Injection Drug Use and HIV Risk

Sharing needles, syringes, or other drug injection equipment­—for example, cookers—puts people at risk for getting or transmitting HIV and other infections.

Risk of HIV

The risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment that someone with HIV has used. This is because the needles, syringes, or other injection equipment may have blood in them, and blood can carry HIV. HIV can survive in a used syringe for up to 42 days, depending on temperature and other factors.^a

Substance use disorder can also increase the risk of getting HIV through sex. When people are under the influence of substances, they are more likely to engage in risky sexual behaviors, such as having anal or vaginal sex without protection (like a condom or medicine to prevent or treat HIV), having sex with multiple partners, or trading sex for money or drugs.

Risk of Other Infections and Overdose

Sharing needles, syringes, or other injection equipment also puts people at risk for getting viral hepatitis. People who inject drugs should talk to a health care provider about getting a blood test for hepatitis B and C and getting vaccinated for hepatitis A and B.

In addition to being at risk for HIV and viral hepatitis, people who inject drugs can have other serious health problems, like skin infections and heart infections. People can also overdose and get very sick or even die from having too many drugs or too much of one drug in their body or from products that may be mixed with the drugs without their knowledge (for example, fentanyl).

Reducing the Risk

The best way to reduce the risk of getting or transmitting HIV through injection drug use is to stop injecting drugs. People who inject drugs can talk with a counselor, doctor, or other health care provider about treatment for substance use disorder, including medication-assisted treatment. People can find treatment centers in their area by using the locator tools on Substance Abuse and Mental Health Services Administration (SAMHSA)external icon or www.hiv.govexternal icon, or call 1-800-662-HELP (4357).

People who continue injecting drugs should never share needles, syringes, or other injection equipment such as cookers. Many communities have syringe services programs (SSPs) where people can get free sterile needles and syringes and safely dispose of used ones. SSPs can also refer people to treatment for substance use disorder and help them get tested for HIV and hepatitis. People can contact their local health department or the North American Syringe Exchange Network (NASEN)external icon to find an SSP. Also, some pharmacies may sell needles and syringes without a prescription.

Other things people can do to lower their risk of getting or transmitting HIV, if they continue to inject drugs, include:

Using bleach to clean needles, syringes, cookers, and surfaces where drugs are prepared. This may reduce the risk of HIV and hepatitis C but doesn’t eliminate it. Bleach can’t be used to clean water or cotton. New, sterile water or cotton should be used each time.

Being careful not to get someone else’s blood on their hands, needles, syringes, or other injection equipment.

Disposing of syringes and needles safely after one use. People can put them in a sharps container or another container like an empty bleach or laundry detergent bottle. Keep all used syringes and needles away from other people.

Asking their health care provider about taking daily medicine to prevent HIV (called pre-exposure prophylaxis or PrEP). People who take PrEP must take an HIV test before beginning PrEP and every 3 months while they’re taking it.

Taking HIV medicine if they have HIV. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV through sex. We don’t know whether keeping an undetectable viral load prevents HIV transmission through sharing needles, syringes, or other injection equipment. It very likely reduces the risk, but we don’t know by how much.

Using a condom the right way every time they have anal or vaginal sex. Learn the right way to use a male condom.

Learn more about how to protect yourself, and get information tailored to meet your needs from CDC’s HIV Risk Reduction Tool .

^a Abdala N, Reyes R, Carney JM, Heimer R. Survival of HIV-1 in syringes: effects of temperature during storageexternal icon. Subst Use Misuse 2000;35(10):1369­–83.