HIV, the human immunodeficiency virus, that causes AIDS, acquired immune deficiency syndrome, has been a part of our conscious since the 80's. At one point early on there was a misconceptions that HIV was a “gay disease” until evidence showed that individuals that did not have a homosexual sexual orientation were testing positive for HIV. Knowledge of how HIV was transmitted quickly became clear. There are four major ways HIV is transmitted which are through blood, semen, vaginal fluids, break milk, and rectal fluids (Aids.gov, 2014). Alcohol and drug use/abuse has been a part of the human consciousness for eons. Even the good book [Bible] says, “One should not drink to the point of drunkenness.” As alcohol and drug use problems continue a new problem emerged with the onset of HIV which has led to a significant number of HIV diagnosis that are directly related to intravenous drug use. This article is to educate readers on how intravenous drug use contributes to the spread of HIV.
Austin Indiana, Dec 2014
In Austin, Indiana, a rural community, with an approximate population of 4,000 has seen nearly 90 cases of newly diagnosis HIV cases from Dec. 2014 to present (British Broadcasting Corporation [BCC], 2015). The governor of Indiana is calling this a state of emergency. To many people, this would not be a state of emergency or consider it an outbreak when on an average there are “50,000 new cases of HIV per year (Centers for Disease Control and Prevention [CDC], 2015, p.1).” What makes this worrisome is that one third of the newly cases have AIDS. The severity of a person’s HIV status can only be diagnosis by a physician when an individual has 200 our less CD4 T-Cells in their body which is normally 1,500 to a 2000 in healthy individuals. Each of the individuals that were newly diagnosis are intravenous drug users.
Intravenous vs Oral Drug Intake
Intravenous drug use is a very serious form or route of admission for a substance to enter the body. There are many ways that a drug can enter the body with the most common being oral. The substance is taken by mouth and enters the blood stream through digestion (i.e. alcohol). Second common method is inhalation (i.e. marijuana or nicotine). The other method is nasal, which means through the nose such as snorting cocaine or other substance that can be crushed. Usually when a person begins using drugs intravenously, they have been using drugs for a long time. When a person has a long duration of drug use, that person begins to experiment with other methods or ways to intensify the high. This can be as simple as a person that smokes weed may inhale and hold the substance longer or lace the weed with PCP or crack cocaine. There are some individuals that start off using substances intravenously. What is so attractive about intravenous route of admission? It is the intensity of the euphoria or high. Each route of admission producing a different intensity related to the high or euphoria. For example, a person can drink a 12oz can of beer over an hour and will have a different effect if that same person guzzled it down within 15 seconds. The attraction of using drugs intravenously is that the drug directly entered into the blood streams for a direct effect unlike any other route of admission. Common drugs that are used intravenously are heroin, cocaine, crystal methamphetamines, amphetamines, opiates, and prescription drugs (Diaz, Chu, Byers, Hersh, Conti, Rietmeijer, Mokotoff, Fann, Boyd, Iglesias, Checko, Fredrick, Hermann, Herr, and Samuel, (1994). Under the influence of substance people do not make healthy safe decisions.
HIV Epidemic Continues
HIV infections through intravenous drug use contribute to the HIV epidemic. CDC (2015) states that “Injection drug users represented 8% of new HIV infections in 2010 and 15% of those living with HIV in 2011” (p.2). Throughout the past couple of years, that rate has been consistent. “Comparing 2008 to 2010, there was no statistically significant change in overall HIV incidence among IDUs (CDC, 2012, p.2).” Overall statistics regarding HIV infections related to intravenous drugs use is that according to CDC ( 2014) “Since the epidemic began, nearly 186,728 people with (AIDS) who inject drugs have died, including an estimated 3,514 in 2012 (p. 2).In an interview that was broadcast by BCC (2015) Tiffany, a self-reported IV drug use made the following statement. She is one of the residents in Austin, Indiana who have shared needles with fellow drug users who tested positive for HIV. Tiffany’s statement has been transcribed for the purpose of this article.
"When I am using I don’t think about it at that time, you know. Am ready to do whatever to get it in me. So, at the time, alright let say I’m way out there somewhere. Knowing there’s no other needle in the house. No way to get one. And somebody is standing there. And they don’t’ tell me they got it [HIV]. And I don’t know that they got it. Ima say, “Can I use your needle?” And then that’s how people.., that’s why everybody.., well that’s how everybody here in this town is."
This is an example of a poor decision that can result in a poor outcome. In the moment the IV drug user is not thinking about safety, however there are ways to make IV drug use more safe and avoids scenarios like Tiffany’s.
A method to prevent HIV infections from intravenous drug users is abstinence. Abstinence is when a person who does drugs decides to reframe from using them. A way that a person goes through that process is through substance treatment. However, there are individuals that do not want to quit using drugs let along reducing the intensity of how the drug affects them. Here’s the other alternative which is called harm reduction. Harm reduction is when a person doesn’t want to stop using drugs; therefore they are taught how to reduce the negative consequences of using drugs. An example, are methadone clinics that help individual get off opiate drugs despite that they may continue to use other non-opiate drugs for their high. A way to reduce harm among intravenous drug users which also combats the spread of HIV is needle exchange programs. Needle exchange program are design where IV drug users can receive free or low cost needles in order to reduce the spread of HIV through blood transmission by (1) a user having their own and (2) using clean, new, sterile needle when they use. According to Nazar, Ahmad, Izhar, Katarey, (2014) in their study showed how effective the reduction of HIV prevalence in states that have harm reduction programs in contrast of those that did not.
HIV continues to be an incurable disease despite the advancements in treating HIV. However, HIV is 100% preventable. Drug use continues to be a factor that cripples communities, families, and individuals. However, treatment programs are available. With the combination of IV drug use and the spread of HIV through blood via “dirty” needles or “works.” Alternatives to providing assistance in combating these problems may not be the social norm or socially acceptable, however they can still be effective in saving lives.
Aids.gov. (2014). How do you get hiv or aids? Retrieved from https://www.aids.gov/hiv-aids-basics/hiv-aids-101/how-you-get-hiv-aids/
British Broadcasting Corporation. (2015, April 3) HIV outbreak strikes Indiana town. Retrieved from http://www.bbc.com/news/world-us-canada-32178448.
Centers for Disease Control and Prevention. (2012, December). CDC factsheet: new hiv infections in the united states. Retrieved from http://www.cdc.gov/nchhstp/newsroom/docs/2012/HIV-Infections-2007-2010.pdf.
Centers for Disease Control and Prevention. (2015, March). Hiv in the united states: at a glance. Retrieved from http://www.cdc.gov/hiv/pdf/statistics_basics_ataglance_factsheet.pdf.
Diaz, T., Chu, S.Y., Byers, R.H., Hersh, B.S., Conti,L., Rietmeijer, C.A., Mokotoff, E., Fann, S.A., Boyd, D., Iglesias, L., Checko, P.J., Fredrick, M., Hermann, P., Herr, M., and Samuel, M.C. (1994). The types of drugs used by HIV-infected Injection drug users in a multistate surveillance project: implications for intervention. American Journal of Public Health, 84(12), 1971 – 1975.
Nazar, C.M.J., Ahmad, S.M.A., Izhar, S, Katarey, D. (2014). Public Health Response to HIV Epidemics among Injecting Drug Users in South Asia: A Systematic Review.Journal of Pioneering Medical Science, 4(1), 35 -48.