Substance abuse is the poisonous use of psychoactive substances, which includes hard drugs and alcohol. The use of psychoactive substances can result in a dependence syndrome. This syndrome is a cluster of cognitive, psychological and behavioral phenomena that develops after repeated substance use; typically including a strong desire to continue the use of the drug. Persisting in the use of the substance despite its harmful consequences, difficulty in controlling the use of the substance, granting of higher priority to the use of the drug rather than other important activities and obligations, sometimes a physical withdrawal state, and increased intolerance.

People who engage themselves in the use of drugs or the high-risk behaviors associated with the use of illicit drugs put themselves at the risk of transmitting or contracting viral infections like Hepatitis, Human Immunodeficiency Virus (HIV), or Acquired Immune Deficiency Syndrome (AIDS). Substance abuse increases the risk of transmitting or contracting viral infections, and this is because certain viruses can spread through body fluids or blood, and HIV/AIDS is no exception. 

When it comes to substance abuse, this transmission of HIV/AIDS happens primarily in two ways:

  • When the drug impairs people’s healthy sense of judgment and hence they make unwise and careless choices concerning intimate contact with an infected person.
  • When drug users inject substance and share needles or other drug equipment, directly with a carrier or in a group that has a carrier of the virus.

About one-quarter of AIDS infections are from intravenous drug use. Also, one out of four people of people living with HIV/AIDS around the period of 2005-2009 reported that they engaged in the use of drugs or alcohol to an extent. HIV/AIDS can affect anyone, but the risk of infection seems significantly higher for people involved in substance abuse, be it through exposure to an unsterilized needle or their engagement in high-risk behaviors due to the loss of judgment.   

The illicit use of drugs affects the brain, alters one’s judgment, lowers one’s inhibitions, and diminishes one’s restraints. The presence of drugs in the body system changes the way the brain works, providing a disruption to the parts of the brain responsible for weighing benefits and risks while trying to make decisions. Inhaling, smoking, or ingesting drugs, as well as drinking alcohol are associated with the increased risk of contracting or transmitting HIV/AIDS. The intake of these substances (excessive alcohol or illicit drugs) can alter one’s judgment. When a user is high, there is that tendency of making a poor decision that puts him/her at the risk of transmitting or getting infected with HIV, such as having unprotected sex, having a hard time using a condom the right way before sex, or having multiple sexual partners. These behaviors tend to increase your risk of exposure to HIV and other sexually transmitted diseases. If you already have an HIV infection, it increases the risk of transmission of the virus to others. 

Injection Drug Use

Injection drug use (IDU) can create a direct avenue for the transmission of HIV/AIDS; if people share syringes, needles, or other injection materials already contaminated with the virus. Injection of drugs puts you at risk of transmitting or contracting HIV/AIDS and other viral diseases like Hepatitis B and C if you share needles or equipment used to prepare drugs, like cotton, water, and cookers. For the same reason, you should not share needles or tools for the injection of steroids, hormones, or silicone.

Substance use disorders are problematic patterns of using alcohol and other substances such as amyl nitrate (“poppers”), prescription opioids, crack cocaine, heroin, and methamphetamine (“meth”). They are closely associated with the rapid spread of HIV/AIDS and other sexually transmitted diseases. Below is a list of some commonly used substances that particularly increase the risk of HIV transfer:

  • Crack cocaine
  • Opioids
  • Inhalants
  • Alcohol
  • Methamphetamine
  • Ketamine

Crack Cocaine

This drug is a stimulant that can create a cycle in which people quickly exhaust their resources. Substance abusers try to get hooked up on the euphoria it gives them as soon as possible. They can engage in dangerous behaviors to get the drug, damning the consequences. This desperation affects their decisions and can consequently increase their risk of exposure to HIV or transmission of the virus. Addicts can go as far as having unprotected sex for the drug; they do whatever it takes to get the next hit.   

Opioids

This class of drug reduces pain. It includes both prescription drugs and heroin. These drugs pose a high HIV risk because they involve careless behaviors like needle sharing and risky sexual acts. This class of drugs is linked to the outbreaks of viral hepatitis and also HIV. Opioid addicts are also at the risk of getting the drug by any available means, which does not exclude trading sex for the drugs or money to buy the drugs, thereby consequently increasing their HIV risk.

Inhalants

This category of substances includes solvents that emit vapors and will intoxicate when inhaled (breathed in). Inhalants intoxication happens rapidly and is short-lived. The abuse of inhalants is termed “huffing”. Amyl nitrate (“poppers”) is an inhalant that has long been linked to illegal drug use, risky sexual behaviors, and the transfer of sexually transmitted diseases amongst bisexual or homosexual men.

Alcohol

The consumption of alcohol in an excessive manner, and importantly binge drinking is associated with HIV risk. This is because it is linked with risky sexual behaviors among people living with HIV/AIDS. When an alcoholic is high, their sense of judgment is clouded. Apart from the fact that alcohol depresses the brain, there is a tendency for alcoholics to throw safe sex procedures to the wind, and indulge themselves; the will to abstain is inexistent. Tests have shown that there is a prevalence of the virus among alcohol abusers.

Methamphetamine 

This drug is also called meth, crank, speed, ice or crystal.  Methamphetamine (“Meth”) is linked to risky sexual behavior of having multiple sexual partners or unprotected sex. This consequently places people at a greater risk of contracting or transmitting HIV/AIDS and other sexually transmitted diseases. Meth can be injected, thereby increasing the risk of HIV infection through needle sharing or the sharing of other injection equipment.

Ketamine

This drug is an anesthetic that can be taken orally or injected into the bloodstream. Ketamine is capable of causing impairment to attention and memory. The fact that this highly addictive drug can be injected, and can affect how the brain works make it a culprit capable of exposing addicts to the risk of HIV.

Substance Abuse Increases the Severity of HIV

Substance abuse is a significant contributor to the spread of HIV/AIDS, as it promotes the acts which increase the initial risk of infection. For patients already living with HIV, substance use may increase the severity of substance-associated toxicities (like increased risk of overdose or increased hepatotoxicity), the potential for drug interactions, and the likelihood of engaging in risk-taking behaviors that can expose others to the virus. Some abused substances can speed up the progression of  HIV and interfere with the effectiveness of the given treatment. Drug use tends to worsen the symptoms of HIV and also the rate at which it progresses, especially in the brain. Studies reveal that substance abuse can make it easier for HIV to enter the brain and create problems with memory, thinking, learning, and also cause greater nerve cell injury. In particular, a study of methamphetamine abusers compared to that of non-drug users showed that HIV caused greater injury to the neurons and brought about cognitive impairment. Substance abuse can also affect adherence to the use of antiretroviral therapies, thereby worsening the overall consequences of HIV. 

The prevention and control of the spread of HIV/AIDS among substance abusers have been quite tricky. Some structural, environmental, and behavioral factors serve as an impediment that makes the control of the spread of HIV among substance abusers difficult. Some of these are listed below:

  • Lack of access to a healthcare system
  • Complexity in health and social needs
  • Adherence to HIV treatment in an unsatisfactory manner

Lack of Access to a Healthcare System

HIV treatment often involves questioning the patient about his/her substance use history. Many of these substance users may not be comfortable with these questions and consequently, refuse to get tested. As a result, getting HIV prevention services to people who abuse substances may be harder.

Complexity in Health and Social Needs

Substance abusers often have complex health and social needs. Research shows that people who abuse substances are more likely to be homeless, experience multiple forms of violence, live in poverty, face unemployment, these factors pose serious challenges to the efforts towards the prevention of HIV.

Adherence to HIV Treatment in a Poor Manner

Substance users that are already living with HIV are less likely to take their antiretroviral therapy (ART) drugs according to prescription, owing to side effects from drug interaction. Failure to take ART in recommended doses at recommended times can worsen the effects of HIV and increase the possibility of passing HIV to others.

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