HIV/AIDS

How Does Drug Abuse Impact the HIV/AIDS Epidemic?

Drug abuse and addiction have been inextricably linked with HIV/AIDS since the beginning of the epidemic. While intravenous drug use is well known in this regard, less recognized is the role that drug abuse plays more generally in the spread of HIV -- the virus that causes AIDS -- by increasing the likelihood of high risk sex with infected partners.¹ This is because of the addictive and intoxicating effects of many drugs, which can alter judgment and inhibition and lead people to engage in impulsive and unsafe behaviors.

Drug abuse and addiction can also worsen the progression of HIV and its consequences, especially in the brain. In animal studies, methamphetamine increased HIV viral replication;² in human methamphetamine abusers, HIV caused greater neuronal injury and cognitive impairment compared with non-drug users.^3,4

Who Is At Risk for HIV Infection and How Does HIV Become AIDS?

Anyone is vulnerable to contracting HIV. And while injecting drug users (IDUs) are still at great risk of contracting HIV/AIDS, anyone under the influence of drugs or alcohol is at heightened risk. This includes IDUs who share contaminated syringes or injection paraphernalia, as well as anyone who engages in unsafe sex (e.g., multiple partners, unprotected sex) or "transactional" sex (e.g., trading sex for drugs or money) that could expose them to infection.

A person infected with HIV has a virus that lives and multiplies primarily in white blood cells, which are part of the immune system. An infected person may look and feel fine for many years and may not even be aware of the infection. However, as the immune system weakens, the individual becomes more vulnerable to illnesses and common infections. Over time, the untreated HIV patient is likely to succumb to multiple, concurrent illnesses and develop AIDS. Recent developments have led to better treatments for HIV infection, the most effective being a strategy known as highly active antiretroviral therapy (HAART).

Approximately 4 out of 10 U.S. AIDS deaths are related to drug abuse.

What Is the Scope of HIV/AIDS in the United States?

Currently, an estimated 1 million people in the United States are living with HIV/AIDS. In this country, annual reported AIDS cases peaked in 1993 at approximately 80,000. Between 1993 and 1998, the incidence of new cases declined steadily before leveling off between 1999 and 2001. However, since 2001, the number of new cases has increased slightly each year, with 43,171 new AIDS cases reported in 2003.

The number of HIV infections is harder to confirm given that, unlike AIDS reporting, HIV reporting is not mandatory. Currently, only about two-thirds of States report HIV infections; from these data, it is estimated that 40,000 new HIV infections have been occurring annually since the early 1990s, down from the peak of 160,000 new infections per year in the mid-1980s. Nonetheless, the persistence of this rate for more than a decade indicates that much remains to be done to improve the effectiveness of HIV prevention.

Estimated Number of AIDS Cases and Deaths Among Adults and Adolescents with AIDS, 1985-2003 -- United States