Living With HIV

HIV and Substance Use

Last Reviewed: September 16, 2025

Key Points

  • Substance use refers to the use of drugs and alcohol and includes the misuse of prescription drugs or over-the-counter medicines.
  • Substance use can lead to less safe behaviors (such as condomless sex or sharing needles) that increase the likelihood of getting HIV or passing it on to others.
  • Substance use can harm the health of a person with HIV by weakening the immune system, damaging the liver, disrupting an HIV medicine schedule, and causing reactions with HIV medicines.

 

What is the connection between HIV and substance use?

Substance use refers to the use of recreational drugs and alcohol, as well as the misuse of prescription drugs and over-the-counter medicines. Examples of each of these substances include:

  • Alcohol: Beer, wine, and liquor
  • Recreational drugs: Opioids (such as heroin), methamphetamine (meth), cocaine, and inhalants (poppers)
  • Prescription drugs: Stimulants (such as Adderall), depressants (such as Xanax), opioid painkillers (such as Vicodin), and sleep medicines (such as Ambien)
  • Over-the-counter medicines: Cough medicine and laxatives (for weight loss)

Substance use is related to HIV in the following ways:

  • Use of alcohol and recreational drugs can lead to less safe behaviors that increase the chances of getting HIV or passing it on to others (called HIV transmission).
  • Some prescription drugs and over-the-counter medicines can also lead to less safe behaviors when misused, including stimulants and opioid painkillers.
  • The use of recreational drugs and alcohol can weaken the immune system and damage the liver.

How does substance use increase the risk of HIV transmission?

Drug and alcohol use affect the brain (including memory, attention, and reasoning) and impair clear thinking and decision-making, which may lead to behaviors that increase the chances of getting HIV.

Like drugs and alcohol, using prescription drugs and over-the-counter medicines for purposes other than prescribed, in excessive amounts, or over a longer period than necessary can affect thinking and decision-making.

Some behaviors can increase the chances 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

Using or misusing substances can make people more likely to engage in these behaviors. For someone with HIV, this increases the risk of passing it to others. For someone without HIV, it increases their chances of getting HIV.

In addition, using or misusing substances can increase the risk of other sexually transmitted infections (STIs), not just HIV. See the HIV and Sexually Transmitted Infections fact sheet for more information.

How can substance use affect a person with HIV?

Substance use can harm the health of a person with HIV in several ways, including poorer immune function, reduced liver function, or interactions between substances and HIV medicines, known as drug interactions.

Drugs, Alcohol, and the Immune System

HIV damages the immune system, making it harder for the body to fight infections and certain cancers. Although HIV medicines help to promote good immune function, drugs and alcohol can counteract those effects.

If damage to the immune system gets worse or continues for a long time, a person with HIV may become more vulnerable to opportunistic infections. See the HIVinfo What is an Opportunistic Infection? fact sheet for more information.

Drugs, Alcohol, and Liver Damage

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 harder to remove toxins from the body. The buildup of toxins can weaken the body and lead to liver disease, including hepatotoxicity. See the HIVinfo HIV and Hepatotoxicity fact sheet for more information.

Interactions With HIV Medicines

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

Some prescription drugs can also have dangerous interactions with HIV medicines, especially if used in excess. This is particularly true for some HIV medicines in the protease inhibitor class. A health care provider can make sure combinations of medicines (such as HIV and anti-anxiety medicines) are safe when taken as prescribed.

Drug, Alcohol, and Medicine Consistency

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

Who is most likely to be affected by substance use and HIV?

Although HIV and substance use can affect anyone, research shows that some people have increased chances of engaging in substance use and/or getting HIV. Examples include those who—

  • Are adolescents and young adults (aged 13 to 24 years)
  • Have mental health disorders
  • Do not have consistent housing
  • Have been to or remain in jail or prison
  • Are men who have sex with men
  • Exchange sex for money
  • Inject drugs

Understanding who may be more affected helps support prevention efforts and connect people to treatment.

What steps can you take to reduce health risks from substance use?

If you or a sexual partner uses drugs or alcohol—

  • Do not have sex if you or a sexual partner is under the influence of drugs or alcohol.
  • 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 a condom correctly.

If you drink alcohol—

  • Drink in moderation. Moderate drinking is up to one drink per day for women and up to two drinks per day for men. One drink is a 12-oz bottle of beer, a 5-oz glass of wine, or a 1.5-oz 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. Syringe Service Programs may help provide resources to people who inject drugs.
  • Visit CDC’s webpage on injection drug use for more information on how to reduce the risk of getting or transmitting HIV from injection drug use.

If a sexual partner injects drugs—

  • Encourage them to get tested for HIV regularly (such as every 3 months).
  • Be sure they have not shared a needle with anyone else before you have sex. Always use a condom regardless of their response.
  • Consider taking pre-exposure prophylaxis (PrEP) in case they unknowingly get HIV.

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).

What should you do if exposed to HIV from substance use?

People who are taking PrEP when they are exposed to HIV may not need to do anything else as long as they have been taking their PrEP exactly as prescribed. However, they should continue their regular PrEP schedule and follow routine HIV testing as recommended by their health care provider.

If you are not on PrEP or have missed doses, postexposure prophylaxis (PEP) should be started as soon as possible after exposure—within 72 hours (3 days) of exposure. If PEP was not started within 72 hours of exposure, it is best to get tested for HIV.

No HIV test can detect HIV immediately after exposure. The window period, or time between HIV exposure and when a test can detect HIV, varies from 10 to 90 days depending on the type of HIV test used. Your health care provider can help schedule an HIV test based on the type of test they use.

You will only start taking HIV medicines for treatment once you test positive. See When to Start Taking HIV Medicines for more information.

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

From CDC:

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov: 

From the Department of Veterans Affairs:

From the 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):

From the Substance Abuse and Mental Health Services Administration:

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