Preventing and treating HIV requires more than just access to medication. It demands consistency, awareness, and supportive care. However, alcohol and drug use can significantly interfere with these goals. Substance use not only increases the risk of behaviors that can lead to HIV transmission, but it also creates challenges for those already on HIV prevention strategies like PrEP or treatment regimens such as antiretroviral therapy (ART). In this blog, we explore the complex ways in which alcohol and drug use impact HIV prevention and treatment, and why a comprehensive, compassionate approach is essential to improving health outcomes for those affected.
In This Blog:
- Understanding HIV Prevention and Treatment
- How Substance Use Affects HIV Risk Behaviors
- Alcohol and Drug Use as Barriers to PrEP Adherence
- Substance Use and Challenges in HIV Treatment Adherence
- Co-Occuring Conditions and Mental Health
Understanding HIV Prevention and Treatment
HIV prevention and treatment rely on proven medical strategies that can significantly reduce transmission and improve quality of life. For individuals at risk of acquiring HIV, pre-exposure prophylaxis (PrEP) is a daily medication that can lower the risk of infection by up to 99% when taken consistently. Other critical prevention tools include condom use, regular HIV testing, and access to clean syringes for those who inject drugs.
For individuals living with HIV, antiretroviral therapy (ART) is essential. When taken as prescribed, ART can suppress the viral load to undetectable levels, meaning the virus cannot be transmitted to others through sex (a concept known as Undetectable = Untransmittable, or U=U). Both PrEP and ART are most effective when used consistently, making adherence a central component of HIV care and prevention. Unfortunately, substance use can disrupt this adherence, leading to lapses in protection or treatment.
How Substance Use Affects HIV Risk Behaviors
Alcohol and drug use can significantly increase the likelihood of engaging in behaviors that raise the risk of HIV transmission. When under the influence, individuals may experience impaired judgment, reduced inhibitions, and decreased ability to make safe choices. This often results in risky sexual practices such as having unprotected sex, having multiple partners, or engaging in sex with partners of unknown HIV status. Among people who inject drugs, the risk is even higher due to practices like sharing needles or other injection equipment, which can directly transmit HIV. In some cases, transactional sex may also be involved, particularly in the context of addiction, further increasing vulnerability. The combination of these behaviors creates a dangerous cycle in which substance use heightens HIV risk, while the consequences of infection may go unaddressed due to continued drug or alcohol dependence.
Alcohol and Drug Use as Barriers to PrEP Adherence
While pre-exposure prophylaxis (PrEP) is a powerful tool for preventing HIV, its effectiveness depends on consistent, daily use. Alcohol and drug use can interfere with this adherence in several ways. For individuals actively using substances, daily routines are often disrupted, making it more difficult to remember to take a pill at the same time each day. Missed doses reduce PrEP’s ability to protect against HIV, especially during periods of high-risk behavior.
In addition to missed doses, people who use drugs or alcohol may struggle to keep up with the regular medical appointments and lab tests required to continue receiving PrEP prescriptions. These appointments are essential for monitoring kidney function, checking for HIV and sexually transmitted infections, and ensuring the medication is working as intended. Without consistent follow-up, individuals may stop taking PrEP altogether or use it inconsistently, reducing its effectiveness.
There are also common misconceptions that discourage people who use substances from starting or continuing PrEP. Some may believe that mixing PrEP with alcohol or drugs is unsafe, even though studies have shown that PrEP can be taken safely alongside most substances. Others may feel judged or unwelcome in healthcare settings, particularly if they have experienced stigma related to their substance use in the past.
To improve PrEP adherence among people who use drugs or alcohol, supportive and nonjudgmental care is essential. This includes education on medication safety, reminders or pill organizers, and flexible healthcare services that meet people where they are.
Substance Use and Challenges in HIV Treatment Adherence
For individuals living with HIV, antiretroviral therapy (ART) is essential for controlling the virus, maintaining a strong immune system, and preventing transmission to others. However, consistent adherence to ART is critical, as missing doses or stopping treatment can lead to viral rebound, increased risk of illness, and drug resistance. Unfortunately, alcohol and drug use often make it difficult for individuals to follow their treatment regimens as prescribed.
People who use substances may face numerous obstacles to ART adherence. Daily routines can be disrupted by intoxication, withdrawal symptoms, or the pursuit of drugs or alcohol. These disruptions can cause individuals to forget doses or deprioritize their health. Cognitive impairment related to substance use may also interfere with memory, planning, and decision-making, further complicating medication schedules.
In addition, certain drugs can interact negatively with antiretroviral medications. For example, combining ART with substances like alcohol, methamphetamine, or opioids may increase the risk of liver damage or reduce the effectiveness of treatment. These interactions can discourage individuals from taking their medications or lead to adverse health outcomes that require additional care.
Beyond the physical and cognitive effects, people who use substances often face systemic barriers to care. These can include unstable housing, food insecurity, lack of insurance, and limited access to transportation. Stigma within the healthcare system may lead to reduced quality of care or reluctance to engage with medical providers. As a result, individuals may avoid follow-up visits, miss lab work, or delay refilling prescriptions. These are all actions that undermine effective HIV management.
To support long-term ART adherence among individuals who use substances, comprehensive and patient-centered strategies are essential. This includes integrating addiction services into HIV care, offering long-acting injectable ART where appropriate, and providing case management to address housing and social needs. Building trusting, nonjudgmental relationships between patients and providers can also empower individuals to stay engaged in their care, even during periods of active substance use.
Co-Occurring Conditions and Mental Health
Substance use disorders rarely exist in isolation and they are often accompanied by mental health conditions such as depression, anxiety, bipolar disorder, or post-traumatic stress disorder (PTSD). These co-occurring conditions can significantly impact a person’s ability to engage in consistent HIV prevention or treatment. For example, someone struggling with untreated depression may lack the motivation or energy to take daily medication, attend appointments, or prioritize their health. Anxiety or trauma-related symptoms can also make it difficult to navigate healthcare systems, especially if past experiences have been stigmatizing or disempowering.
For individuals living with HIV, the emotional toll of the diagnosis itself can contribute to or exacerbate existing mental health issues. Feelings of fear, shame, or hopelessness may be compounded by ongoing substance use, further complicating the individual’s ability to adhere to antiretroviral therapy (ART). Similarly, those using PrEP for HIV prevention may stop taking the medication due to underlying anxiety or mistrust of medical systems, particularly if they are also battling addiction or facing discrimination.
Mental health and substance use can create a reinforcing cycle that disrupts HIV care. For instance, a person experiencing trauma may turn to drugs or alcohol as a coping mechanism, which in turn interferes with their ability to manage HIV prevention or treatment. Without access to integrated support services, this cycle can go unbroken, placing the individual at heightened risk for HIV transmission, disease progression, and poor overall health outcomes.
Effective HIV prevention and care must therefore include screening and support for co-occurring mental health conditions. Integrated care models that address both behavioral health and HIV treatment in a coordinated way have been shown to improve outcomes. This might include co-located mental health and HIV clinics, access to psychiatric care, trauma-informed therapy, and peer support groups. By acknowledging and addressing the full scope of a patient’s needs, healthcare providers can help individuals build the stability and resilience necessary to stay engaged in their HIV care.
Conclusion
Alcohol and drug use can significantly complicate both the prevention and treatment of HIV by increasing risky behaviors, disrupting medication adherence, and compounding underlying mental health challenges. These factors create barriers that must be addressed with empathy, evidence-based care, and comprehensive support systems. Whether it’s helping someone stay consistent with PrEP or supporting long-term adherence to ART, healthcare providers and community programs play a vital role in bridging these gaps. By integrating substance use treatment, mental health support, and HIV care, we can empower individuals to take control of their health and reduce the impact of HIV in vulnerable communities.
If you or someone you know is navigating HIV prevention or treatment while dealing with substance use, help is available. Reach out to Healthcare Unity Group today. Healthcare Unity Group (HUG) has locations in Melbourne, FL and Kearny, NJ. We are also available via telehealth in 30+ states. Contact us to schedule an appointment or for more information about our telehealth services. Taking the first step toward comprehensive, compassionate care can make all the difference in managing your health and well-being. Don’t wait—get the support you deserve today.
