Living with HIV

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: Amphetamines (such as Adderall), depressants (such as Xanax), pain killers (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 risky 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 contain stimulants that can also lead to risky behaviors when misused.

• The use of recreational drugs and alcohol can weaken the immune system and damage the liver.

Drug and alcohol use affects the brain (including memory, attention, and reasoning), impairs clear thinking, and increases the likelihood of poor decisions and risky behaviors. Using prescription drugs and over-the-counter medicines for purposes other than prescribed, in excessive amounts, or over a longer period than necessary can have similar effects.

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

Substance use can harm the health of a person with HIV in several ways, including reduced immune function, reduced liver function, or adverse reactions with HIV medicines.

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. While HIV medicines can effectively improve immune function, drugs and alcohol can counteract those effects.

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 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 have been linked to interactions between some HIV medicines and recreational drugs, such as ecstasy (MDMA) or painkillers.

Drug and alcohol use can make it hard to take HIV medicines as prescribed.
People with HIV often take HIV medicines (called an HIV treatment regimen) on a strict daily or monthly 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.

If you use drugs or alcohol:

• Do not have sex if you are high or drunk.
• 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 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 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.

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).

From CDC:

• HIV and Injection Drug Use 
• HIV and Substance Use
• Preventing HIV

From the NIH Office of AIDS Research: 

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Substance Use Disorders and HIV

From the Department of Veterans Affairs:

• Drugs, Alcohol, and HIV

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

• 2015 – 2020 Dietary Guidelines for Americans: Appendix 9. Alcohol

From HIV.gov:

• Substance Use and HIV Risk

From the National Cancer Institute:

• Substance Abuse 

From the National Institute on Drug Abuse (NIDA):

• Drug Use and Viral Infections (HIV, Hepatitis) Drug Facts

• Misuse of Prescription Drugs Research Report: Overview

• Over-the-Counter Medicines Drug Facts

From the Substance Abuse and Mental Health Services Administration:

• Chronic Substance Use and Cognitive Effects on the Brain: An Introduction

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