HIV is transmitted through certain bodily fluids. Behaviors that increase a person's contact with the bodily fluids of others increase the likelihood of HIV transmission.
Worldwide, unprotected sexual intercourse with an HIV-infected partner is the most common way of getting and giving HIV (Chin, 2000; Kalichman, 1998; NIAID, 2003). During sex, HIV can be transmitted through cuts and tears on the penis, vagina, or anus. Through these cuts and tears, infected blood, semen, vaginal fluids, and anal fluids may enter the uninfected person's body. Cuts and scrapes are more likely during anal sex, forced sex, dry sex, or when women are very young (because their cervixes are not fully developed and therefore more likely to rip or tear during intercourse).
Sharing injecting drug use paraphernalia, such as needles and syringes, increases the risk of HIV transmission and contraction because the paraphernalia are often tainted with blood. This risk is increased in areas where many drug users also have HIV, as the chances that any given needle has infected blood on it are higher (Ostrow, 2000).
Sex and drugs/alcohol interact in many ways to increase a person's risk of getting or giving HIV (Kalichman, 1998; Ostrow, 2000). When people use drugs or alcohol, their decision-making abilities, awareness of their surroundings and memories are altered, making them less likely to choose or remember to practice safer sex. In addition, use of these substances can increase sexual desire and enhance underlying personality characteristics, such as high sensation-seeking behavior and sexual compulsivity. Some people also may use drugs or alcohol to escape the awareness of sexual risk.
Drug use also can increase biological susceptibility to HIV transmission during sex by promoting local drying or irritation of vaginal or anal tissues, which can create tears and cuts through which HIV can enter the body. Cocaine and nitrite inhalants increase immune functioning, meaning that HIV becomes concentrated in bodily fluids and therefore easier to transmit. People who use drugs are also more likely to have STIs/STDs, which increase their risk for both contracting and transmitting HIV (Kalichman, 1998; Ostrow, 2000).
Discussion question: How can alcohol and/or drug use increase risk of HIV?
When taken on time and in the right dosages, antiretroviral drugs can decrease the amount of HIV in an HIV+ person's body. The less a person's viral load, the less likely he or she is to infect other people. However, when people do not take their antiretroviral drugs properly, they have more HIV in their systems, and are therefore more likely to infect other people through sexual transmission or through sharing needles.
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