Addiction and HIV/AIDS

Individuals who inject drugs are 28 times more at risk of contracting HIV compared to the average person. The risk emanates from sharing injecting equipment such as needles and is reinforced by poverty, criminalisation and marginalisation. According to researchers, the rate of HIV infection amongst injecting drug users is increasing by the day.

Global Fund to Fight Aids – one of the world’s leading independent authorities – warned that the only way to stop the trend was to decriminalise illicit drugs and re-evaluate drug laws. There are over 11 million people who inject drugs like Heroin, Oxycodone, Cocaine, Crystal Meth and DMT – 14% of whom are reportedly living with HIV in the United States, with China and Russia making up the core of the figure.

What is HIV/AIDS?

HIV is a virus which attacks the immune system of the human body – your natural defence against diseases and illness. It destroys T-helper cells (CD4), a white blood cell in the immune system and replicates itself in these cells. HIV breaks down your immune system by duplicating itself, meaning that someone who has this virus can’t fight off diseases or sickness.

AIDS is the most severe and dangerous type of HIV infection. It stands for Acquired Immune Deficiency Syndrome. Breaking that down, ‘Acquired’ refers to the person becoming infected, whereas ‘Immune Deficiency’ denotes that a person’s immune system is weakened. Meanwhile, ‘Syndrome’ refers to the disease as a group of health problems.

The stages of HIV include:

Acute infection stage: Most people start developing flu-like symptoms within two to four weeks after infection sets in. You’ll notice flu-like symptoms such as swollen glands, fever, joint and muscle pain, sore throat, rashes and headaches. Starting treatment for the acute retroviral syndrome has significant benefits for your physical health.

Clinical latency stage: Latency simply means that the virus is developing without producing any symptoms in your body. You might experience mild symptoms as HIV continues to duplicate at low, undetected levels. With the application of ART therapy, you can live with clinical latency for decades, without the disease progressing to AIDS.

AIDS: AIDS develops from HIV. It’s a sign that you have an extremely low number of CD4+ cells, which can be deadly. HIV doesn’t automatically progress to AIDS, as it takes a long time for the change to occur – sometimes up to 12 years, even without treatment. When the CD4+ cells fall below 200 cells per cubic metre of blood, you will have contracted AIDS. Without treatment, you can live for three years. In some cases, you may live for as little as one year.

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Health problems caused by untreated HIV/AIDS

When HIV infection isn’t treated with antiretroviral drugs, there is a timeline of phases before AIDS sets in: the acute stage, clinical latency stage and AIDS itself. If HIV infection is left untreated beyond this stage, health risks include:

Blindness: Cytomegalovirus is a common disease when HIV progresses to AIDS. Without treatment, retinitis causes complete blindness, but with HIV/AIDS retroviral, you can prevent cytomegalovirus infection.

Tuberculosis: A bacterial infection that damages the lungs and leads to death.

Encephalitis: Brain infection occurs when HIV/AIDS is left untreated. It’s caused by the Toxoplasma gondii parasite, and leads to coma and death when left untreated.

Other infections include herpes, thrush, malaria, pneumonia, Pneumocystis and Mycobacterium avium complex.

What is the connection between substance addiction and HIV?

Substance abuse occurs when you use drugs excessively, take higher doses of prescription medication, use drugs for periods longer than they were prescribed, combine medication with illicit substances, or inject, snort or smoke prescription pills to increase the potency of the ‘high’.

Drug abuse plays a significant role in the progression of HIV. The risk of infection is higher among those abusing drugs, either by sharing needles or engaging in reckless behaviour, such as unprotected sex. Many substances (like alcohol) impair judgement and reduce inhibitions. The actions you take under the influence increase the risks of contracting HIV and also affect HIV/AIDS treatment and maintenance – especially for long-term users with a chronic abuse problem.

The negative impact of alcohol abuse on HIV/AIDS

The immune system of individuals with HIV/AIDS is weakened by the disease. Anything that adds to the burden raises the chances of HIV replication and reduces the efficacy of antiretroviral therapy (ART). Alcoholics are less likely to achieve positive response from ART, because alcohol inhibits judgement and decreases awareness. You need a structured regimen of medication and to avoid illicit substances to negate the progression of AIDS.

The effects of smoking on HIV/AIDS

Smoking is a popular habit among HIV-positive individuals. There are various diseases related to smoking. Since the immune system is weakened by HIV, smoking makes you susceptible to many diseases. HIV individuals have a higher risk of lung, mouth and throat infections.

Individuals with HIV/AIDS are also more likely to contract pneumonia. The opportunistic pathogen Pneumocystis leads to more life-threatening infections in HIV/AIDS patients than it does in the general population. Other respiratory diseases include yeast infection of the mouth, characterised by sores.

The effects of illicit drugs on HIV/AIDS

Anyone living with HIV/AIDS should not abuse drugs. HIV/AIDS complicates treatment and abusing drugs increases the risk of contracting HIV. When you share needles, there’s a risk you will use contaminated injection supplies. The craving for drugs increases risky behaviour. Therefore, it’s likely you’ll use shared needles without caring about the risks.

Individuals with substance use disorder are unlikely to access effective treatment options. This results from a lack of access to clinics that treat HIV and substance abuse.

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Why drug use increases HIV risk

Drug abuse has been linked with HIV/AIDS since the disease was first detected. The intoxicating effect of most addictive substances alters inhibition and judgement, leading you to engage in unsafe, impulsive behaviours. Under the influence of drugs, you’re more likely to have unprotected sex or engage in risky sexual activities with a view to source more drugs.

A quarter of new AIDS cases originate from intravenous drug use, while one in four HIV/AIDS patients abused alcohol until they required inpatient treatment. Illicit substances also aggravate consequences and progression of HIV in the brain, causing cognitive impairment and neural injury in meth users.

Direct risk occurs when you share needles or use contaminated ones, as traces of blood are transferred between individuals. Even when you use a needle obtained from a needle-exchange programme, other materials such as cotton balls or dissolving solutions might contain blood or body fluids.

Living with HIV/AIDS and addiction

Individuals with drug use disorder have an increased risk of contracting and spreading HIV. Drug abuse also worsens symptoms of the infection. HIV spreads through transmission of body fluids like vaginal secretions, semen and blood. It is also transferred through mucous membranes, unhygienic surgical procedures, broken skin and sharing contaminated needles.

It is important that you seek specialised addiction treatment if you’re living with HIV/AIDS and dealing with substance addiction. The best route for recovery depends on the issues that affect you most and determining what should be prioritised in therapy. Substance use treatment supersedes HIV diagnosis and all mental health problems noticed during evaluation should be addressed in treatment.

Effects of drug use on HIV treatment

While some illicit drug use doesn’t interact with HIV/AIDS treatments, it interferes with treatment schedules. There are medications HIV/AIDS patients have to take every day – at specific times – to live a full, healthy life and block the onset of AIDS. When you’re under the influence of drugs, you lose sense of time, which disrupts your treatment schedules and daily activities. For recovering addicts, relapse increases your chances of engaging in risky behaviour.

Methadone is safe to use with antiretroviral therapies, but it might decrease levels of therapeutic methadone in patients. Methamphetamine worsens symptoms of HIV/AIDS, as both carry neurological symptoms compounded by methamphetamine abuse. A recent study shows that methamphetamine users living with HIV/AIDS were more likely to experience severe cognitive impairment.

Cocaine is another dangerous substance that affects the efficacy of treatment. CD4 T cell population is lower in cocaine users than other individuals as adherence to ART isn’t enough to manage HIV when you’re abusing the drug.

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Who is at higher risk for this co-occurring disorder?

Co-occurring infections are common amongst HIV patients, making it more difficult to treat addiction. The most common infections are Hepatitis and Tuberculosis. Several factors increase the risk of co-infection in HIV patients. They include weak immune system, injection drug use, environment and non-adherence to treatment.

Individuals at higher risk include:

Members of the LGBT community: Men who engage in anal intercourse with each other are at greater risk than those who have vaginal sex. The fear of homophobia prevents many gay men from seeking proper treatment.

Pregnant women: 90% of women with substance abuse disorder are of reproductive age. Expectant mothers who abuse drugs increase risk of negative outcome in babies.

Commonly used substances and the HIV risk

Recreational drugs sometimes interfere with ART to decrease or increase ART drug levels, leading to failure of the treatment. Drug interactions also reinforces drug use. The liver metabolises ART, causing these drug interactions. Common interactions include:

Crank/Crystal meth, methamphetamine: Gay men using crystal meth are five times more likely to contract HIV. Amphetamine levels double or triple when used with ritonavir.

MDMA/Ecstasy: Protease inhibitors and ecstasy use the same liver pathway. It causes extremely high levels of ecstasy in the body, leading to conditions such as kidney stones when used with indinavir.

Alcohol: Alcohol weakens the immune system. Consuming alcohol whilst undergoing ART limits its effectiveness. Alcoholics are unable to maintain the regular schedule required for taking medication, which increases the risk of pancreatitis when used with didanosine.

Marijuana: Interaction statistics are unknown, but it’s suspected that when you eat marijuana instead of smoking it (whilst taking ART medication), this increases its effects.

Opioids: a class of prescription pain medication associated with increased risk behaviour that exposes you to HIV when you share needles or have sex without using contraception.

Facts and statistics about HIV and substance use

  • Between 2005 and 2009, one in four HIV patients reported extreme drug use that required treatment.
  • A quarter of AIDS cases originate from intravenous drug use.
  • 10% of global HIV infections result from injecting drugs.
  • Drugs and alcohol lead to risky behaviour that increases the chances of contracting or spreading HIV.
  • Abusing illicit substances carries health risks such as tuberculosis, hepatitis, liver damage, brain damage, pneumonia and blindness.
  • Drug abuse makes it harder to stick with a HIV regimen, required to stay healthy. Skipping medications allows HIV to replicate and cause further damage to your immune system.
  • Drug interactions between HIV medication and substances like alcohol, meth, ketamine and LSD increase the risk of dangerous and life-threatening side effects.

Addiction treatment in the presence of HIV/AIDS: Best practices

Addiction is a common trend amongst individuals living with HIV/AIDS. It’s necessary to understand how drug abuse affects you and know the best addiction remedies that align with HIV treatment. You can receive treatment for HIV, co-occurring conditions and drug addiction simultaneously.

According to recent data, one in four HIV/AIDS patients need treatment for substance abuse. The success of any treatment depends on co-infection such as hepatitis and tuberculosis and the presence of mental health issues and financial barriers to treatment.

When you decide to get treatment, choose a specialised rehab centre that provides medical care for co-infections and HIV symptoms. You’ll continue to receive ART during detox and receive addiction treatment – either at an inpatient or outpatient rehab centre.

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How does HIV/AIDs affect addiction treatment?

Many factors complicate treatment for HIV/AIDS individuals receiving addiction treatment. They include: co-infection diseases, co-occurring psychiatric disorders, type of substance being abused, severity of addiction and interactions between ART and addiction medicine.

Therapeutic drugs used in AER and medication-assisted treatment might have some side effects when taken either together or independently. For example, treating Hepatitis C and HIV together affects liver function and the metabolism of opioid maintenance medication like buprenorphine or methadone.

Getting treatment

Treatment for drug rehabilitation can include:

Inpatient care: This is 24/7 rehab that last 30 to 90 days. It helps you focus on making a full recovery by learning about your addiction, improving communication skills and learning how to apply those skills in everyday society.

Outpatient care: This is ideal for individuals who want to receive treatment from home. This works best for patients with a strong support network.

Recovery and aftercare

Aftercare is an essential part of addiction treatment. Many individuals who seek treatment feel a deep sense of shame for their actions, especially pregnant women and members of the LGBT community.

Treatment helps you get past the shame and equips you with the tools needed to live a healthy, drug-free life after rehab. Recovery and support groups like Narcotics Anonymous and Alcoholics Anonymous are ideal groups to join. HIV-positive recovering addicts can provide support and guidance to each other.

Your aftercare plan will include wellness maintenance and proper nutrition, two important areas of focus for HIV patients. You’ll be taught to avoid food and water containing dangerous pathogens, eating undercooked meat, drinking unfiltered water or eating unwashed vegetables.


What is HIV/AIDS?

Human Immunodeficiency Virus (HIV) attacks the body’s natural defence system – the immune system. It makes it impossible for you to fight off disease, because the white blood cells needed to fight against infection (CD4+) are destroyed. When HIV is diagnosed, it can be managed with the right medication to prevent it from developing into AIDS.

Can you contract HIV from using drugs?

You can’t physically contract HIV from using drugs, but it increases the risk. Sharing contaminated needles and risky behaviours like engaging in unprotected sex whilst under the influence of drugs increases the risk of HIV/AIDS. If you use a needle that has already been used by someone who has HIV/AIDS, you will also contract the disease.

How does drug abuse affect the HIV epidemic?

Drug abuse lowers inhibitions and increases the risk of engaging in risky behaviour. The intoxicating effects of alcohol and other substances hinders judgment and makes you more amenable to risky sexual behaviour in order to source more drugs.

How does drug usage affect symptoms and outcomes of a viral infection?

Alcohol and injection drugs are major factors leading to the spread of HIV. Apart from sub-Saharan Africa, injections account for one in three new HIV cases. Alcohol weakens the immune system, so combined with HIV, you have almost no chance of fighting any disease on your own. Illicit substances like crystal meth lead to worsened cognitive impairment. Smoking when you have HIV leads to tuberculosis and other associated health risks. Without proper treatment, you could die within one to three years.

How can people lessen the spread of viral infections?

If you’re not 100% sure that those you’re sharing needles or having sex with are not living with HIV, you should always take preventive measures. In the acute HIV phase, the risk of spreading the disease is higher than during the chronic stage, due to high viral load. The best way is to practice abstinence from sex and get help for addiction to ensure you don’t share needles with other substance users. Safe sexual activities include erotic massage, kissing and masturbation.

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