HIV Early Intervention

People With Alcohol Use Disorders Are More Likely To Contract HIV

Research findings clearly show: the use of alcohol and other drugs is a factor in the spread of HIV and can complicate the long-term health outcomes of persons living with HIV.

People with alcohol use disorders are more likely than the general population to contract HIV. Similarly, people with HIV are more likely to abuse alcohol at some time during their lives.¹ Alcohol use is associated with high-risk sexual behaviors and IV drug use, two major modes of HIV transmission.

Concerns about HIV have increased as recent trends suggest a resurgence of the epidemic among gay men,² as well as dramatic increases in the proportion of cases transmitted heterosexually.^{3, 4} In persons already infected, the combination of heavy drinking and HIV has been associated with increased medical and psychiatric complications, delays in seeking treatment,⁵ difficulties with HIV medication compliance,^{6, 7} and poorer HIV treatment outcomes.⁸ 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.

Trends in HIV Transmission in the United States

HIV is most commonly transmitted by sexual contact and the sharing of contaminated needles by IV drug users.⁹ By the end of 2000, an estimated 900,000 Americans were living with HIV. Approximately 40,000 new cases of active AIDS disease are diagnosed annually.³

Historically, HIV has been most prevalent among gay men,¹⁰ whereas most new infections are seen among gay men and among injection drug users.³ Recently, the proportion of HIV cases acquired through heterosexual contact has increased and almost equals the proportion of cases attributable to injection drug use.^{3, 4} The proportion of all AIDS cases reported among women has tripled since the mid-1980s, primarily as a result of heterosexual exposure and secondarily through IV drug use.⁴ Minority groups are the most heavily affected by HIV associated with drug injection, and Blacks and Hispanics now account for an estimated 70% of all new AIDS cases.^{3, 4}

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 IV drug use are high among alcoholics in treatment,^11, 12 and increasing levels of alcohol ingestion are associated with greater injection drug–related risk behaviors, including needle sharing.¹³

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.^{11, 14–16} There may be many reasons for this association. For example, alcohol can act directly on the brain to reduce inhibitions and diminish risk perception.^17–19

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.^19–22 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.²⁰

Alcohol and Medical Aspects of AIDS

Alcohol increases susceptibility to some AIDS related infections. Infections associated with both alcohol and AIDS include tuberculosis; pneumonia; and hepatitis C, a leading cause of death among people with HIV.^{9, 23} Alcohol may also increase the severity of AIDS-related brain damage, which is characterized in its severest form by profound dementia and a high death rates.^{9, 24}

In addition, many patients fail to comply with the complex medication regimen^{2, 25}. Studies have associated heavy alcohol use with decreased medication compliance.^{7, 8} as well as with poorer response to HIV therapy in general.⁸ The outcome of HIV therapy improves significantly among alcoholics who stopped drinking.⁸

Alcoholism Treatment as HIV Prevention

Decreasing alcohol use among HIV patients not only reduces the medical and psychiatric consequences associated with alcohol consumption but also decreases other drug use and HIV transmission⁸. Thus, alcohol and other drug abuse treatment can be considered primary HIV prevention as well.¹²

Alcoholism prevention among youth is of particular importance. AIDS is a leading cause of death among people ages 15 to 24¹⁶, and new IV drug users who contract HIV or viral hepatitis often become infected within 2 years after beginning to inject drugs.²⁶

Researchers have found that:

binge and heavy drinking peaks between the ages of 18 and 24,37 which is a high-risk period for beginning IV drug use28 drug injection is usually associated with prior use of alcohol in conjunction with non-injection drugs29, especially among adolescents with alcohol use disorders28 high rates of risky sexual practices have been reported among adolescents30 and may be correlated with alcohol consumption16

Therefore, it has been suggested that HIV prevention programs for youth should target alcohol consumption in addition to injection drug use and sexual risk reduction.²⁶

Treatment Access and Integration

Timeliness is an essential aspect of effective HIV treatment and prevention. Early detection of HIV infection facilitates the prompt initiation of behavioral changes aimed at reducing transmission and also may enhance treatment effectiveness.³¹ Unfortunately, many facilities for the treatment of alcohol or other drug use disorders do not routinely or consistently screen patients for HIV.³¹ In addition, many people who test positive for HIV fail to seek medical care until the disease has reached an advanced stage.⁵ Alcohol abuse has been associated with longer delays in seeking treatment.⁵

References

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4	Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report, 2001 13(1):1–41, 2001.
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25	McKirnan, D.J.; Vanable, P.A.; Ostrow, D.G.; and Hope, B. Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse 13(1–2):137–154, 2001.
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30	Grunbaum, J.A.; Kann, L.; Kinchen, S.A.; et al. Youth risk behavior surveillance: United States, 2001. MMWR—Morbidity and Mortality Weekly Report 51(SS-4):1-62, 2002.
31	Samet, J.H.; Mulvey, K.P.; Zaremba, N.; and Plough, A. HIV testing in substance abusers. American Journal of Drug and Alcohol Abuse 25(2):269–280, 1999.