Living with HIV

HIV and Substance Use

Last Reviewed: August 13, 2021

Key Points

  • Substance use refers to the use of drugs and alcohol and includes the misuse of prescription drugs and over-the-counter medicines.
  • Substance use can lead to risky behaviors that increase the chance of getting HIV or passing it onto others (called HIV transmission). Risky behaviors include having sex without a condom and sharing needles. For example, a person using drugs or alcohol may have sex without a condom or share needles when injecting drugs.
  • Substance use can harm the health of a person with HIV. Specifically, drug and alcohol use can weaken the immune system and damage the liver.
  • People with HIV take a combination of HIV medicines (called an HIV treatment regimen) every day to stay healthy. Substance use can make it hard to focus and stick to a daily HIV treatment regimen. Skipping HIV medicines allows HIV to multiply and damage the immune system.
  • Drug interactions between HIV medicines and recreational drugs can increase the risk of dangerous side effects.

What is the connection between HIV and substance use?

Substance use is the use of drugs and alcohol and includes the misuse of prescription drugs and over-the-counter medicines. Substance use is related to HIV in the following ways:

  • Use of alcohol and recreational drugs can lead to risky behaviors that increase the chances of getting HIV or passing it on to others (called HIV transmission). Recreational drugs include injection and non-injection drugs, such as opioids (including heroin), methamphetamine (meth), crack cocaine, and inhalants (poppers). Some prescription drugs and over-the-counter medicines contain stimulants that when used inappropriately can also lead to risky behaviors.
  • Substance use can harm the health of a person with HIV. Specifically, drug and alcohol use can weaken the immune system and damage the liver.

How does substance use increase the risk of getting HIV?

Drugs and alcohol use affect the brain, making it hard to think clearly. This includes the use of prescription drugs and over-the-counter medicines for purposes other than prescribed, in excessive amounts, or over a longer period than was intended. People using drugs or alcohol may make poor decisions and take risks.

Some risky behaviors can increase the risk of getting or transmitting HIV. For example, a person using drugs or alcohol may have sex without a condom or share needles when injecting drugs.

In the United States, HIV is spread mainly by:

  • Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV
  • Sharing injection drug equipment (works), such as needles, with someone who has HIV

How can substance use affect a person with HIV?

Substance use can harm the health of a person with HIV in several ways.

Drugs and alcohol can weaken the immune system.
HIV damages the immune system, making it harder for the body to fight infections and certain cancers. Drug or alcohol use can further damage the immune system and cause HIV infection to worsen.

Drugs and alcohol can damage the liver and cause liver disease.
One of the main functions of the liver is to remove harmful substances (toxins) from the blood. Toxins are produced when the liver breaks down the chemicals in drugs or alcohol.

Drug and alcohol use can damage the liver, making it work harder to remove toxins from the body. The buildup of toxins can weaken the body and lead to liver disease.

Some recreational drugs can interact with HIV medicines.
Drug interactions between HIV medicines and recreational drugs can increase the risk of dangerous side effects. For example, overdoses due to interactions between some HIV medicines and drugs, such as ecstasy (MDMA) or GHB, have been reported.

Drug and alcohol use can make it hard to take HIV medicines every day.
People with HIV take a combination of HIV medicines (called an HIV treatment regimen) every day to stay healthy. Drug or alcohol use can make it hard to focus and stick to a daily HIV treatment regimen. Skipping HIV medicines allows HIV to multiply and damage the immune system.

If you use drugs or drink alcohol, take the following steps to protect your health.

If you use drugs or alcohol:

  • Do not have sex if you are high.
  • Use a condom correctly every time you have sex. Read this fact sheet from the Centers for Disease Control and Prevention (CDC) on how to use condoms correctly.

If you drink alcohol:

  • Drink in moderation. Moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men. One drink is a 12-oz bottle of beer, a 5-oz glass of wine, or a shot of liquor.
  • Visit Rethinking Drinking, a website from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This website can help you evaluate your drinking habits and consider how alcohol may be affecting your health.

If you inject drugs:

  • Use only new, sterile needles and drug injection equipment (works) each time you inject.
  • Never share needles and works.
  • Visit CDC’s webpage on how to protect yourself if you inject drugs for more information on how to reduce the risk of getting or transmitting HIV from injection drug use.

Therapy, medicines, and other methods are also available to help you stop or cut down on drinking alcohol or using drugs. You can talk with a counselor or a health care provider about options that might be right for you. To find a substance abuse treatment center near you, visit the Substance Abuse and Mental Health Services Administration’s treatment locator or call 1-800-662-HELP (4357).

This fact sheet is based on information from the following sources:

From CDC:

From the Department of Health and Human Services (HHS):

From the Department of Veterans Affairs:

From Department of Health and Human Services, Office of Disease Prevention and Health Promotion:

From HIV.gov:

From the National Cancer Institute:

From the National Institute on Drug Abuse (NIDA):

  1. Drug Use and Viral Infections (HIV, Hepatitis) Drug Facts
  2. Misuse of Prescription Drugs Research Report: Overview
  3. Over-the-Counter Medicines Drug Facts

Also see the HIV Source collection of HIV links and resources.