Dangerous Intersection of Drug Use and Sexual HIV Transmission Points to Critical Need for Comprehensive HIV Prevention
Sharing syringes and other
equipment for drug injection is a well known route of HIV transmission, yet
injection drug use contributes to the epidemic's spread far beyond the circle
of those who inject. People who have sex with an injection drug user (IDU) also
are at risk for infection through the sexual transmission of HIV. Also,
children born to mothers who contracted HIV through sharing needles or having
sex with an IDU may become infected as well.
Since the epidemic began, injection drug use
has directly and indirectly accounted for more than one-third (36%) of AIDS
cases in the United States. This disturbing trend appears to be continuing. Of
the 48,269 new cases of AIDS reported in 1998, 15,024 (31%) were
Kaposi's sarcoma (KS) is a type of cancer that mainly affects the skin, mouth, and lymph nodes -- infection-fighting glands -- but can also affect other organs such as the lungs and gastrointestinal tract. KS was once rare, only affecting older men of Eastern European or Mediterranean background, young African men, or people who had organ transplants. HIV (human immunodeficiency virus) infection has now become the most common cause of Kaposi's sarcoma.
Due to weakened immune systems,...
Racial and ethnic minority populations in the
United States are most heavily affected by IDU-associated AIDS. In 1998, IDUs
accounted for 36% of all AIDS cases among both African American and Hispanic
adults and adolescents, compared with 22% of all cases among white
IDU-associated AIDS accounts for a larger
proportion of cases among women than among men. Since the epidemic began, 59%
of all AIDS cases among women have been attributed to injection drug use or sex
with partners who inject drugs, compared with 31% of cases among
Noninjection drugs (such as "crack"
cocaine) also contribute to the spread of the epidemic when users trade sex for
drugs or money, or when they engage in risky sexual behaviors that they might
not engage in when sober. One CDC study of more than 2,000 young adults in
three inner-city neighborhoods found that crack smokers were three times more
likely to be infected with HIV than non-smokers.
Preventive Strategies for IDUs Must Be Comprehensive
Comprehensive HIV prevention interventions for substance abusers must provide education on how to prevent transmission through sex.
Numerous studies have documented that drug users are at risk for HIV through
both drug-related and sexual behaviors, which places their partners at risk as
well. Comprehensive programs must provide the information, skills, and support
necessary to reduce both risks. Researchers have found that many interventions
aimed at reducing sexual risk behaviors among drug users have significantly
increased the practice of safer sex (e.g., using condoms, avoiding unprotected
sex) among participants.
Drug abuse treatment is HIV prevention, but drug treatment slots are scarce.
In the United States, drug use and dependence are widespread in the general
population. Experts generally agree that there are about 1 million active IDUs
in this country, as well as many others who use noninjection drugs or abuse
alcohol. Clearly, the need for substance abuse treatment vastly outstrips our
capacity to provide it. Effective substance abuse treatment that helps people
stop using drugs not only eliminates the risk of HIV transmission from sharing
contaminated syringes, but, for many, reduces the risk of engaging in risky
behaviors that might result in sexual transmission.