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Substance Abuse/Use

HIV can be transmitted by sharing drug preparation or injecting equipment (works) with a person who has HIV. Alcohol and drugs can impair your judgement and affect your ability to make safe choices, putting you at grater risk for HIV. The CDC recommends that people who inject drugs or engage in other risky behaviors get tested for HIV at least once every year.
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How Are Alcohol and Drug Use Related to HIV?

Alcohol and other drug use can play a significant role in the spread of HIV. For example:

  • Sharing needles, syringes, and other injection equipment is a direct route of HIV transmission.
  • Drinking alcohol or taking other drugs can increase your risk for HIV and other sexually transmitted diseases (STDs). Being drunk or high affects your ability to make safe choices and lowers your inhibitions, leading you to take risks you are less likely to take when sober, such as having sex without a condom or without taking daily medicine to prevent getting or transmitting HIV.
  • Transactional sex (trading sex for drugs, money, food, or shelter) can also increase your risk for getting HIV.
  • If you use drugs, you at are a higher risk for HIV infection and therefore should seek HIV testing. Use the HIV Testing and Care Services Locator to find a HIV testing site near you.
  • If you already have HIV, drinking alcohol or taking other drugs can affect your immune system and may speed up the progression of the disease. Drinking or taking drugs also can affect your HIV treatment adherence.

What Are the HIV Risks of Using Alcohol and Different Types of Drugs?

It’s important to know how alcohol and different types of drugs can increase your risk of getting HIV or passing it to others.

Alcohol

Drinking alcohol, particularly binge drinking, can increase your risk for HIV. Being drunk affects your ability to make safe choices and lowers your inhibitions, which may lead you to take risks you are less likely to take when sober, such as having sex without a condom or without taking daily medicine to prevent getting or transmitting HIV.

Alcohol use and abuse can also make the effects of HIV worse if you already have HIV. For example, alcohol use and abuse may make it difficult for you to follow your HIV treatment plan. In addition, alcohol abuse can contribute to health conditions such as liver disease that have an impact on the progression of HIV infection.

For more information, see NIAAA’s Alcohol and Health: HIV/AIDS.

Injected Drugs

Injection Drug Use and HIV Infection

The risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment that someone with HIV has used. For a summary of the latest data and ongoing prevention challenges, see CDC’s HIV and Injection Drug Use.

Injected drugs are drugs that are introduced into the blood stream using a needle and syringe. People who inject drugs, hormones, steroids, or silicone can get HIV by sharing needles or syringes and other injection equipment. The needles and equipment may have someone else’s blood in them, and blood can transmit HIV.

Another reason people who inject drugs can get HIV (and other sexually transmitted diseases) is that when people are under the influence of drugs (or “high”), they’re more likely to engage in risky behaviors, such as having sex without a condom or without taking daily medicine to prevent getting or transmitting HIV.

Also, “street sellers” of syringes may repackage used syringes and sell them as sterile syringes. For this reason, people who inject drugs should get syringes from reliable sources of sterile syringes, such as pharmacies or needle-exchange or syringe services programs.

Methamphetamine

Methamphetamine ("meth") is a very addictive stimulant that can be snorted, smoked, or injected. It has many street names, including crystal, tina, black beauties, and more.

Meth can reduce your inhibitions and interfere with your sound judgment regarding your behavior, which may make you less likely to protect yourself or others. This increases your risk of getting or transmitting HIV infection, both through sex and injection drug use.

Even though using meth is an HIV risk factor for anyone who does it, there is a strong association between meth use and increased risk of getting or transmitting HIV among men who have sex with men (MSM). Meth and other “party drug” use is common among some young MSM and can lead to increased drug use and sexual risk-taking.

Meth use can also make the effects of HIV worse for people who already have HIV.

Crack Cocaine

Cocaine is a powerfully addictive stimulant drug. The powdered form of cocaine is either inhaled through the nose (snorted), or dissolved in water and injected into the bloodstream. Crack is a form of cocaine that has been processed to make a rock crystal that users smoke.

If you use crack cocaine, you put yourself at risk for contracting HIV because crack impairs your judgment, which can lead to risky sexual behavior or further drug use.

In addition, crack’s short-lived high and addictiveness can create a compulsive cycle in which you quickly exhaust your resources and may turn to other ways to get the drug, including trading sex for drugs or money, which increases your HIV infection risk.

Other Drugs

Other drugs are also associated with increased risk for HIV infection. For example:

  • Using “club drugs” like Ecstasy, ketamine, GHB, and poppers can alter your judgment and impair your decisions about sex or other drug use. You may be more likely to engage in risky sexual behaviors or use other drugs, including injection drugs or meth. Those behaviors can increase your risk of exposure to HIV. If you have HIV and your viral load is not suppressed, use of club drugs could impair your judgment in ways that could increase your risk of spreading HIV to others.
  • The use of amyl nitrite (an inhalant known as “poppers”) has also been associated with HIV risk. Poppers, which are sometimes used in anal sex because they relax the sphincter, have long been linked to risky sexual behaviors, illegal drug use, and sexually transmitted infections among gay and bisexual men. They also have been linked to increased use among adolescents.

Injection Drug Use Also Poses Hepatitis Risk

Hepatitis is broad term referring to inflammation of the liver. This condition is most often caused by a virus. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are common among people who are at risk for, or living with, HIV.

That’s because you can get HBV and HCV the same way you get HIV—through sexual contact with a person with viral hepatitis or injection drug use. In fact, about 80% of people with HIV who inject drugs also have HCV.

HCV infection sometimes results in an acute illness, but most often becomes a chronic condition that can lead to liver disease and liver cancer. HCV infection is more serious in people living with HIV because it leads to liver damage more quickly.

If you are a person living with HIV, co-infection with HCV may also affect your HIV treatment. Therefore, it’s important to get tested for HCV so that you can start HCV treatment or, if you test negative, take steps to prevent HCV infection. To find out if you have HCV, ask your doctor or other healthcare provider to test your blood. HCV can be treated successfully, even in people who have HIV.

What If I Am Already Using Drugs?

If you are using drugs—including injection drugs, meth, alcohol, or other drugs—the best way to reduce your risk of getting or transmitting HIV is to stop using drugs. Substance abuse treatment programs can help you do this.

Many substance abuse treatment programs include HIV counseling to help people stop or reduce their risk behaviors, including risky injection practices and sexual behaviors, so that they can stay healthy and reduce their risk of contracting HIV or transmitting it to others. Many treatment facilities also offer HIV and HCV testing and linkage to care, if needed. Find a substance abuse treatment program near you.

If you are injecting drugs, syringe services programs (SSPs) are available in many communities to help you. SSPs (sometimes referred to as needle exchange programs) provide access to sterile needles and syringes free of cost and facilitate safe disposal of used needles and syringes, and offer safer injection education. Many also provide linkage to other services such as referral to treatment programs and screening, care, and treatment for HIV and viral hepatitis.

If you are injecting drugs and believe you cannot stop using yet, here are some other things that will reduce your risk of getting HIV or transmitting it to others:

  • Never use or "share” syringes (needles), water, “works,” or drug preparation equipment that has already been used by someone else.
  • Use a new, sterile syringe each time you prepare and inject drugs. You can get clean needles from pharmacies or SSPs.
  • Only use syringes that come from a reliable source (e.g., pharmacies or SSPs).
  • Use sterile water to prepare drugs, such as water that has been boiled for 5 minutes or clean water from a reliable source (such as fresh tap water).
  • Use a new or disinfected container ("cooker") and a new filter ("cotton") each time you prepare drugs.
  • Before you inject, clean the injection site with a new alcohol swab.
  • Safely dispose of syringes after one use.

Also, if you engage in sexual activity, reduce your sexual risk factors for HIV infection.

The Importance of HIV Testing for People Who Use Drugs

CDC and the U.S. Preventive Services Task Force Exit Disclaimer recommend that people who inject drugs or engage in other behaviors that put them at increased risk get tested for HIV at least once every year. (CDC also recommends that sexual partners of those who inject drugs also get tested at least once per year.)

Talk to your healthcare provider about getting tested for HIV. You can use the HIV Testing and Care Services Locator or call 1-800-458-5231 to find a confidential HIV testing site near you and learn about what kinds of HIV tests are offered at each site. You can also buy a home testing kit at a pharmacy or online.

What If I Already Have HIV?

If you are already living with HIV, you need to take care of yourself so that you stay healthy. Substance use and abuse can negatively affect your health and well-being in a variety of ways. See Staying Healthy with HIV/AIDS: Substance Abuse Issues for more information.

Last revised: 04/10/2017