HIV and People Who Inject Drugs

icon of a lighter, spoon and syringe

People who inject drugs are at high risk for HIV if they use needles, syringes, or other drug injection equipment–for example, cookers–that someone with HIV has used.

Although HIV diagnoses among PWID have remained stable in recent years, injection drug use in some areas of the United States have created prevention challenges and placed new populations at risk for HIV. This highlights the need for strengthened HIV prevention efforts for PWID, such as expanding coverage and support for comprehensive syringe services programs (SSPs).

HIV Risk Behaviors

The risk of getting or transmitting HIV varies widely depending on the type of exposure or behavior. Most commonly, people get or transmit HIV through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment—for example, cookers.

Syringe Sharing

Sharing needles, syringes, or other drug injection equipment means using a needle or syringe after someone else used it to inject drugs or medicine or for tattoos or piercings.

HIV Prevention

Syringe Services Programs

Syringe services programs (SSPs) are community-based prevention programs that provide a range of services, including access to sterile needles and syringes, facilitation of safe disposal of used syringes, and provide and link people to other important services and programs, such as substance use disorder treatment, vaccination, testing, and linkage to care and treatment for infectious diseases.

Receipt of Syringes from Syringe Services Programs Among People Who Inject Drugs in 23 US Cities, 2018

In 2018, 53 percent of people who inject drugs reported getting syringes from syringe services programs.

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Source: CDC. HIV infection risk, prevention, and testing behaviors among persons who inject drugs–National HIV Behavioral Surveillance: injection drug use – 23 U.S. Cities, 2018 pdf icon[PDF – 2 MB]. HIV Surveillance Special Report 2020; 24.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) combines medications and behavioral therapy to treat substance use disorders and prevent overdose.

Access to Medication-Assisted Treatment Among People Who Inject Drugs in 23 US Cities, 2018

In 2018, 28 percent of people who inject drugs tried but were unable to get medicine for opioid use treatment.

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Source: CDC. HIV infection risk, prevention, and testing behaviors among persons who inject drugs–National HIV Behavioral Surveillance: injection drug use – 23 U.S. Cities, 2018 pdf icon[PDF – 2 MB]. HIV Surveillance Special Report 2020; 24.

HIV Testing

HIV testing tells you whether or not you have HIV. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. People with certain risk factors should get tested at least once a year.

HIV Testing Among People Who Inject Drugs in 23 US Cities, 2018

In 2018, 55 percent of people who inject drugs tested for HIV in the past 12 months.

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Source: CDC. HIV infection risk, prevention, and testing behaviors among persons who inject drugs–National HIV Behavioral Surveillance: injection drug use – 23 U.S. Cities, 2018 pdf icon[PDF – 2 MB]. HIV Surveillance Special Report 2020; 24.

HIV Diagnoses

Diagnoses refers to the number of people who received an HIV diagnosis during a given year. Adult and adolescent PWIDa accounted for 10% (3,864)b of the 37,968 new HIV diagnoses in the United States (US) and dependent areasc in 2018 (2,492 cases were attributed to injection drug use and 1,372 to male-to-male sexual contactd and injection drug use).

New HIV Diagnoses Among People Who Inject Drugs in the US and Dependent Areas by Sex, 2018*

Among people who inject drugs, most new HIV diagnoses were among men.

Among people who inject drugs, 37 percent (1,434) of new HIV diagnoses were among men; 36 percent (1,372) of new HIV diagnoses were among gay and bisexual men; and 27 percent (1,058) of new HIV diagnoses were among women who inject drugs.

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Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

New HIV Diagnoses Among People Who Inject Drugs in the US and Dependent Areas by Race/Ethnicity, 2018*

White people accounted for the highest number of new HIV diagnoses among people who inject drugs.

This chart shows new HIV diagnoses in the United States and dependent areas among people who inject drugs by race/ethnicity. White people accounted for 46 percent (1,788), Black/African American people accounted for 26 percent (1,017), Hispanic/Latino people accounted for 22 percent (848), Multiple Races accounted for 3 percent (133), American Indian/Alaska Native people accounted for 1 percent (44), Asian people accounted for 1 percent (29), and Native Hawaiian and Other Pacific Islander people accounted for less than 1 percent (6).

Download and Share This Infographicimage icon* Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for people of African descent with ancestry in North America.
Hispanic/Latino people can be of any race.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

New HIV Diagnoses Among People Who Inject Drugs in the US and Dependent Areas by Age, 2018*

People aged 13 to 34 made up nearly half of all new HIV diagnoses among people who inject drugs.

This chart shows new HIV diagnoses in the United States and dependent areas among people who inject drugs by age. People aged 13 to 24 accounted for 12 percent (447), people aged 25 to 34 accounted for 35 percent (1,357), people aged 35 to 44 accounted for 24 percent (944), people aged 45 to 54 accounted for 17 percent (659), and people aged 55 and older accounted for 12 percent (460).

Download and Share This Infographicimage iconThe numbers have been statistically adjusted to account for missing transmission categories. Values may not equal the total number of PWID who received an HIV diagnosis in 2018.
* Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

New HIV Diagnoses Among People Who Inject Drugs in the US and Dependent Areas by Sex, Race/Ethnicity, and Transmission Category, 2018*

This chart shows the number of new HIV diagnoses in the United States and dependent areas among people who inject drugs by transmission category and race/ethnicity. Black/African American men who inject drugs equal to 436; Hispanic/Latino men who inject drugs equal to 350; White men who inject drugs equal to 591; Black/African American gay and bisexual men who inject drugs equal to 268; Hispanic/Latino gay and bisexual men who inject drugs equal to 343; White gay and bisexual men who inject drugs equal to 668; Black/African American women who inject drugs equal to 313; Hispanic/Latina women who inject drugs equal to 155; White women who inject drugs equal to 529.

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* Based on sex assigned at birth and includes transgender people.
Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for people of African descent with ancestry in North America.
Hispanic/Latino people can be of any race.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

From 2014 to 2018, HIV diagnoses remained stable among PWID overall. While progress has been made with reducing HIV diagnoses among some groups of PWID, efforts will continue to focus on lowering diagnoses among all PWID.

HIV Diagnoses Among People Who Inject Drugs in the US and Dependent Areas, 2014-2018*

This chart shows HIV diagnoses trends among people who inject drugs from 2014 to 2018. Among men who inject drugs, HIV diagnoses remained stable and among women who inject drugs, HIV diagnoses increased 7 percent. Among Black/African American people who inject drugs, HIV diagnoses decreased 11 percent, among Hispanic/Latino people who inject drugs, HIV diagnoses decreased 6 percent, among white people who inject drugs, HIV diagnoses increased 26 percent, and among people of multiple races, HIV diagnoses decreased 29 percent.

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This chart does not include subpopulations representing 2% or less of all PWID who received an HIV diagnosis in 2018.
* Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
Based on sex assigned at birth and includes transgender people.
Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for people of African descent with ancestry in North America.
** Hispanic/Latino people can be of any race.
†† Changes in subpopulations with fewer HIV diagnoses can lead to a large percentage increase or decrease.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

PWID With HIV

People with HIV who take HIV medicine as prescribed can live long, healthy lives and help prevent HIV transmission.

PWID With HIV in the 50 States and District of Columbia, 2018

At the end of 2018, an estimated 1.2 million people had HIV. Of those, 186,500 were among people with HIV attributed to injection drug use.

9 in 10 people who inject drugs knew they had the virus.

graphic of a pill bottle

It is important for PWID to know their HIV status so they can take medicine to treat HIV if they have the virus. Taking HIV medicine every day can make the viral load undetectable. People who get and keep an undetectable viral load (or remain virally suppressed) can stay healthy for many years and have effectively no risk of transmitting HIV to their sex partners.

Keeping an undetectable viral load also likely reduces the risk of transmitting HIV through shared needles, syringes, or other drug injection equipment, though we don’t know by how much.

* Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
Had 2 viral load or CD4 tests at least 3 months apart in a year.
Based on most recent viral load test.
Source: CDC. Estimated HIV incidence and prevalence in the United States 2014–2018 pdf icon[PDF – 3 MB]HIV Surveillance Supplemental Report 2020;25(1).
Source: CDC. Selected national HIV prevention and care outcomes pdf icon[PDF – 2 MB] (slides).

Selected Characteristics Among PWID With HIV in 23 US Cities, 2018

Among people with HIV who inject drugs, 64 percent reported being homeless, 31 percent reported being incarcerated, and 21 percent reported having no health insurance.

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Source: CDC. HIV infection risk, prevention, and testing behaviors among persons who inject drugs–National HIV Behavioral Surveillance: injection drug use – 23 U.S. Cities, 2018 pdf icon[PDF – 2 MB]. HIV Surveillance Special Report 2020; 24.

Deaths

In 2018, there were 4,905 deaths among PWID with diagnosed HIV in the US and dependent areas. These deaths could be from any cause.

Prevention Challenges

syringe

Many communities do not have the resources or support to establish effective syringe services programs (SSPs). Barriers to SSPs include legal and regulatory issues, insufficient funding, and misunderstandings about the effectiveness and safety of SSPs.

graphic of a bottle of painkiller pills

The prescription opioid and heroin crisis has led to increased numbers of PWID, placing new populations at risk for HIV. The crisis has disproportionately affected nonurban areas, where HIV prevalence rates have been low historically. These areas have limited services for HIV prevention and treatment and substance use disorder treatment.

graphic of two men in bed

PWID may also engage in risky sexual behaviors, such as having sex without protection (like condoms or medicine to prevent or treat HIV), having sex with multiple partners, or trading sex for money or drugs. Studies have found that young PWID are more likely than older PWID to have sex without a condom, have more than one sex partner, and have sex partners who also inject drugs.

stop HIV stigma

PWID may face stigma and discrimination. Although substance use disorder is a health issue that requires treatment, it is often viewed as a criminal activity. Stigma and mistrust of the health care system may prevent PWID from seeking HIV testing, care, and treatment.

MAT MOUD

PWID may not have access to substance use disorder treatment, including medication-assisted treatment (MAT) and medication for opioid use disorder (MOUD). MAT and MOUD can lower HIV risk among PWID by reducing injection drug use. Also, PWID who have HIV are more likely to take HIV medicine as prescribed if they are on MAT or MOUD. Barriers may include lack of prescribers, legal and regulatory issues, insurance coverage, and confusion about the use of MAT and MOUD.

Icon of doctor's bag

PWID are also at risk for getting other sexually transmitted diseases (STDs), blood-borne diseases, and bacterial infections. Having another STD can greatly increase the likelihood of getting or transmitting HIV through sex. For people with HIV, getting hepatitis B or C can put them at increased risk for serious, life-threatening complications. PWID can also have other bacterial infections, such as endocarditis and methicillin-resistant staphylococcus aureus.

What CDC Is Doing

CDC is pursuing a high-impact HIV prevention approach to maximize the effectiveness of HIV prevention interventions and strategies. Funding state, territorial, and local health departments and community-based organizations (CBOs) to develop and implement tailored programs is CDC’s largest investment in HIV prevention. This includes longstanding successful programs and new efforts funded through the Ending the HIV Epidemic initiative. In addition to funding health departments and CBOs, CDC is also strengthening the HIV prevention workforce and developing HIV communication resources for consumers and health care providers.

  • Under the integrated HIV surveillance and prevention cooperative agreement, CDC awards around $400 million per year to health departments for HIV data collection and prevention efforts. This award directs resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the US.
  • In 2019, CDC awarded $12 million to support the development of state and local Ending the HIV Epidemic plans in the nation’s 57 priority areas. To further enhance capacity building efforts, CDC uses HIV prevention resources to fund the National Alliance of State and Territorial AIDS Directors (NASTAD) with $1.5 million per year to support strategic partnerships, community engagement, peer-to-peer technical assistance, and planning efforts.
  • In 2020, CDC awarded$109 million to 32 state and local health departments that represent the 57 jurisdictions across the United States prioritized in the Ending the HIV Epidemic initiative. This award supports the implementation of state and local Ending the HIV Epidemic plans.
  • Under the flagship community-based organization cooperative agreement, CDC awards about $42 million per year to community organizations. This award directs resources to support the delivery of effective HIV prevention strategies to key populations.
  • In 2019, CDC awarded a cooperative agreement to strengthen the capacity and improve the performance of the nation’s HIV prevention workforce. New elements include dedicated providers for web-based and classroom-based national training, and technical assistance tailored within four geographic regions.
  • CDC supports intervention programs that deliver services to PWID such as Community PROMISE, a community-level HIV prevention program that uses role-model stories and peer advocates to distribute prevention materials within social networks.
  • CDC provides guidance on SSP activities that can be supported with CDC funds and how CDC-funded programs may request to direct resources to support SSPs.
  • CDC provides technical assistance on SSP implementation. SSPs are proven and effective community-based prevention programs that provide a range of services, including access to and disposal of sterile syringes and injection equipment, vaccination, testing, and linkage to infectious disease care and substance use treatment. SSPs play a key role in preventing HIV and other health problems among PWID.
  • CDC uses cutting-edge technology to detect and respond to clusters of HIV transmission, and supports state and local responses to HIV outbreakspdf icon traced to injection drug use.
  • CDC supports programs to deliver biomedical approaches to HIV prevention and treatment for PWID such as pre-exposure prophylaxis (PrEP) for people at risk, post-exposure prophylaxis (PEP) to lower the chances of getting HIV after an exposure, and antiretroviral therapy (ART) or medicines to treat HIV.
  • CDC maintains the National HIV Behavioral Surveillance(NHBS) system among populations at risk for HIV. Every three years, NHBS collects information on HIV infection and behaviors from PWID in jurisdictions with high HIV prevalence, including drug use and sexual risk behaviors, testing behaviors, and use of HIV prevention services.
  • Through its Let’s Stop HIV Together campaign, CDC offers resources about HIV stigma, testing, prevention, and treatment. This campaign is part of the Ending the HIV Epidemic initiative.


a Adult and adolescent PWID aged 13 and older.
b Includes infections attributed to injection drug use and those attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
Unless otherwise noted, the term United States (US) includes the 50 states, the District of Columbia, and the 6 dependent areas of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
d The term male-to-male sexual contact is used in CDC surveillance systems. It indicates a behavior that transmits HIV infection, not how people self-identify in terms of their sexuality. This web content uses the term gay and bisexual men to represent gay, bisexual, and other men who reported male-to-male sexual contact.

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