Drug-Associated HIV Transmission 

Continues in the United States 

Sharing syringes and other equipment for drug injection is a well known route of HIV transmission, yet 

injection drug use contributes to the epidemic’ s 

spread far beyond the circle of those who inject. 

People who have sex with an injection drug user 

(IDU) also are at risk for infection through the sexual 

transmission of HIV. Children born to mothers who 

contracted HIV through sharing needles or having sex 

with an IDU may become infected as well. 

Since the epidemic began, injection drug use has 

directly and indirectly accounted for more than onethird (36%) of AIDS cases in the United States. This 

disturbing trend appears to be continuing. Of the 

42,156 new cases of AIDS reported in 2000, 11,635 

(28%) were IDU-associated. 

Proportion of IDU Associated 

AIDS Cases, by Exposure Category, 

Reported in 2000, United States 

n=11, 635 

IDU 

73% 

Children 

of IDUs or 

their sex 

partners 

1% 

IDU/MSM 

13% 

Sex 

partners 

of IDU 

13% 

Racial and ethnic minority populations in the United 

States are most heavily affected by IDU-associated 

AIDS. In 2000, IDU-associated AIDS accounted for 

26% of all AIDS cases among African American and 

31% among Hispanic adults and adolescents, compared with 19% of all cases among white adults/ 

adolescents. 

IDU-associated AIDS accounts for a larger proportion of cases among adolescent and adult women than 

among men. Since the epidemic began, 57% of all 

AIDS cases among women have been attributed to 

injection drug use or sex with partners who inject 

drugs, compared with 31% of cases among men. 

Noninjection drugs (such as “crack” cocaine) also 

contribute to the spread of the epidemic when users 

trade sex for drugs or money, or when they engage in 

risky sexual behaviors that they might not engage in 

when sober. One CDC study of more than 2,000 

young adults in three inner-city neighborhoods found 

that crack smokers were three times more likely to be 

infected with HIV than non-smokers. 

Strategies for IDUs Must Be 

Comprehensive 

Comprehensive HIV prevention interventions for 

substance abusers must provide education on how to 

prevent transmission through sex. 

Numerous studies have documented that drug users 

are at risk for HIV through both drug-related and 

sexual behaviors, which places their partners at risk as 

well. Comprehensive programs must provide the 

information, skills, and support necessary to reduce 

both risks. Researchers have found that many interventions aimed at reducing sexual risk behaviors 

among drug users have significantly increased the 

practice of safer sex (e.g., using condoms, avoiding 

unprotected sex) among participants. 

Drug abuse treatment is HIV prevention, 

but drug treatment slots are scarce. 

In the United States, drug use and dependence are 

widespread in the general population. Experts generally agree that there are about 1 million active IDUs in 

this country, as well as many others who use 

noninjection drugs or abuse alcohol. Clearly, the need 

for substance abuse treatment vastly exceeds our 

capacity to provide it. Effective substance abuse 

treatment that helps people stop using drugs not only 

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IDU, May 2002 
eliminates the risk of HIV transmission from sharing 

contaminated syringes, but, for many, reduces the risk 

of engaging in risky behaviors that might result in 

sexual transmission. 

For injection drug users who cannot or will 

not stop injecting drugs, using sterile 

needles and syringes only once remains 

the safest, most effective approach for 

limiting HIV transmission. 

To minimize the risk of HIV transmission, IDUs must 

have access to interventions that can help them protect 

their health. They must be advised to always use sterile 

injection equipment; warned never to reuse needles, 

syringes, and other injection equipment; and told that 

using syringes that have been cleaned with bleach or 

other disinfectants is not as safe as using new, sterile 

syringes. 

Having access to sterile injection 

equipment is important, but it is not 

enough. 

Preventing the spread of HIV through injection drug 

use requires a comprehensive approach that incorporates several basic principles: 

� ensure coordination and collaboration among all 

providers of services to IDUs, their sex partners, 

and their children, 

� ensure coverage, access to, and quality of 

interventions, 

� recognize and overcome stigma associated with 

injection drug use, and 

� tailor services and programs to the diverse 

populations and characteristics of IDUs. 

Strategies for prevention should include: 

� preventing initiation of drug injection, 

� using community outreach programs to reach drug 

users on the streets, 

� improving access to high quality substance abuse 

treatment programs, 

� instituting HIV prevention programs in jails and 

prisons, 

� providing health care for HIV-infected IDUs, and 

� making HIV risk-reduction counseling and testing 

available for IDUs and their sex partners. 

Better integration of all prevention and 

treatment services is critically needed. 

HIV prevention and treatment, substance abuse 

prevention, and sexually transmitted disease treatment 

and prevention services must be better integrated to 

take advantage of the multiple opportunities for 

intervention—first, to help the uninfected stay that 

way; second, to help infected people stay healthy; and 

third, to help infected individuals initiate and sustain 

behaviors that will keep themselves safe and prevent 

transmission to others. 

For more information... 

CDC National Prevention Internet Resources: 

CDC National STD & AIDS Hotlines: Information Network: NCHSTP: http://www.cdc.gov/nchstp/od/ 

1-800-342-AIDS P.O. Box 6003 nchstp.html 

Spanish: 1-800-344-SIDA Rockville, Maryland 20849-6003 DHAP: http://www.cdc.gov/hiv 

Deaf: 1-800-243-7889 1-800-458-5231 IDU:http//www.cdc.gov/idu 

NPIN: http://www.cdcnpin.org 

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2 IDU, May 2002