A person can contract the human immunodeficiency virus (HIV) from injecting drugs. HIV is a virus that attacks the body’s immune system by targeting and destroying infection-fighting white blood cells. Injection drug use is recognized as one of the primary non-sexual routes of HIV transmission, placing individuals at a high risk of infection.
The Specific Pathway of Transmission
HIV is transmitted when blood or certain other bodily fluids containing the virus enter the bloodstream of another person. When a needle or syringe is used, a small amount of the user’s blood is drawn into the barrel. If the user has HIV, the virus can survive in the used syringe for up to 42 days. Sharing a needle or syringe allows this residual, HIV-infected blood to be injected directly into the next person’s vein, providing a high-efficiency route for transmission.
Transmission is not limited to the needle; any shared paraphernalia, often called “works,” can facilitate the virus’s spread. This includes items like the cotton used to filter the drug solution, the water used to mix it, or the cooker used to dissolve the drug. These accessory items can become contaminated with blood during the preparation or injection process, and even trace amounts of blood are sufficient to carry the virus.
Reducing Risk Through Sterile Equipment Programs
To mitigate the transmission risk associated with shared equipment, Syringe Service Programs (SSPs), also known as Needle Exchange Programs, have been established. These community-based programs operate on the principle of harm reduction by providing access to sterile needles, syringes, and other injection supplies, as well as a safe method for disposing of used equipment. SSPs are designed to ensure that people who inject drugs (PWID) can use a new, sterile syringe for every injection, thereby eliminating the primary pathway for HIV transmission.
Research indicates that PWID who utilize SSPs have an estimated 58% reduction in HIV incidence compared to those who do not. SSPs also frequently provide referrals to substance use treatment, medical services, and testing for HIV and hepatitis C. The success of these public health interventions relies on providing sufficient equipment to meet a user’s needs without restriction. Obtaining sterile equipment from reliable sources, such as pharmacies or SSPs, and committing to never reusing or sharing any part of the injection setup remain the most effective behavioral strategies for preventing transmission.
Pharmacological Tools for Prevention (PrEP and PEP)
In addition to sterile equipment, medications offer a layer of protection against HIV acquisition. Two distinct pharmacological strategies are available: Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). PrEP is taken by people who are HIV-negative but are at high risk of infection, including those who inject drugs.
Taken consistently, PrEP works by keeping antiretroviral drug levels high enough to block HIV from establishing a permanent infection if the body is exposed to the virus. For people who inject drugs, consistent use of PrEP reduces the risk of contracting HIV by at least 74%. PrEP is available as a daily pill or in a long-acting injectable form administered every two or six months.
PEP is a short-term regimen of antiretroviral drugs used only in emergency situations after a potential exposure, such as sharing a contaminated needle. To be effective, PEP must be started as soon as possible, ideally within a few hours, and no later than 72 hours following the exposure. The full course of PEP requires taking the medication daily for 28 days. Due to the time-sensitive nature of PEP, anyone who believes they have been exposed to HIV through shared injection equipment should immediately contact a healthcare provider or emergency room.