HIV and Injection Drug Use in the United States
- HIV infections due to injection drug use have declined, but injecting drugs remains a significant risk.
- Sharing syringes is a direct route of HIV transmission.
- In one study, two out of five people who inject drugs and were diagnosed with HIV did not know they were infected.
New HIV Infectionsa
- In 2010, 8% (3,900) of the estimated 47,500 new HIV infections in the United States were attributed to injection drug use (IDU).
- Men accounted for 62% (2,400), and women accounted for 38% (1,500) of all IDU-associated HIV infections in 2010.
- In 2010, another 4% (1,600) of all estimated new HIV infections among men were among men who engage in both injection drug use and male-to-male sexual contact.b
- Blacks/African Americans* accounted for 50% (1,950) of the estimated new HIV infections among people who inject drugs (PWID) in 2010. Whites accounted for 26% (1,020) and Hispanic/Latinos represented 21% (850) of the total.
*Referred to as African Americans in this fact sheet.
HIV Diagnosesc and Deaths
- In 2013, 7% (3,096) of the estimated 47,352 diagnoses of HIV infection in the United States were attributed to IDU and another 3% (1,270) to male-to-male sexual contact/IDU.
- Sixty-three percent (1,942) of the 3,096 HIV diagnoses attributed to IDU in 2013 were among men. Thirty-seven percent (1,154) were among women.
- Forty-six percent (1,435) of all diagnoses of HIV infection attributed to IDU in 2013 were among African Americans, 28% (866) were among whites, and 21% (655) were among Hispanics/Latinos. American Indians/Alaska Natives, Asians, Native Hawaiians/Other Pacific Islanders, and those of multiple races made up the remaining 5% of HIV diagnoses attributed to IDU in 2013.
- Of the total 26,688 AIDS diagnoses in 2013, 10% (2,753) were attributed to IDU and another 4% (1,026) were attributed to male-to-male sexual contact/IDU.
- More than one in four (26%, 3,514) of the 13,712 deaths among people with AIDS in 2012 were attributed to IDU and another 8% (1,088) were attributed to male-to-male sexual contact/IDU.
- Through 2012, the cumulative total of deaths among people with AIDS attributed to IDU was 186,728 or 28% of the total deaths among people with AIDS (658,507) since the beginning of the epidemic. An additional 50,001 deaths among people with AIDS were attributed to male-to-male sexual contact/IDU, or 8% of the total cumulative deaths.
Estimated New Infections among People Who Inject Drugs by Gender and Race/Ethnicity, 2010—United States*
*Subpopulations representing 2% or less of the overall US epidemic are not represented in this chart.
Legend: Estimated HIV Incidence among Adults and Adolescents in the United States, 2007-2010, HIV Surveillance Supplemental Report 2012
- The high-risk practice of sharing syringes and other injection equipment is common among PWID. HIV can be transmitted by sharing needles, syringes, or other injection equipment (e.g., cookers, rinse water, cotton) that were used by a person living with HIV. According to a CDC study of cities with high levels of HIV, approximately one-third of PWID reported sharing syringes and more than half reported sharing other injection equipment in the past 12 months.
- Some states have syringe services programs that provide new needles, syringes, and other injection equipment to reduce the risk of HIV. The North American Syringe Exchange Network has a directory of syringe services programs. If new needles and syringes are not available, cleaning used needles and syringes with bleach may reduce the risk of HIV.
- Use of injection drugs can reduce inhibitions and increase risk behaviors. These include not using a condom or taking preventive medicines (such as pre-exposure prophylaxis, or PrEP) as directed. In the study of cities with high levels of HIV, 72% of females who inject drugs reported having sex without a condom in the last year. People who inject drugs may also take part in risky sexual behaviors to get drugs or while under coercion.
- Young people (aged 15-30 years) who inject drugs have many of the same risk factors for HIV found in older PWID, including a significant risk of sexual HIV transmission among MSM who inject drugs and among PWID who exchanged sex for money or drugs. These findings suggest HIV prevention interventions for PWID should include sexual risk reduction as well as injection risk reduction.
- Injection drug use is often viewed as a criminal activity rather than a medical issue that requires counseling and rehabilitation. Stigma related to drug use may prevent PWID from seeking HIV testing, care, and treatment. Studies have shown that people treated for substance abuse are more likely to start and remain in HIV medical care, adopt safer behaviors, and take their HIV medications correctly than those not receiving such treatment.
- Social and economic factors affect access to HIV treatment. PWID are at especially high risk for getting and spreading HIV, but often have trouble getting medical treatment for HIV because of social issues. Almost two-thirds (65%) of PWID with HIV reported being homeless, 61% reported being incarcerated, and 44% reported having no health insurance in the last 12 months. Because of these issues, some providers may hesitate to prescribe HIV medications to PWID because they believe PWID will not take them correctly. Research has not supported these concerns—studies among people receiving HIV treatment have found similar rates of survival between people who don’t inject drugs and people who do.
What CDC Is Doing
CDC and its partners are pursuing a High-Impact Prevention approach to advance the goals of the National HIV/AIDS Strategy (NHAS), maximize the effectiveness of current HIV prevention methods, and improve what we know about the behaviors and risks faced by PWID. For example, CDC
- Provides funding for state and local health departments, including a 5-year, $339 million prevention initiative to provide HIV prevention services to at-risk populations, including PWID.
- Supports intervention programs that deliver services to PWID, such as PROMISE, which helps people move toward safer sex or risk reduction practices.
- Supports biomedical approaches to HIV prevention, including the use of pre-exposure prophylaxis medicines (PrEP). In 2013, CDC announced the findings that providing PrEP to PWID who are at very high risk of getting HIV may reduce their risk of contracting HIV. For PWID living with HIV, antiretroviral therapy (ART) can improve health and reduce the risk of transmitting the virus to others.
- Publishes guidelines, including
- Integrated Prevention Services for HIV Infection, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis for Persons Who Use Drugs Illicitly for local and federal agencies, leaders and managers of prevention and treatment services, HIV treatment providers, social service providers, and prevention and treatment support groups.
- PreExposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014, a Clinical Practice Guideline for HIV treatment providers that recommends the use of PrEP for people at substantial risk for contracting HIV, including PWID (with the US Public Health Service).
- Conducts surveys and HIV testing in cities with high levels of HIV among PWID to determine their risk, testing behaviors, and use of prevention services, and publishes reports to inform HIV prevention planning and evaluation at the local and national levels.
a New HIV infections refer to HIV incidence, or the number of people who are newly infected with HIV, regardless of whether they are aware of their infection.
b The terms male-to-male sexual contact and male-to-male sexual contact and injection drug use (IDU) indicate behaviors that transmit HIV infection, not how individuals self-identify in terms of their sexuality.
c HIV and AIDS diagnoses refer to the number of people diagnosed with HIV infection (regardless of stage of infection) and the number of people diagnosed with AIDS, respectively, during a given time period. The terms do not indicate when the people were infected, but rather, when they were diagnosed.
Injection Drug Use Data
CDC’S National HIV Surveillance System is the primary source for monitoring HIV trends in the United States. It combines information on characteristics, utilization of care services, disease progression, and behaviors of people diagnosed with HIV infection. CDC funds and assists state and local health departments to collect the information and report data to CDC after personal identifiers are removed. Information from around the country can be analyzed to determine who is being affected and is essential for monitoring whether people are receiving the vital HIV medical care services they need to live long, healthy lives and reduce transmission to others. Data from NHSS on HIV infection among persons who inject drugs is disseminated through national HIV/AIDS surveillance reports, surveillance slide sets, the National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention (NCHHSTP) Atlas , and other sources for a wide range of uses at the federal, state, and local levels.
CDC conducted a meta-analysis of behavioral data from national surveys to estimate the number of persons in the U.S. who have injected drugs to use as a denominator to calculate HIV diagnosis and prevalence rates for IDU. National estimates of population sizes can be used to provide a broader understanding of the HIV epidemic among those at risk for transmission and acquisition of HIV. These estimates and disease rate calculations also provide important tools for monitoring and characterizing the HIV epidemic in the United States as well as planning and optimizing the allocation of resources to programs serving disproportionately affected populations and addressing health inequities.
- Estimated HIV Incidence among Adults and Adolescents in the United States, 2007-2010, HIV Surveillance Supplemental Report 2012 ; vol. 17(No. 4). Accessed 3/19/2015.
- CDC. Diagnoses of HIV Infection in the United States and Dependent Areas, 2013. HIV Surveillance Report 2013; vol. 25. Accessed 3/19/2015.
- CDC. HIV Infection, Risk, Prevention and Testing Behaviors Among Persons Who Inject Drugs—National HIV Behavioral Surveillance: Injection Drug Use, 20 U.S. Cities, 2012. HIV Special Report 10. March 2015.
- Semaan S, Des Jarlais, Malow R. Behavior change and health-related interventions for heterosexual risk reduction among drug users. Subst Use Misuse 2006; 40(10-12):1,349-78.
- Broz D, Pham H, Spiller M, Wejnert C, Le B, Neaigus A, Paz-Bailey G. Prevalence of HIV infection and risk behaviors among younger and older injecting drug users in the United States, 2009. AIDS Behav 2014; 18 (3) Supplement:284-296. Accessed 3/19/2015.
- Rondinelli AJ, Ouellet LJ, Strathdee SA, Latka MH, Hudson SM, Hagan H, et al. Young adult injection drug users in the United States continue to practice HIV risk behaviors. Drug Alcohol Depend 2009; 104(1-2):167-74. Accessed 3/19/2015.
- Wagner KD, Lankenau SE, Palinkas LA, Richardson JL, Chou CP, Unger JB. The perceived consequences of safer injection: an exploration of qualitative findings and gender differences. Psychol Health Med 2010;15(5):560-73. Accessed 3/19/2015.
- CDC. Recommendations for HIV prevention with adults and adolescents with HIV in the United States, 2014. Accessed 4/15.
- Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection among people who inject drugs in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomized, double-blind, placebo-controlled phase 3 trial. Lancet.2013;381(9883):2083-90. doi: 10.1016/S0140-6736(13)61127-7.
- US Public Health Service. PreExposure prophylaxis for the prevention of HIV infection in the United States – 2014. A clinical practice guideline. Accessed 3/19/2015.
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- White House Office on National Drug Control Policy 2014 National Drug Control Strategy
- Page last reviewed: October 27, 2015
- Page last updated: October 27, 2015
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