Drug Abuse and HIV/AIDS: Challenges and Interventions

Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS) and is transmitted through contact with infected blood and bodily fluids. Such contact can occur through unprotected sex, through sharing of needles or other drug injection equipment, through mother-to-child transmission during pregnancy or breast-feeding, and through receipt of infected blood transfusions and plasma products during medical care in some parts of the world. There is currently no cure for HIV/AIDS. Once an individual contracts HIV, he or she has it for life.Nearly one-quarter of AIDS cases stem from intravenous drug use, and one in four people living with HIV/AIDS in the period of 20052009 reported use of alcohol or drugs to an extent that required treatment. Drug abuse and addiction can also worsen the progression of HIV and its consequences, especially in the brain. For example, in animal studies, methamphetamine increased the amount of HIV virus present in the brain;5 and in human studies, HIV caused greater neuronal injury and cognitive impairment in methamphetamine abusers compared to non-drug users. The Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people are infected with HIV in the United States and that 1 in 5 (20 percent) are unaware that they are infected. In 2010, over 47,000 people were newly diagnosed with HIV, the majority of whom were men. HIV infection is over-represented in the African-American community: African-Americans make up almost one-half of the newly diagnosed cases, followed by Whites and Hispanics. Effective treatments have dramatically decreased the number of deaths from AIDS since the peak years of the epidemic (19931998); however, more than 17,000 people still died from AIDS-related illnesses in 2009. In fact, even among those diagnosed with HIV, a substantial proportion does not receive proper care or remain in treatment (see figure). Additionally, the trend of people living longer with HIV presents new, long-term healthcare challenges for this population.Alcohol and substance abuseApproximately 2 billion people worldwide consume alcohol (WHO, 2004) and 200 million use illicit drugs annually (UN, 2007), corresponding to about one third and 5 percent of the world's population respectively. Alcohol use disorders are estimated to affect 76.3 million people (WHO, 2004). According to United Nations estimates, 79.4 percent of those reporting drug use annually worldwide use cannabis, 12.5 percent amphetamine, 7.2 percent cocaine and 4.3 percent MDMA (UN, 2007). Approximately 8 percent report using opiates, including heroin (5.6 percent) (UN, 2007); however, most studies have not distinguished non-injection opiate use from injection, and therefore opiate use will not be discussed in the context of non-injection substance use (NISU). Individuals may also change their pattem of drug use over time, with non-injectors taking up injection use, and injectors discontinuing injection but maintaining drug use through other forms of administration (Des Jariais et al., 2007). Therefore, associations between HIV prevalence and current or past NISU may be confounded by changes in drug-administration behavior.Adolescents who use alcohol and drugs are at increased risk of having sex, multiple sexual partners and to be at greater risk for sexually transmitted diseases and HIV/AIDS. There are number of drugs such as MDMA (Ecstasy) etc. is used by adolescents in nightclubs, parties, discotheque, pubs etc. which, in turn, may cause higher rate of HIV infection. People who think that alcohol improves sex are more likely to HIV infection. Injection drug is the most well known cause of transmission of HIV spread. Alcohol and substance abuse have a positive impact on sexual arousal, reduced sexual inhibition, sexual pleasure and sexual risk taking behaviors which further heightens the risk for sexually transmitted diseases including HIV infection. Studies have shown that adolescents who initiated alcohol use prior to age 14,20% had sex at 14 or younger compared to only 7% of those who did not initiate alcohol use at such an age (Grave et al. …