SUBSTANCE USE DISORDERS AND HIV

Substance use disorders, which are problematic patterns of using alcohol or other substances, such as cocaine, methamphetamine (meth), prescription opioids, and heroin, are closely associated with HIV and other sexually transmitted infections (STIs).

Injection drug use can be a direct route of HIV transmission if people share needles, syringes, or other injection materials, such as cookers, cottons, or water. Drinking alcohol and/or ingesting, smoking, or inhaling drugs are also associated with increased risk for HIV. These substances alter judgment and lower inhibitions, which can lead to risky sexual behaviors (e.g., having sex without a condom, having multiple partners, or trading sex for money or drugs) that can make people more likely to get and transmit HIV.

For people with HIV, substance use can hasten disease progression, affect adherence to antiretroviral therapy (ART), and worsen the overall consequences of HIV. Read more about substance use among people with HIV.

COMMONLY USED SUBSTANCES AND HIV RISK

Here are some commonly used substances and their link to HIV risk:

Alcohol. Excessive alcohol consumption, notably binge drinking, can be an important risk factor for HIV because it is linked to risky sexual behaviors and, among people with HIV, can hurt treatment outcomes.

Opioids. Opioids, a class of drugs that reduce pain, include both prescription drugs and heroin. They are associated with HIV risk behaviors such as sharing needles and other injection equipment and risky sex.

Methamphetamine. Meth is linked to risky sexual behavior that places people at greater HIV risk. It can be injected, which also increases HIV risk if people share needles and other injection equipment.

Cocaine. Cocaine is a stimulant that can create a cycle in which people quickly exhaust their resources and turn to other ways to get the drug, including trading sex for drugs or money, which increases HIV risk.

Inhalants. Use of amyl nitrite (poppers) has long been linked to risky sexual behaviors, illegal drug use, and STIs among men who have sex with men (MSM).

HIV AND INJECTION DRUG USE

The risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment that someone with HIV has used. This is because the needles, syringes, or other injection equipment may have blood in them and blood can carry HIV. HIV can survive in a used syringe for up to 42 days, depending on temperature and other factors.

Sharing needles, syringes, or other injection equipment also puts people at risk for getting viral hepatitis. People who inject drugs (PWID) should talk to a healthcare provider about getting a blood test for hepatitis B virus (HBV) and hepatitis C virus (HCV) and getting vaccinated for hepatitis A virus (HAV) and HBV.

In addition to being at risk for HIV and viral hepatitis, people who inject drugs can have other serious health problems, like skin infections and heart infections. People can also overdose and get very sick or even die from having too many drugs or too much of one drug in their body or from products that may be mixed with the drugs without their knowledge (for example, fentanyl).

HOW CAN YOU PREVENT GETTING OR TRANSMITTING HIV FROM ALCOHOL USE?

The best way to lower your chances of getting HIV is to stop drinking alcohol. You may need help to stop or cut down, but there are many resources available to help you. To find a substance abuse treatment center near you, visit SAMHSA’s treatment locator or call 1-800-662-HELP (4357).

If you keep drinking, here are some ways to lower your risk for getting HIV and other infections:

    • Drink in moderation. Moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men. One drink is a 12-ounce bottle of beer, a 5-ounce glass of wine, or a shot of liquor.
    • Visit Rethinking Drinking, a website from NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA). This website can help you evaluate your drinking habits and consider how alcohol may be affecting your health.
    • Don’t have sex if you’re drunk or high from other drugs.
    • Use a condom every time you have sex. You can also consider sexual activities that are lower risk for HIV than anal or vaginal sex (like oral sex).
    • If you are HIV-negative, talk to your healthcare provider about pre-exposure prophylaxis (PrEP). PrEP is when people at very high risk for HIV take ART daily to lower their chances of getting HIV. PrEP must be taken every day as prescribed and alcohol use can make it hard to stick to a daily HIV regimen. Be open and honest about your alcohol use so you and your healthcare provider can develop a plan for you to take PrEP daily.
    • If you have HIV, taking ART every day exactly as prescribed is also important to stay healthy and prevent transmission. People with HIV who take ART daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners. Like PrEP, ART must be taken every day exactly as prescribed.

HOW CAN YOU PREVENT GETTING OR TRANSMITTING HIV FROM INJECTION DRUG USE?

The best way to lower your chances of getting HIV is to stop injecting drugs. You may need help to stop or cut down using drugs, but there are many resources available to help you. To find a substance abuse treatment center near you, visit SAMHSA’s treatment locator or call 1-800-662-HELP (4357).

If you keep injecting drugs, here are some ways to lower your risk for getting HIV and other infections:

    • Use only new, sterile needles and works each time you inject. Many communities have syringe service programs (SSPs) where you can get new needles and works and some pharmacies may sell needles without a prescription.
    • Never share needles or works.
    • Clean used needles with bleach only when you can’t get new ones. Bleaching a needle may reduce the risk of HIV but doesn’t eliminate it.
    • Use sterile water to fix drugs.
    • Clean your skin with a new alcohol swab before you inject.
    • Be careful not to get someone else’s blood on your hands, needles, or works.
    • Dispose of needles safely after one use. Use a sharps container and keep used needles away from other people.
    • Get tested for HIV at least once a year
    • Ask your healthcare provider about taking PrEP to prevent HIV.
    • If you think you’ve been exposed to HIV within the last 3 days, ask a healthcare provider about post-exposure prophylaxis (PEP) right away. PEP can prevent HIV, but it must be started within 72 hours.
    • Don’t have sex if you’re high. If you do have sex, make sure to protect yourself and your partner by using a condom the right way every time or by using other effective methods.

THE BOTTOM LINE

Substance use disorders are closely associated with HIV and other sexually transmitted infections (STIs). The best way to prevent getting or transmitting HIV is to not drink alcohol or use illicit drugs, however there are many ways to reduce the risk of getting or transmitting HIV if you continue to use substances.

Injection drug use can be a direct route of HIV transmission if people share needles, syringes, or other injection materials, such as cookers, cottons, or water. Drinking alcohol and/or ingesting, smoking, or inhaling drugs are also associated with increased risk for HIV.

For people with HIV, substance use can hasten disease progression, affect adherence to antiretroviral therapy (ART), and worsen the overall consequences of HIV.

You may need help to stop or cut down using alcohol or drugs, but there are many resources available to help you. To find a substance abuse treatment center near you, visit SAMHSA’s treatment locator or call 1-800-662-HELP (4357).

MORE INFORMATION

HIV.gov: Alcohol and Drug Use

HIV.gov: How Can Using Drugs Put Me at Risk for Getting or Transmitting HIV?

National Harm Reduction Coalition: Safer Drug Use

National Harm Reduction Coalition: Find Harm Reduction Resources Near You

CDC: Substance Use Disorder and Treatment

Reviewed June 2024

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