|
|  |
|
|
SUBSTANCE ABUSE AND HIV/AIDS
 |
To
order free copies of the 2008 Ryan White
Grantee folder and fact sheets, call 1.888.ASK.HRSA
or order
online.
|
On
this page...
| |
| SURVEILLANCE |
|
A
reported 13 percent of adults and adolescents
with AIDS who were diagnosed in 2006 were
infected through IDU.2
|
| TOP |
| MEN |
- Among
reported AIDS cases for men in 2006, IDU
was the transmission category in 12 percent
of diagnoses, and male-to-male sexual
contact and IDU in 6 percent of diagnoses.3
- Among
all men estimated to be living with AIDS
at the end of 2006, an estimated 19 percent
contracted HIV through IDU, but the estimated
rate was higher among Black and Hispanic
men (27 and 23 percent, respectively).4
- AIDS
mortality estimates among men for whom
the HIV transmission category was IDU
declined by over 29 percent from 2002
to 2006; mortality decreased by over 17
percent among men for whom the HIV exposure
category was male-to-male sexual contact
and IDU.5
|
| TOP |
| WOMEN |
- Among
women, IDU was the transmission category
in 17 percent of AIDS diagnoses in 2006.6
- At
the end of 2006, IDU was the HIV exposure
category for an estimated 32 percent of
women living with AIDS, ranging from 38
percent among White women and 39 percent
among American Indian/Alaska Natives to
30 percent for Blacks, 30 percent for
Hispanics, and just 15 percent for Asian/Pacific
Islanders.4
- Among
women infected through IDU, the AIDS mortality
rate decreased by over 24 percent from
2002 to 2006.5
|
| TOP |
| CRITICAL
ISSUES |
|
In
2006, the National Survey on Drug Use and
Health reported that an estimated 22.6 million
Americans (9.2 percent of the population
aged 12 or older) were either substance-dependent
or substance abusers.7 Substance-dependent
people rely on an illicit drug and cannot
physically or psychologically cope without
it in their system; they need addiction
treatment. Substance abusers are people
who abuse a drug regularly but have not
become physically or psychologically addicted
to it.7
The
risk for HIV associated with substance abuse
involves more than simply the sharing of
IDU paraphernalia. Use of drugs and alcohol
interferes with judgment about sexual and
other behavior. As a result, substance users
may be more likely to have unplanned and
unprotected sex.1
Even
though substance abuse treatment is crucial
for staying in HIV care and adhering to
a treatment regimen, it is in short supply.
The introduction of buprenorphine, a treatment
for opiate addiction that may be given in
a primary care setting, offers hope for
improved access to treatment for addiction.
Special training, however, is required to
administer buprenorphine, and the training
may not be readily available in all health
care environments.
Recent
studies have found that trauma, substance
abuse, and sexual risk factors are interconnected.
For example, women who have experienced
sexual abuse, whether as a child or an adult,
may be more likely than other women to use
drugs as a coping mechanism, have difficulty
refusing unwanted sex, or engage in sexual
activities with strangers. Women who have
experienced trauma also may be less assertive
about birth control and have a greater number
of lifetime partners, increasing their risk
for HIV infection.8 In addition,
research has found that people who suffer
from mental illness are more likely to use
injection drugs.9
|
| TOP |
| HRSA'S
RESPONSE |
| Given
the challenges of accessing drug addiction
treatment, the Ryan White Special Projects
of National Significance (SPNS) Program funded
the Buprenorphine Initiative to determine
the effectiveness of integrating buprenorphine
opioid abuse treatment into HIV primary care
settings. The initiative is designed to improve
the health of people living with HIV/AIDS
(PLWHA) in the primary care setting who also
have substance abuse issues. This initiative
began in September 2004 and comprises 10
demonstration sites coordinated by a technical
assistance/evaluation center. As a demonstration
project, this initiative seeks to determine
the feasibility and/or effectiveness of integrating
buprenorphine opioid abuse treatment into
HIV primary care settings. The results of
this study will be published at the end of
the initiative in 2009.
Users
of illicit substances may receive HIV services
through all parts of the Ryan White HIV/AIDS
Program. The lack of drug treatment services
in the United States has placed increased
pressure on Ryan White HIV/AIDS Program
providers because they must address substance
abuse issues to sustain individuals in care
over time.
For
more information about substance abuse and
HIV/AIDS, see the March 2004 issue of HRSA
CAREAction, available at http://www.hab.hrsa.gov/publications/march04.
|
| TOP |
| END
NOTES: |
| 1 |
National
Institute on Drug Abuse (NIDA). HIV/AIDS:
How does drug abuse impact the HIV/AIDS
epidemic? Research Report Series. Bethesda,
MD: NIDA; 2005. Available at: www.nida.nih.gov/PDF/RRhiv.pdf
(PDF – 789KB). Accessed April
10, 2008. |
| 2 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:37.Table 17. |
| 3 |
CDC. HIV/AIDS Surveillance Report.
2006;18:39. Table 19. |
| 4 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:23. Table 11. |
| 5 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:17.Table 7. |
| 6 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:43.Table 21. |
| 7 |
Substance Abuse and Mental Health Services
Administration (SAMHSA). Illicit drug
use. In: SAMHSA. Results from the 2006
National Survey on Drug Use and Health:
National Findings. Rockville, Md: Author;
2007. Available at: www.oas.samhsa.gov/NSDUH/2k6nsduh/tabs/2k6tabs.pdf
(PDF – 219KB). Accessed April
25, 2008. |
| 8 |
Simoni
JM, Sehgal S, Walters KL. Triangle of
risk: urban American Indian women’s
sexual trauma, injection drug use, and
HIV sexual risk behaviors. AIDS
Behav. 2004;8:33–45. |
| 9 |
Weiser
SD, Wolfe WR, Bangsberg DR. The HIV
epidemic among individuals with mental
illness in the United States. Curr
HIV/AIDS Rep. 2004;1:186-92. |
|
| TOP |
|
