Reducing the Risk of HIV Infection Associated With Illicit Drug Use

Abstract

Substance abuse, specifically the use of illicit drugs that are administered intravenously, continues to play a role in the transmission of human immunodeficiency virus type 1 (HIV-1) among adolescents and young adults (youth). Risks of HIV-1 infection may result from direct exposure to contaminated blood through sharing of injection drug equipment and from unsafe sexual practices (while under the influence of drugs and/or in exchange for drugs). Reducing the risk of HIV-1 infection that is associated with illicit drug use requires prevention education and prompt engagement in treatment. Providing patients with education, instruction on decontamination of used injection drug equipment, improved access to sterile syringes and needles, and postexposure prophylaxis may decrease their risk of acquiring HIV-1 infection. Pediatricians should assess risk behaviors as part of every health care encounter, including queries about tobacco, alcohol, and marijuana use. The risks and benefits of postexposure prophylaxis with antiretroviral drugs should be considered for youth with a single recent (within 72 hours) high-risk exposure to HIV-1 through sharing needles/syringes with an HIV-1–infected individual or having unprotected intercourse with an individual who engages in injection drug use. Such prophylaxis must be accompanied by risk-reduction counseling, appropriate referrals for treatment, and evaluation for pregnancy and associated sexually transmitted infections. There is an urgent need for more substance-abuse prevention and treatment programs, legislation that facilitates unencumbered access to sterile syringes, and expedient availability of reproductive health care services for sexually active youth, including voluntary HIV-1 counseling and testing.

Substance Use and its Association with Psychiatric Symptoms in Perinatally HIV-infected and HIV-Affected Adolescents

“…However, increasing severity of anxiety and depression symptoms in both HIV-infected and HIV-affected adolescents were associated with significantly increased odds of substance use. These patterns are important to identify as early as possible, since drug use in combination with psychiatric illness may lead to unsafe sexual risk behavior and increased risk for secondary HIV transmission [30-36]. It appears clear that HIV-affected adolescents also have high rates of both psychiatric conditions and substance use, and the number of such youth in the US is growing [17].…”

Comparative Effectiveness of Web-Based vs. Educator-Delivered HIV Prevention for Adolescent Substance Users: A Randomized, Controlled Trial

“…Accurate HIV prevention knowledge and skills education are also rarely provided to youth who engage in substance use. Only 10% of adolescents who need substance abuse treatment have access to it, and only a minority of adolescent treatment programs integrate effective HIV education 10 . Additionally, although the Centers for Disease Control and Prevention have created program materials and training resources to help promote greater adoption of evidence-based prevention interventions in youth community agencies (e.g., Replicating Effective Programs and Diffusion of Effective Behavioral Interventions projects), the majority of teens in community-based substance abuse treatment do not receive evidence-based HIV prevention interventions, and virtually none receive evidence-based interventions targeting Sexually Transmitted Infections (STIs) or hepatitis 11 .…”