Though AIDS (acquired immune deficiency syndrome) may not currently be getting as much media attention as in the past, it is still very much a public health threat.
According to Best Health, each year approximately 50,000 new cases of infection are reported in the US. Significantly, approximately 20 percent of individuals who are infected with HIV (human immunodeficiency virus, which leads to the development of AIDS) are not aware of their status, which can increase the risk of transmission. Per research in this area, it is thought that 1.7 million Americans have been infected with HIV since it was first detected. Although many individuals are benefiting from ongoing treatment, prevention is still key.
The Centers for Disease Control and Prevention (CDC) discusses who may be most at risk. Here we see the strong connection between HIV and drug abuse. Per the CDC, certain lifestyle factors can increase the risk of contracting HIV.
- Individuals who use injectable drugs and are infected with HIV (whether knowingly or unknowingly) can contaminate needles and syringes, as well as other injection-related instruments and accessories.
- Individuals who engage in sexual behaviors for drugs or money face a heightened risk.
- Anyone who engages in unprotected sex (oral, vaginal, or anal), has multiple sexual partners, or does not know the identity of their sexual partners is at an increased risk.
- Research shows that individuals who have diseases, such as hepatitis, tuberculosis, or STDs (sexually transmitted diseases, such as syphilis), may be more likely to also be HIV positive.
Even if a person has not engaged in any of the above behaviors, having unprotected sexual relations with someone who has done so presents a serious risk of infection.
Even a cursory review of the above risk factors for HIV reflects that drug abuse can play a key role in contracting this virus. In general, drug abuse is associated with increased risk tolerance. Since drugs alter a person’s perception and can lower inhibitions, it is understandable that people may takes risks they would not take in a drug-free state. Such risks include sharing needles and/or syringes and having unprotected sex.
While a person may initially consent to using illicit drugs, one hallmark of drug abuse is that the practice becomes less and less voluntary over time.
Another hallmark is that people who are regularly using drugs act uncharacteristically, which can often mean being reckless in terms of safety.
The Origin and Spread of AIDS
In America, AIDS and drug addiction have been intertwined since HIV first appeared on the continent; however, the origin of HIV is not thought to be related to drug abuse. According to the AIDS Institute, a nonprofit organization, a version of HIV (HIV-1) was first detected in 1959, and the infected individual was from the Democratic Republic of the Congo, Africa. It is unknown exactly how the man contracted the virus, but one theory (advanced in 1999) is that he may have eaten West African chimpanzee meat that was infected with simian immunodeficiency virus (SIV). It is widely accepted in the AIDS research community that the West African chimpanzee is the source of HIV. In humans, chimpanzee SIV mutated into HIV.
In the US, research shows that the virus was in circulation by the mid to late 1970s. From about 1979 to 1981, doctors saw some new, severe symptoms in patients, mostly in men who had engaged in male-to-male sex. The symptoms related to poor immune functioning. In 1982, the medical community named this health condition – acquired immune deficiency syndrome – and an understanding of AIDS started to balloon in the public mind. In 1983, scientists realized that HIV was responsible for AIDS. Addiction enters the AIDS story not in terms of its origins, but its spread throughout the US.
As the National Institute on Drug Abuse (NIDA) explains, HIV can be transmitted from one person to another through blood or bodily fluids, such as semen. It is also important to understand how HIV is not spread. The CDC notes that HIV cannot survive for very long on surfaces (outside of a human host), and it cannot be spread by:
- Saliva, sweat, or tears (as long as these fluids are not mixed with blood)
- Ticks, mosquitoes, or other insects
- Sharing dishes or toilets
- Shaking hands
- Closed mouth kissing or cheek kissing
- Sexual acts that only include touching
NIDA points out that many people may associate the use of intravenous drug use with the transmission and contraction of HIV, but actually, HIV is most commonly contracted through unprotected sex, which includes sex in exchange for money or drugs. In this way, when the public thinks about AIDS and addiction, it is important to take an expansive approach. Drug abuse in general increases the risk of HIV infection, not just abuse of intravenous drugs.
It is also helpful to understand which groups, engaging in which activities, tend to be associated with the greatest risk. According to NIDA, in 2010, there were at least 47,000 new cases of HIV infection. Here is a breakdown of the sources of the new cases of infection:
- Of all the new cases, 8 percent had a history of injectable drug use.
- Men who have sex with other men and used intravenous drugs represented 3 percent of new cases.
- Men who have sex with other men made up 61 percent of the group.
- Transmission through heterosexual sex represented 28 percent of the group.
- There is also a race dimension to these statistics. In 2010, over 50 percent of all the people newly infected were African American, followed by Caucasian, and then Hispanic.
At present, there is no vaccine for HIV, nor is there a cure for AIDS; however, HIV and AIDS are largely preventable. One way to prevent the spread of HIV is to know one’s status. Per the CDC, an estimated 1.2 million Americans have HIV but one in five people (20 percent) are unaware of their status. That translates to this fact: An estimated 240,000 American are HIV positive and do not know it.
According to US Preventive Services, individuals who use injectable drugs or engage in any risky behavior (including drug abuse in general and unprotected sex) should be tested for HIV at least once each year. This recommendation extends to anyone who has sex with an individual who fits this description. There are now HIV tests that can provide a result in as little as 20 minutes. However, testing does not provide accurate results for about 6-8 weeks after the initial exposure. This is because the test detects HIV antibodies, and they typically take at least this long to emerge. Later in this article, there is information about PEP, a medication that may be available for people who believe they have been exposed to HIV in the last three days.
To help the public find a facility that can provide an HIV test, AIDS.gov maintains an online searchable database. All public and most private health insurance plans under the Affordable Care Act (known colloquially as Obamacare) provide testing for free. In addition, the US Food and Drug Administration has approved HIV home test kits.
How People Who Use Drugs Can Reduce Their HIV Risk
For individuals who abuse alcohol and illicit drugs, the most obvious way to reduce one’s HIV risk may feel like one of hardest: going to rehab for addiction. It is critical to bear in mind that the specialized staff and research-based methodologies available at drug treatment centers can help a person to safely overcome any mental barriers to treatment. Drug abuse is a self-perpetuating process, but treatment can intervene and reroute a person onto the road of abstinence. But if, for whatever overriding reasons, a person is not going to presently seek treatment, it is imperative to know some ways to reduce the risk of HIV infection.
Public health officials advise individuals who use injectable drugs to take the following precautions:
- Understand that it is never safe to share syringes, needles, water, or drug preparation instruments.
- When getting ready to inject, use a sterile, new syringe. Some syringes have fixed needles and others have removable ones. The syringe and the needle should be new and sterilized. Clean needle programs or needle exchange programs provide new, sterile syringes and needles. The Harm Reduction Coalition provides the public with a searchable database of needle exchange programs. In some areas, a local clinic or pharmacy may provide sterile syringes for free.
- When using a syringe, make sure it comes from a trusted source, such as a needle exchange program, pharmacy, or clinic.
- The water that is used to prepare drugs should be sterilized. Boiling water for five minutes can sterilize it.
- When preparing the injectable drug, always use a new cooker and new cotton filter.
- Use alcohol swabs to clean the injection site on the skin before injecting.
- After use, safely discard the syringe and needle. This should happen after each and every use. In other words, a syringe should only ever be used once and never shared with another person.
Again, unsafe sex practices present an increased risk of HIV infection. If abstinence is not opted for, there are several ways to engage in safer sex practices that reduce the risk of HIV transmission and infection.
- Consistently and appropriately use condoms. AIDS.gov provides helpful information on how to correctly use condoms.
- Engage in sexual practices that present a reduced risk of infection. The riskiest type of sexual activity is anal sex. Both individuals face an increased risk, but research shows that the person who receives, if HIV negative, faces a serious risk of infection. Vaginal sex is risky, but less so than anal sex. There are documented cases of transmission by oral sex, but there is typically little risk this way.
- Regarding the number of partners, on the one hand, just one infected partner presents a serious risk, but overall, the recommendation is to limit one’s number of partners.
- For individuals who are HIV negative, a preventative medication is available, and it is called pre-exposure prophylaxis (PrEP). The pill must be taken every day to maximize its effectiveness. This medication helps prevent the transmission of HIV through sex.
- For HIV negative people who are not taking PrEP and think that they may have been exposed to HIV through sex in the last three days, it is critical to speak with a doctor about post-exposure prophylaxis (PEP).
- For individuals who have one or more sexually transmitted diseases, getting treatment can reduce the risk of contracting HIV. Research shows that having an STD is a risk factor for getting HIV. For individuals who do not know their STD status, it is recommended to get tested and continue to do so each year.
- Individuals who have a sexual partner who is HIV positive are encouraged to help that partner get treatment (if the person hasn’t done so already) and maintain it. Today, there are HIV treatments that can significantly reduce the likelihood that a person will transmit HIV to a partner.
The reality of HIV and AIDS today is that there is a general public awareness of how to prevent transmission, but there are continually new cases of infection. Scientists, despite research efforts for three decades and counting, have developed treatments but no cure or vaccine. For this reason, self-education is critical, especially among individuals who use drugs, including alcohol.
There are innumerable advantages associated with getting treatment for substance abuse, and preventing or better managing a disease is one of the most significant ones.
For this reason, a drug treatment center will often provide its clients with education on HIV, AIDS, STDs, and other diseases and viruses as preventative efforts. For individuals who are infected with HIV or another virus, a qualified rehab center can provide treatment for the addiction that complements treatment for the virus or disease.