From the Philadelphia Gay News

April 14th, 2016

By Joe Cotter

Since the beginning of the HIV/AIDS crisis, the epidemic has had a direct and reciprocal link to substance use and addiction. While various efforts have helped to raise public awareness of the risk that intravenous drug use has in the contraction of HIV, less attention has been paid to the other ways that substance use impacts HIV-positive populations.

The medical and scientific community have made great advances in treating HIV/AIDS. However, substance abuse can greatly reduce the effectiveness of any number of antiretroviral medications, potentially damaging the heart, kidneys and liver. An HIV-positive person who continues to use drugs may see many of their HIV symptoms worsen and increase the likelihood of many health issues.

These issues are compounded by an unwillingness to seek treatment and adhere to prescriptions and other medical instructions consistently.

“Number one, most people won’t go to the doctor when they are tweaked,” said AIDS activist Keith Carter. “They won’t go to the dentist because they think they have meth mouth. They don’t want doctors to see their track marks. They won’t go to the ear, nose and throat doctor because of the effects on the nose.

“When you are in that state, the last thing you are thinking about is taking meds or going to the doctors,” Carter added.

Given how much adherence impacts the effectiveness of HIV medications, not sticking to a treatment regimen will greatly reduce the success of these medications.

Research has consistently shown that an individual is more likely to engage in risky sexual behaviors when under the influence of certain drugs. Drug use also affects the ways that someone communicates with his or her partners about sexual health and risk reduction, significantly increasing the likelihood of transmitting HIV to others.

The availability of drugs in today’s society further magnifies all of these issues. We are in the midst of an opioid-abuse epidemic of unprecedented scale. Access to prescription medications like Percocet, Vicodin and Oxycontin, both in doctors’ offices as well as on the black market, is acting as a gateway to harder, less-expensive intravenous drugs like heroin. The Centers for Disease Control has warned that this could lead to more severe outbreaks of HIV and Hepatitis C.

One rural county in Indiana, for example, had 145 new cases of HIV diagnosed in a four-month span in 2015, in an area that had not witnessed more than five new cases of HIV or Hepatitis C in a given year. The outbreak was highly correlated with increasing opioid abuse in the county.

Drugs such as crystal meth also contribute to the cycle of HIV and substance use. Meth, or methamphetamine, is a synthetic stimulant that releases a barrage of dopamine into the brain, responsible for the positive feelings that accompany a range of everyday tasks, from eating breakfast to having sex. Carter notes that during his years as an activist, “most people that I come across in Philadelphia either smoke, snort, slam or all of the above. I really do think that crystal meth use in the gay community is high and underreported.”

Meth is the ultimate “feel-good” drug, offering the user a long-lasting, easily accessible high, making it especially appealing in the LGBT community, which, according to the American Psychological Association, experiences higher rates of general depression and anxiety than does the general population.

LGBT people who are HIV-positive are at an even higher risk of isolation and depression, often having lost community supports due to the various stigmas surrounding being LGBT and HIV-positive. It is therefore unsurprising that many LGBT HIV-positive people turn to meth or other drugs after their diagnosis, with these drugs serving as a coping mechanism or offering an escape.

These high rates of drug use currently impacting individuals living with HIV/AIDS highlight the need to increase the services and supports available to these communities. Greater funding for community health centers, treatment services and community-outreach programs is a place to start.

In March, the federal government announced it would send $95 million to health centers in 45 states, including Pennsylvania, to address opioid abuse. Unfortunately, Philadelphia will only receive $325,000 of that funding. Nevertheless, it is encouraging that the federal government seems to be recognizing, albeit belatedly, the toll that drug abuse is taking across the country.

On May 21, the LGBT Elder Initiative will hold a free community forum on substance use and HIV, as part of our HIV & Aging series. For more information about this program, contact info@lgbtei.org.

Joe Cotter is a master of social work student at Temple University and an intern with the LGBT Elder Initiative. For more information on the organization, visit www.lgbtei.org.