Human Immunodeficiency Virus in Intravenous Drug Users: Epidemiology, Issues, and Controversies

Intravenous drug users are the second most common risk group for acquired immunodeficiency syndrome (AIDS) in the United States, and they account for approximately 25 percent of the cases. Drug users may spread human immunodeficiency virus (HIV) by sharing contaminated drug injection paraphernalia and through sexual contact; women who use drugs can transmit the virus to their children. The rapid spread of HIV in this risk group and the fact that intravenous drug users are a source for heterosexual and perinatal transmission underscore the need for immediate intervention. In addition, many drug addicts are poor, have limited career possibilities, and lack health insurance, which leaves the cost of hospitalization and treatment to the public sector. In the absence of a vaccine or an effective chemotherapy, efforts to prevent the spread of HIV must be focused on education, behavior modification, and drug treatment. Drug treatment programs with a strong emphasis on HIV education should be available to all drug users. Community outreach programs will be difficult and expensive to initiate, because drug addicts have no formal organization or community AIDS prevention groups. To prevent the spread of HIV, federal, state, and local resources will have to be employed in conjunction with a community infrastructure dedicated to stopping drugs, providing effective drug treatment, and educating active drug users on methods of AIDS prevention. Intervention strategies for controlling the spread of HIV among active intravenous drug users should include teaching them safer sex practices and encouraging them to seek drug treatment and stop needle sharing. In addition, such strategies should be accompanied by information about needle disinfection and access to sterile needles