Drug Abuse and AIDS

Behavior associated with drug abuse is now the single largest factor in the spread of HIV infection in the United States. HIV is the Human Immunodeficiency Virus, which causes Acquired Immunodeficiency Syndrome, or AIDS. AIDS is a condition characterized by a defect in the body's natural immunity to diseases, and individuals who suffer from it are at risk for severe illnesses that are usually not a threat to anyone whose immune system is working properly. Although many individuals who have AIDS or carry HIV may live for many years with treatment, there is no known cure or vaccine.

Using or sharing unsterile needles, cotton swabs, rinse water, and cookers, such as when injecting heroin, cocaine, or other drugs, leaves a drug abuser vulnerable to contracting or transmitting HIV. Another way people may be at risk for contracting HIV is simply by using drugs of abuse, regardless of whether a needle and syringe are involved. Research sponsored by NIDA and the National Institute on Alcohol Abuse and Alcoholism has shown that drug and alcohol use interfere with judgment about sexual (and other) behavior, making it more likely that users have unplanned and unprotected sex. This places them at increased risk for contracting HIV from infected sex partners.

Infection Rates

Half of all new infections with HIV now occur among injecting drug users (IDUs), according to a review of 1996 data from the Centers for Disease Control and Prevention (CDC).* This review used data gathered from the Nation's 96 largest cities, where HIV infection rates are the highest. Most newly HIV-infected IDUs live in northeastern cities from Boston to Washington, D.C., as well as in Miami and San Juan, Puerto Rico. In these cities, where injection drug use rates are the highest among the 96 cities surveyed, an average of 27 percent of all IDUs are HIV-infected.

The 96 metropolitan areas surveyed have an estimated 1.5 million IDUs, 1.7 million gay and bisexual men, and 2.1 million at-risk heterosexuals (men and women who have sex with IDUs or gay and bisexual men). Among these three risk groups, there are currently an estimated 565,000 HIV infections, with 38,000 new infections occurring each year. Using these data to make nationwide projections, the review concludes that there are about 700,000 current HIV infections, with 41,000 new HIV infections occurring each year in the U.S.

An estimated 19,000 IDUs are infected each year in these areas, indicating an HIV incidence rate of about 1.5 infections per 100 IDUs per year. Infection rates are lower for the other two high-risk groups. Although gay and bisexual men still represent the group with the greatest number of current HIV infections, the rate of infection - except in young and ethnic/ minority gay men - is much lower now than it was a decade ago. For gay and bisexual men, the HIV infection rate per 100 persons per year is 0.7; for at-risk heterosexuals, the rate is 0.5 infections per 100 persons per year. At-risk heterosexual women outnumber at-risk heterosexual men about 4 to 1.

Prevention of HIV among IDUs

It is clear from research that drug abuse treat ment is a proven means of preventing the spread of HIV and AIDS, especially when combined with prevention and community-based outreach programs for at-risk people. These efforts can reduce or eliminate drug use and drug-related HIV risk behaviors such as needle sharing and unsafe sex practices. One study comparing HIV infection rates among drug abusers enrolled in methadone treatment programs to rates among those not in treatment found that those not in treatment were nearly seven times more likely to have become infected with HIV during the first 18 months. The study also found that the longer drug abusers remained in treatment, the less likely they were to become infected.

In addition, drug treatment programs help reduce the spread of other blood-borne infections, including hepatitis B and C viruses. Adequate medical care for HIV or AIDS and any related illnesses is also critical to reducing spread.

To learn more about resources for HIV/AIDS information or HIV testing in your area, call the National AIDS Hotline at 1-800-342-2437 (in Spanish, 1-800-344-7432; deaf, 1-800-243-7889), or the National AIDS Clearinghouse at 1-800-458-5231, or write PO Box 6003, Rockville, MD 20849-6003.

* Holmberg, S.D. The estimated prevalence and incidence of HIV in 96 large U.S. metropolitan areas. American Journal of Public Health 86(5):642-654, 1996