Substance Use and HIV Risk

Can Using Drugs Increase Your Chances of Getting or Transmitting HIV?

Yes. Using drugs affects your brain, alters your judgment, and lowers your inhibitions. When you use drugs, you may be more likely to make decisions that increase your chance of getting or transmitting HIV. These include having anal or vaginal sex without HIV prevention tools, such as HIV prevention and treatment medications or condoms, having sex with multiple partners, or exchanging sex for drugs.

If you inject drugs, sharing and reusing needles, syringes, or other injection equipment ("works") like cookers can increase your chance of getting or transmitting HIV or hepatitis B and C. This is because the needles, syringes, or works may have blood in them, and blood can carry HIV. You should not share needles, syringes, or works for injecting silicone, hormones, or steroids for the same reason.

Here are some commonly used substances and their link to getting or transmitting HIV:

1. Alcohol. Excessive drinking, notably binge drinking, is linked to behaviors that increase your chance of getting or transmitting HIV, like having condomless sex without using HIV prevention or treatment medications. It could also lead to missing doses of these medications, which can make them less effective.
2. Opioids. Opioids are a class of drugs used to reduce pain, including the illegal drug heroin, the synthetic opioid fentanyl, and prescription painkillers like oxycodone. These drugs are often injected, and people who share needles, syringes, or other injection equipment have an increased chance of getting or transmitting HIV. Opioid use also has been associated with other behaviors that can increase your chance of getting or transmitting HIV, such as exchanging sex for drugs or money to buy drugs, having multiple sex partners, having condomless sex without using HIV prevention or treatment medications, or missing doses.
3. Methamphetamine. Meth is a powerful, highly addictive stimulant. It can be smoked, snorted, injected, or taken orally and is often used with other substances. People who inject meth and share needles/syringes and other injection equipment have an increased chance of getting or transmitting HIV. Some people use meth to enhance their sexual experience, known as chemsex (or “partying and playing”), which often involves multiple partners and is linked to condomless sex, sex without HIV prevention or treatment medications, or missing doses.
4. Cocaine. Cocaine is a stimulant that can be used as a powder or in its crystal form (“crack”). Injecting cocaine, crack, or multiple substances can increase your chance of getting or transmitting HIV if you share needles and other injection equipment.
5. Club Drugs. Club drugs are a group of drugs that act on your central nervous system and affect your mood, awareness, and behavior. Some of the most common club drugs are MDMA, GBH and GBL, ketamine, and others. These drugs are associated with chemsex. 

How Can You Prevent Getting or Transmitting HIV from Injection Drug Use?

The best way to lower your chances of getting HIV is to stop injecting drugs. You may need help to stop or cut down using drugs, but there are many treatment resources available to help you.

If you inject drugs, here are some ways to lower your risk for getting and transmitting HIV and other infections:

1. Use new, clean needles and syringes every time you inject. Many communities have syringe services programs where you can get new needles and works, and some pharmacies sell new, clean needles and syringes. In some places, health care providers can write prescriptions for new, clean needles and syringes.
2. Never share needles, syringes, or other drug equipment.
3. If you do share needles and syringes, use bleach to clean them. Cleaning your needles and syringes with bleach can greatly reduce your risk for HIV and viral hepatitis but doesn’t eliminate it. Learn how to clean your syringes.
4. Don’t use bleach to clean water or cotton. Use new, clean water and cotton each time.
5. Ask a health care provider about taking pre-exposure prophylaxis (PrEP), medicine to prevent HIV. When taken as prescribed, PrEP is highly effective for preventing HIV. It is much less effective when it is not taken as prescribed.
6. Ask a health care provider about post-exposure prophylaxis (PEP) if you think you’ve been exposed to HIV in the last 72 hours and are not on PrEP. PEP can prevent HIV, but it must be started within 72 hours.
7. Use a condom the right way every time you have anal or vaginal sex, or choose less risky activities, like oral sex. Abstinence (not having sex) is also an option.
8. Get tested for HIV at least once a year.

What Are Syringe Services Programs?

Many communities have syringe services programs (SSPs). These are community-based programs that provide access to sterile needles and syringes, facilitate safe disposal of used syringes, and provide and link to other important services and programs such as referral to substance use disorder treatment programs; screening, care, and treatment for viral hepatitis and HIV; and education about overdose prevention and safer injection practices.

SSPs have been demonstrated to be an effective component of a comprehensive approach to preventing HIV and viral hepatitis among people who inject drugs, while not increasing illegal drug use. Find a SSP near youExit Disclaimer.

At the Intersection: HIV and Substance Use ResearchExit Disclaimer is a National Institute of Drug Abuse (NIDA) video series in which participants, peers, and clinicians at an SSP relate their lifesaving approach to addressing the intertwined epidemics of HIV, overdose, and addiction.

How Can You Stay Healthy?

People with HIV take a combination of HIV medicines (called an HIV treatment regimen) as prescribed to stay healthy. If you have HIV, substance use can make it hard to focus and affect your ability to stick to an HIV treatment regimen. Skipping HIV medicines allows HIV to multiply and damages your immune system, making it harder for your body to fight infections and certain cancers. Drug interactions between HIV medicines and recreational drugs can also increase the risk of dangerous side effects. Use the HIV.gov Locator to find substance use treatment services if you need them.

Learn more about how alcohol and substance use can affect the health of people with HIV.