Drug Abuse and AIDS

By the National Institute on Drug Abuse

AIDS is a serious, life-threatening disease that results from severe damage to part of the body's cellular immune system—the defense system against opportunistic infections and some cancers. AIDS stands for Acquired Immune Deficiency Syndrome. The disease is acquired, as opposed to genetic or hereditary, and presents with a myriad of clinical manifestations (syndrome) that result from severe damage to the body's immune system. AIDS was first identified in 1981 among homosexual men in California and New York City. Between 1981 and 1993, the numbers of AIDS patients has grown rapidly, and AIDS has been diagnosed in over 600,000 persons in several different groups of individuals throughout the world. In the United States alone, over 35O,OOO cases and 20O,OOO deaths have been reported.

Substance abusers, especially those who inject drugs, are at greater risk for HIV/AIDS than people who do not use drugs. Injecting drug abusers account for 20 percent of cases among men, 50 percent of cases among women, and about 55 percent of pediatric cases (children of mothers who are injecting drug abusers or mothers who have sex with male injecting drug abusers). AIDS has been diagnosed among injectors of various illicit substances, including opiates, cocaine, amphetamines, and anabolic steroids. AIDS has also been reported among non-injecting drug abusers, such as alcoholics, cocaine "snorters" and "crack" smokers, who are infected through sexual contact.

What is AIDS?

AIDS is caused by a viral infection. The virus is named HIV (human immunodeficiency virus) and is one of a group of viruses called retroviruses. HIV gradually destroys certain white blood cells called T-helper lymphocytes. The loss of these cells results in the body's inability to control microbial organisms that the normal immune system controls easily. These infections are called opportunistic because they take advantage of damage to part of the immune system.

Injecting drugs of abuse and sharing needles may lead to infection with HIV, but drug abuse may also operate in conjunction with HIV to affect the transmission or progression of the disease. For example, some data suggests that HIV-infected individuals who continue to inject drugs and/or continue tobacco use do not survive as long as individuals who do not abuse those substances. There is also an association of the abuse of nitrate inhalants ("poppers") among HIV-infected homosexual men and the development of Kaposi's sarcoma, a rare skin cancer associated with AIDS.

HIV Transmission

HIV can be transmitted from person to person in three ways: intimate sexual contact; exposure to infected blood or blood products; and from an infected pregnant mother to her fetus. The most common way for drug abusers to become infected is by sharing needles and syringes. Nearly one-third of AIDS cases in this country result directly or indirectly from injecting drugs.

Direct inoculation of blood containing HIV occurs when one injects illicit substances such as heroin, cocaine, and amphetamines after an HIV-infected person.

Sexual contact is also a common route of transmission between drug abusers and to other sexual partners. The trading of sex for drugs or money has played a key role in the spread of HIV/AIDS, just as it has with other sexually transmitted diseases.

The AIDS epidemic has had a profound effect on minority communities, particularly African Americans and Hispanic/Latinos. Part of the reason for the high rate of AIDS cases in these populations is the result of injection drug use. African Americans account for half and Hispanic/Latinos for 29 percent of persons with AIDS whose disease is linked to injection drug use.

AIDS is now the fourth leading cause of death among women of childbearing age in the United States. Most women with the disease were infected through sexual contact, although many also are drug users.

Prevention Among Drug Abusers

Because there is no reliable cure or vaccine for HIV infection, now or probably in the near future, the hope to slow the spread of HIV infection is through education and behavior change strategies. Among injecting drug abusers, the most effective way to avoid infection is to stop injecting drugs and avoid sexual contact with individuals who may be HIV-infected. Former drug abusers in drug abuse treatment consistently have been found to have lower HIV infection rates than those "on the streets." Methadone maintenance therapy has been shown to be an effective therapy for opiate addicts and has decreased HIV transmission among compliant patients.

The National Institute on Drug Abuse (NIDA) continues to conduct research on innovative treatment of drug abuse. In 1987 NIDA implemented AIDS outreach projects to go out to drug abusers currently not in treatment to inform them about AIDS, and encourage them to change their HIV risk behaviors. These programs have reached tens of thousands of drug abusers and their sexual contacts, and have changed drug abusing behaviors in many individuals. The use of the HIV serological test, counseling about HIV infection, and partner notification projects in drug abuse treatment programs have met with limited success so far.