations and starting treatment for those who test positive prevents HIV transmission by decreasing viral load, infectivity (the ability to infect others), and subsequent illness—to the benefit of all.

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