Chapter 13 - HIV risk and prevention for non-injection substance users

Abstract

Given the high prevalence of substance use reported within populations at risk for HIV infection and the number of studies demonstrating significant associations between high-risk sexual behavior and substance use—particularly use of methamphetamine, cocaine and poppers, and perhaps alcohol—substance-use treatment appears to be a logical intervention for HIV prevention. Individuals may also change their pattern of drug use over time, with non-injectors taking up injection use, and injectors discontinuing injection but maintaining drug use through other forms of administration. Therefore, associations between HIV prevalence and current or past non-injection substance use (NISU) may be confounded by changes in drug-administration behavior. NISU is far more common than injection drug use, and has been studied as a factor in increased risk for HIV infection in a number of studies, either directly or through increased risky sexual behavior. Prevention of HIV through reduction and cessation of NISU has been less straightforward than with injection drug use, because direct parenteral HIV transmission is not present with NISU as it is in the setting of high-risk injection behaviors. NISU can result in increased HIV risks, and treatment can diminish these risks, greater efforts to identify the most effective NISU treatment programs for HIV prevention must be made. HIV prevention efforts should prioritize research to identify effective treatment interventions, and make effective substance-use treatment available to those most in need.