Substance Abuse and HIV: It’s Not What You Think

Post Image

People with a substance use disorder show some of the highest rates of contracting HIV, which indicates a correlation between HIV and drug use.

There’s a misconception that people believe most substance abusers either have HIV or will eventually contract the virus. HIV indeed occurs at an elevated rate among substance users compared to the general population. However, research has suggested that the reason people with substance use disorder are contracting HIV isn’t the same as it is widely perceived to be.

Elevated Rates of HIV and Substance Use 

When we think about HIV and drug use, the first thought is that intravenous drug users are the most susceptible to contracting HIV or other bloodborne pathogens.

Until somewhat recently, that was the case. The United Nations Office on Drugs and Crime found that if you exclude Africa, up to 30 percent of global HIV infections occur due to intravenous drug use. With Africa included, the rate drops to only 10 percent, reflecting the high number of Africans with HIV who aren’t intravenous drug users.

Moreover, statistics from the National Institute on Drug Abuse (NIDA) indicate that one-third of all individuals with HIV regularly abuse alcohol or drugs. However, the statistics also indicate that there’s another cause for HIV transmission that accounts for a much higher percentage of HIV cases among drug users. Data aggregated from the U.S. Centers for Disease Control and Prevention (CDC) found that only 16 percent of HIV cases among drug users occurred due to intravenous drug use. 

It is more indicative of HIV risk among drug users to engage in risky behavior such as unprotected sex. Unprotected sex accounted for the other 84 percent of HIV cases among substance abuse users, suggesting that the majority of drug users aren’t actually getting HIV from sharing needles, a common misperception among the general public.

Substance Use and Risky Sexual Behavior

To understand why intravenous drug use is so dramatically overshadowed by the effect of unprotected sex among drug users, one must conceptualize the lifestyle of someone with substance use disorder.

Although heroin addiction has become an epidemic in the United States, there are still many individuals who are abusing other substances such as alcohol, marijuana, cocaine, and even prescription pain medication. With these other substances, intravenous use is less of an issue. In fact, the majority of mind-altering substances cannot be used intravenously, making it virtually impossible for users of those substances to contract HIV through the sharing of needles.

Mind-altering substances cause individuals to behave in risky or impulsive ways. Intoxication results in distorted perceptions, altered cognition, and an overall inability to make informed, aware choices. 

As such, substance abusers are a population that shows high rates of risky sexual behavior. According to a study, the most common behaviors that resulted in the contraction of HIV were inconsistent condom use, having more than one sexual partner, and resorting to exchanging sex and sexual favors for drugs or money.

Substance Abuse Interferes with HIV Treatment

Another big problem with the tendency for individuals with HIV to abuse alcohol and drugs is that substance abuse greatly interferes with an individual’s medical treatments for the disease. 

It’s been found that the majority of HIV infected people also require some level of substance abuse treatment. Some of the theories why individuals with HIV need treatment include the possibility that the substance abuse behavior is lingering from past addiction, or perhaps these individuals begin abusing alcohol or drugs as a means of coping with the experience and stress of receiving an HIV diagnosis.

A person with HIV and a substance use disorder may have memory troubles, poor decision-making skills and may not be able to make or adhere to plans or appointments, such as those for HIV-related treatment. When an HIV-infected person misses medical appointments, the possibility of developing AIDS is real. AIDS is considered a late-stage HIV infection. 

Antiretroviral therapy (ART), which is the most effective treatment for HIV, requires consistency to be optimally effective. It is another reason why inconsistent treatment is dangerous. Therefore, it’s essential for individuals who have HIV and a substance use disorder to seek the appropriate treatments.



Back in the early 1980s when HIV was first diagnosed, intravenous drug use was one of the top causes of HIV infection. Unprotected sex was another. Today, more than 30 years later, unprotected sex is still the main cause for HIV infection, and it is more so for those struggling with a substance use disorder. While HIV is not a fatal diagnosis anymore, abusing drugs or alcohol can affect treatment and care. Someone who is addicted to drugs or alcohol and has HIV needs help to fight the addiction and treat the virus at the same time. 

Addiction Treatment and HIV

Since most drug treatment centers offer dual-diagnosis support for people with a substance use disorder and a co-occurring or comorbid condition, individuals can receive treatment for an HIV diagnosis while overcoming addiction. 

If you or someone you love would benefit from learning more about addiction treatment or HIV support, we are here to help. If you need more information about addiction treatment or someone to hear how having HIV and using drugs is causing grief, we’re here to listen. Call today.

Related Reading

Leave a Comment