HIV, Drugs & Alcohol

Alcohol and drug use does exist within the community. There are also cases of addiction. History tells us that there has never been a time when society was ‘drug-free’.

Alcohol and drug usage exposes any individual to risky behavior, and the same is true for gay men living with HIV. Excessive drinking or the consumption of drugs can alter our outlook on risks, and can also negatively affect our judgment.

For people struggling with these issues the options for community-based care and support are extremely limited or nonexistent. Fear of stigma and criminalisation of this issue has prevented many people from seeking help.

At BE, our response to this issue is to take a harm reduction approach. Therefore we have made available educational resources, advice and assistance based on fact and without judgement, in hopes of reducing risks and injury associated with alcohol and drug use.

We believe that everyone has a right to health and dignity, without prejudice.

1. Alcohol

Background & Interactions
Alcohol is the most accessible and legal intoxicant; consuming too much of it undoubtedly affects our decision-making capacity, perception, and how we react to certain stimuli.

There are many ways that alcohol consumption can affect PLHIVs. For instance, it can change the way HIV medicines are metabolized in our bodies, resulting in the reduced effectiveness of the medicines, or  adverse side effects. Alcohol may also heighten the side effects of treatments containing efavirenz (Stoctrin, Atripla); on the flipside, efavirenz can also intensify the effects of alcohol, consequently increasing the chances of errors in our judgment.

The main concern surrounding overconsumption of alcohol, however, is how excessive drinking affects the ability to adhere to the antiretroviral treatment regimen. Furthermore, intoxication can also impair our judgement over prevention during sex .

Practical advice
Consult your doctor on how to address risks related to alcohol use. Abstaining from it is not absolutely necessary, but there is a need to make sure that PLHIVs are able to adhere to the treatment regimen. Abstaining completely from alcohol should also be considered, particularly if PLHIVs have also contracted diseases which could be worsened by alcohol consumption, such as hepatitis C or other liver conditions. That said, the key to everything in life, is moderation.

2. Recreational drugs

Background & Interactions
A number of gay men engage in drug use, and yet drugs and drug use risk reduction approaches are hardly talked about in our communities. Since drugs and drug use are illegal in many countries, the public health dimension of the issue, especially in relation to HIV, is hardly talked about. In reducing risks associated with drug use and HIV with education, we hope we are able to contribute to protecting the well-being of PLHIVs and their sexual partners.

Drugs such as methamphetamine crystals or powder (also known as “crystal meth”, “ice”, “ice cream”, “tina”), cocaine powder, ecstasy tablets or capsules (also known as “partee”, “E)”, ketamine powder or liquid (also known as “K”, “kitty”), MDMA powder (also known as “molly”), and liquid GHB (Gamma hydroxybutyrate) or liquid GBL (gamma-Butyrolactone), also known as “G water” are used not just to get high, but also to enhance sexual pleasure.

Consequently, taking risks is so much more likely when under the influence of drugs, or when sex on drugs occurs (known by some as “partee and play” or “PNP”, “chill fun” or “CF”, “ecstasy sex” or “ES”, or sometimes “chem-sex”). In these situations, certain prescription drugs such as sildenafil (Viagra), or tadalafil (Cialis), testosterone supplements or herbal medicine preparations are used to enhance erections or sexual performance, and are often combined with recreational drugs. Many gay men say that they use drugs to escape from inhibition and heighten sexual sensation – These very same reasons actually also contribute a lot to why people have sex without condoms, despite the inherent health risk.

Like alcohol, drugs can also cloud our judgment when it comes to sex, sometimes leading to choices that we wouldn’t normally make if sober. This could include who we have sex with, where we have sex, what sort of sex we have, and decisions about safer sex. “Coming down” after drug use  can also be difficult and usually attributed to a lack of sleep and proper sustenance, dehydration and other side effects (e.g. depression, headaches, stomach upset), depending on the type of drug used .

HIV medicines and recreational drugs can interact, which could lead to an overdose (when HIV medicines boost the effect of the recreational drug) or reduced effectiveness of your HIV medication. The same dose of a recreational drug you may have taken before starting HIV medication could have unexpected and unpleasant effects when combined with your HIV medication. Recreational drugs, alcohol and HIV medication can all put a strain on your liver or kidneys, so combining them may bring additional health risks.

For more in depth information visit Aidsmap’s guide to HIV medicines and interactions with recreational drugs or the chart (2015) on antiretrovirals and recreational drugs from the University of Liverpool UK.

Practical advice
If you are going to mix drugs and HIV medicines, avoid taking them at the same time. When using drugs, it’s important to establish some personal rules (for instance rules on taking your HIV medicines on time, rules about using condoms and lubricant, rules about eating and staying hydrated). It’s most important, though, that we stick to these rules which we set for ourselves.

Talk to your doctor, peers or support groups to learn more about HIV and drug use. 

3. Injecting drugs

The facts are clear: Each year, over 8,000 people are newly infected with HIV, and over 15,000 people are newly infected with hepatitis C virus (HCV), due to sharing syringes and other equipment among people who inject drugs.

Practical Advice
If you're injecting drugs (also known as “shooting up” or “slamming”), there are some basic steps you can follow to protect yourself from HIV and HCV. If you're infected with either of these viruses, the same steps should be followed to help prevent the spread of these infections to others.

  1. Always use new needles and equipment. Using new needles, syringes, and other drug-taking gear every time you inject is the most effective way to prevent HIV or HCV infection. In many Asian cities, new needles and syringes may be bought in pharmacies without prescription. In a few cities, there are some organizations and facilities that implement needle and syringe exchange programs (NSP) where you can exchange your used shooting gear for new ones.
  2. If you have no access to fresh needles and syringes, you can clean the equipment with bleach and clean water. The procedure is simple: draw water into the syringe and then tap it to loosen any blood that’s remaining inside. Shoot the water out through the needle, and repeat the process until the water inside becomes clear. Afterwards, draw some bleach up into the syringe and let it sit for 30 seconds before shooting out the bleach through the needle and rinse the syringe with clean water. While this method helps to kill HIV, its effectiveness on HCV and hepatitis B remains unclear.
  3. Shoot your own drugs and don’t let others to handle your gear. This helps to reduce the possibility of you sharing them with others.

Acknowledgement: This information has been adapted from the “Next Steps” booklet with permission from the Australian Federation of AIDS Organisations (AFAO).