Substance Abuse, Drug Addiction – Alcoholism, Heroin, Cocaine, Meth-Amphetamine: A Practice Contributing to HIV Infection in Women by Rachel Hayon, MPH
August 6, 2004 -- Intravenous Drug Use (IDU) is known to be a major risk for HIV (Human Immunodeficiency Virus) infection. Drug use is also responsible for about 60% of hepatitis C cases [1. IDU can also put the user's partner at higher risk to contract HIV/AIDS. The percentage of AIDS (Acquired Immunodeficiency Syndrome) cases among women in the United States has more than tripled, from 7% in 1985 to 23% in 1998 [2. Close to two-thirds of the reported female AIDS cases have been found among African-Americans women and 37% of these cases were contracted heterosexually. Today women are the largest growing population of infected individuals. Intravenous drug use with needle sharing is known to be a popular mode of HIV infection for women [3. In fact in 2003, approximately one-third of AIDS cases in the United States were associated with the sharing of injection equipment among drug users [4. In addition to drug use behaviors, there are many reasons that women are more of a target of the HIV/AIDS virus.
Depending on what the cultural background of an individual is, he or she will be at higher risk for HIV infection. For instance, in Hispanic or African-American culture, men are still considered to be the dominant individual in the relationship. As such, women may not feel that they are in the position to demand that their partners use a condom [5. They are also not entitled to ask their partners who they have had sexual relationships with prior to the current relationship or even during it [5. In regards to this, since in most Latin families, homosexuality is not an accepted practice, men will still engage in MSM (men who have sex with men) sexual behaviors and will keep a girlfriend or wife on the side [6. Because of such behaviors, heterosexual transmission is a considerably large transmission route. In addition, just from a biological standpoint, HIV transmission is up to 19 times more efficient from men to women than the reverse [7.
Stopping HIV transmission, especially among women can prove to be problematic for several reasons. For those women that are substance users, the majority tend to be poorly educated in general and specifically about their sexual and reproductive health. They are also often times, dependant on a man for financial support and not willing to change their behaviors or demand that their partner change his [8. In fact, a recent study which examined the relationship between partner violence and sexual risk behaviors in a sample of predominately African-American and Hispanic women found that nearly half of the participants said they had been abused by a partner in the past. It was discovered that abused women were five times more likely than unabused women to have reported an STD (sexual transmitted disease) and were four times more likely to have engaged in sex with a risky sexual partner [9.
The effect of risky sexual behavior for women is two fold, as women can pass the virus on not only to other sexual partners but to their children as well. There are country wide prevention programs trying to assist pregnant mothers, so that their children have the option of living an HIV free life. Ways to prevent transmission include: prenatal care such as HIV counseling and testing as well as zidovudine (AZT) treatment for infected mothers and their children. AZT is a drug which can reduce the viral load, or amount of the virus in the individuals system. It can prevent transmission of the virus from mother to child if taken during pregnancy [10.
Without intervention, a 25% mother-to-infant transmission rate would result in the birth of an estimated 1,750 HIV-infected infants annually in the United States, with lifetime medical costs of $282 million. The estimated annual cost of perinatal prevention in the United States is $67.6 million [10. This investment prevents 656 HIV infections and saves $105.6 million in medical care costs alone - a net cost-savings of $38.1 million annually. HIV transmission from mother to child during pregnancy, labor, and delivery or by breast-feeding has accounted for 91% of all AIDS cases reported among U.S. children. The best ways to prevent infection in children are to prevent infection in women and to encourage early prenatal care that includes HIV counseling and testing [10.
Having said this, the hardest population to reach are women who use drugs during pregnancy since they are the least likely to get prenatal care. Increased efforts are needed at all levels (community, state, national) to integrate substance abuse and HIV prevention activities and assist pregnant women in accessing needed services to improve their own health and the health of their babies [10. When looking at the HIV from this angle, it is apparent that substance abuse treatment can also be a key factor in reducing transmission rates. Statistics show that IDUs who do not enter treatment are up to six times more likely to become infected with HIV than individuals who enter and remain in treatment. Stopping substance abuse can affect many aspects of the IDUs life [1. This includes improving their health, their ability to get and keep a job, their family stability and also should reduce their involvement with crime. If used appropriately, substance abuse treatment is as effective as treatments for diabetes, asthma and other chronic illnesses [1.
Long-term addiction treatment and rehabilitation can stop HIV transmission rates and can also save everyone concerned a great deal of money. $1 invested in treatment reduces the costs of drug-related crime, criminal justice costs, and theft by $4 to $7. The average cost of methadone maintenance treatment is $4,700 as opposed to $18,700 for one year of incarceration per person. When health care costs are added in, total savings can exceed costs by a ratio of 12 to 1. Substance abuse and HIV prevention are closely related and for those populations, such as women, that need the most assistance stopping drug use can be the solution to more than one problem and can save more than one person in the process.
More information on drug and alcohol rehabilitation can be found at http://www.drugrehabcenter.com, http://www.drug-alcohol-rehab.net and http://www.helpaddicts.com.
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