Drugs & Alcohol


Drug and alcohol use is a major factor in the spread of HIV infection. Shared equipment for using drugs can carry HIV and hepatitis, and drug and alcohol use is linked with unsafe sexual activity.

Drug and alcohol use can also be dangerous for people who are taking antiretroviral medications (ARVs). Drug users are less likely to take all of their medications, and street drugs may have dangerous interactions with ARVs. Drug and alcohol treatment to stop drug use can lower your risk of HIV infection.


HIV infection spreads easily when people share equipment to use drugs. Sharing equipment also spreads hepatitis B, hepatitis C, and other serious diseases.

Infected blood can be drawn up into a syringe and then get injected along with the drug by the next user of the syringe. This is the easiest way to transmit HIV during drug use because infected blood goes directly into someone’s bloodstream. Even small amounts of blood on your hands, cookers, filters, tourniquets, or in rinse water can be enough to infect another user.

To reduce the risk of HIV and hepatitis infection, never share any equipment used with drugs, and keep washing your hands. Carefully clean your cookers and the site you will use for injection.

A recent study showed that HIV can survive in a used syringe for at least 4 weeks. If you have to re-use equipment, you can reduce the risk of infection by cleaning it between users. If possible, re-use your own syringe. It still should be cleaned because bacteria can grow in it.

The most effective way to clean a syringe is to use water first, then bleach and a final water rinse. Try to get all blood out of the syringe by shaking vigorously for 30 seconds. Use cold water because hot water can make the blood form clots. To kill most HIV and hepatitis C virus, leave bleach in the syringe for two full minutes. Cleaning does not always kill HIV or hepatitis. Always use a new syringe if possible.


For a lot of people, drugs and sex go together. Drug users might trade sex for drugs or for money to buy drugs. Some people connect having unsafe sex with their drug use. Research shows that sexual behavior is the main HIV risk factor for injection drug users.

Drug use, including methamphetamine or alcohol, increases the chance that people will not protect themselves during sexual activity. Someone who is trading sex for drugs might find it difficult to set limits on what they are willing to do. Drug and alcohol use reduces condom use and safer sex practices.

Often, substance users have multiple sexual partners. This increases their risk of becoming infected with HIV or another sexually transmitted disease. Also, substance users may have an increased risk of carrying sexually transmitted diseases. This can increase their risk of becoming infected with HIV, or of transmitting HIV infection.


It is very important to take every dose of ARVs. People who are not adherent (miss doses) are more likely to have higher levels of HIV in their blood, and to develop resistance to their medications. Drug use is linked with poor adherence, which can lead to treatment failure. 

Some street drugs interact with medications. The liver breaks down some medications used to fight HIV, especially the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. It also breaks down some recreational drugs, including alcohol. When drugs and medications are both “in line” to use the liver, they might both be processed much more slowly. This can lead to a serious overdose of the medication or of the recreational drug.

An overdose of a medication can cause serious side effects. An overdose of a recreational drug can be deadly. At least one death of a person with HIV has been blamed on mixing a protease inhibitor with the recreational drug Ecstasy.

Some ARVs can change the amount of methadone in the bloodstream. It may be necessary to adjust the dosage of methadone in some cases. See the fact sheets for each of the medications you are taking, and discuss your HIV medications with your methadone counselor and your HIV health care provider.


Drug use is a major cause of new HIV infections. Shared equipment can spread HIV, hepatitis, and other diseases. Alcohol and drug use, even when just used recreationally, contribute to unsafe sexual activities and an increase in sexually transmitted infections.

To protect yourself from infection, never re-use any equipment for using drugs. Even if you re-use your own syringes, clean them thoroughly between times. Cleaning is only partly effective.

In some communities, new syringes can be bought without a prescription. Also, needle exchange programs in some areas provide free, new syringes. These programs reduce the rate of new HIV infections.

Drug use can lead to missed doses of ARVs. This increases the chances of treatment failure and resistance to medications. Mixing recreational drugs and ARVs can be dangerous.

Drug interactions can cause serious side effects or dangerous overdoses.

Source: The AIDS InfoNet
Alcohol Risks

Alcohol is highly addictive and tolerance develops quickly with severe withdrawal symptoms including nervousness, tremors, seizures and hallucinations. It lowers your inhibitions, increases the chance of impaired judgment as well as increased sociability. Some of the side effects of alcohol include dizziness, nausea, slurred speech, slow reflexes and sleepiness. Overdose causes loss of motor control, blackouts, passing out and in extreme cases, death. Long-term use damages the liver, brain and other organs, which can result in mental and physical problems. Drinking too much alcohol at once can cause death through acute alcohol toxicity. Women, who drink during pregnancy, can cause their babies to be born with fetal alcohol syndrome (FAS). Mixing alcohol with medications, or illegal drugs is dangerous. Combine that with driving and you can endanger everyone!

People with alcohol use disorders are more likely than the general population to contract HIV (human immunodeficiency virus). Similarly, people with HIV are more likely to abuse alcohol at some time during their lives . Alcohol use is associated with high-risk sexual behaviors and injection drug use, two major modes of HIV transmission.

Concerns about HIV have increased as recent trends suggest a resurgence of the epidemic among men who have sex with men , as well as dramatic increases in the proportion of cases transmitted heterosexually . In persons already infected, the combination of heavy drinking and HIV has been associated with increased medical and psychiatric complications, delays in seeking treatment , difficulties with HIV medication compliance , and poorer HIV treatment outcomes. Decreasing alcohol use in people who have HIV or who are at risk for becoming infected reduces the spread of HIV and the diseases associated with it.

Alcohol and HIV Transmission
People who abuse alcohol are more likely to engage in behaviors that place them at risk for contracting HIV. For example, rates of injection drug use are high among alcoholics in treatment , and increasing levels of alcohol ingestion are associated with greater injection drug–related risk behaviors, including needle sharing.

A history of heavy alcohol use has been correlated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners (e.g., injection drug users, prostitutes), and the exchange of sex for money or drugs . There may be many reasons for this association. For example, alcohol can act directly on the brain to reduce inhibitions and diminish risk perception.

However, expectations about alcohol’s effects may exert a more powerful influence on alcohol-involved sexual behavior. Studies consistently demonstrate that people who strongly believe that alcohol enhances sexual arousal and performance are more likely to practice risky sex after drinking.

Some people report deliberately using alcohol during sexual encounters to provide an excuse for socially unacceptable behavior or to reduce their conscious awareness of risk .

Finally, the association between drinking levels and high-risk sexual behavior does not imply that alcohol necessarily plays a direct role in such behavior or that it causes high-risk behavior on every occasion (19–22). For example, bars and drinking parties serve as convenient social settings for meeting potential sexual partners . In addition, alcohol abuse occurs frequently among people whose lifestyle or personality predisposes them to high-risk behaviors in general.