Addiction Recovery and HIV: Finding Synergy
October 7, 2016
When we talk about HIV and drug addiction, we most often focus on injection drug use (IDU) as a risk factor for HIV transmission. While only 2.6% of the country’s population over the age of 13 reports having injected drugs at some point during their lives1, approximately 10% of new HIV infections occur through shared injection equipment2 and 22% of people living with HIV (PLWH) were infected through IDU.3 These numbers do not account for people who use non-injection drugs, who experience HIV prevalence similar to that of people who inject drugs.4
Nor does drug use cease to be an issue for PLWH once they are HIV-diagnosed. About 8% of the respondents (all PLWH) to the HIV Cost and Services Utilization Study (HCSUS) reported heavy drinking, a rate double that found in the general population; two-fifths (40%) of respondents reported the use of an illicit drug other than marijuana and more than 1 in 8 screened positive for drug dependence.5 These data point to the urgency of an integrated approach to the dual epidemics of HIV and drug addiction in the United States.
The Substance Abuse and Mental Health Services Administration (SAMHSA) funds two peer recovery support services projects—Targeted Capacity Expansion for Peer-to-Peer Programs (TCE-PTP) and Recovery Community Services Project (RCSP)—to address the issue of drug addiction in communities across the country. The former of these provides funding to organizations to implement peer-delivered services to empower people who use drugs in entering and maintaining recovery; the latter provides funding to support the development of statewide networks that bolster peer-led recovery efforts through partnership development and systems change and improvement. Both projects work to promote recovery holistically by addressing the “four major dimensions that support a life in recovery” as outlined by SAMHSA: health, home, purpose, and community.
In their promotion of recovery from drug addiction, these projects work to address HIV both directly and indirectly. Project PEERS, the statewide network project in Indiana facilitated by Mental Health America of Indiana, has worked to address the recent HIV outbreak in Clark County6 by making peer recovery support services available in the region in collaboration with multiple stakeholders including health care providers treating HIV and providing access to PrEP. This program is intended to assist people in maintaining their recovery, directly responding to the outbreak by reducing the risk of HIV transmission through injection equipment-sharing and providing adherence support for PLWH.
The Medication Assisted Recovery Services (MARS) Project addresses HIV more indirectly through its statewide network promoting peer recovery support services for those achieving recovery through medication such as methadone and buprenorphine. Medication-assisted treatment has been widely associated with lower risk of HIV infection among people who inject drugs7 as well as increased antiretroviral treatment adherence and improved treatment outcomes among PLWH.8,9
These are just a pair of examples of the myriad ways in which efforts that promote addiction recovery have the potential to impact the HIV epidemic in the United States. It is imperative that those in the field of HIV prevention, care, and treatment get involved in efforts that promote holistic recovery, such as those occurring as part of SAMHSA’s RCSP-SN project. While these networks are only funded in ten states, there are recovery community organizations and recovery efforts across the country that you can collaborate with to ensure an integrated response to the syndemic of HIV, viral hepatitis, overdose, and drug addiction. To find out more about how you can get involved in recovery efforts in your city or state, reach out to Adam Viera or any of the members of the Altarum Institute Behavioral Health TA Center or join us on Facebook, Twitter, or Instagram to dialogue with us about how we can work together for meaningful change in our communities. We look forward to hearing from you!
Lansky A, Finlayson T, Johnson C, Holtzman D, Wejnert C, et al. (2014) Estimating the Number of Persons Who Inject Drugs in the United States by Meta-Analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections. PLoS ONE 9(5): e97596. doi:10.1371/journal.pone.0097596
CDC. (2014) Diagnoses of HIV infection in the United States and dependent areas, 2012. HIV Surveillance Report, 2012. Vol. 24.
CDC. (2012) Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveillance Supplemental Report 17 (No. 3, part A).
Strathdee SA & Stockman, JK. (2010) Epidemiology of HIV Among Injecting and Non-injecting Drug Users: Current Trends and Implications for Interventions. Curr HIV/AIDS Rep 7:99–106
Galvan FH, Bing EG, Fleishman JA, London AS, Caetano R, Burnam MA, Longshore D, Morton SC, Orlando M, and Shapiro M. (2002) The Prevalence of Alcohol Consumption and Heavy Drinking Among People with HIV in the United States: Results from the HIV Cost and Services Utilization Study. Journal of Studies on Alcohol 63: 179–186.
Conrad C, Bradley HM, Broz D, et al. (2015) Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone — Indiana, 2015. MMWR Morb Mortal Wkly Rep 64: 443-444.
MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, et al. (2012). Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ 345: e5945
Reddon H, Millow M-J, Simo A, Montaner J, Wood E & Kerr T. (2014). Methadone Maintenance Therapy Decreases the Rate of Antiretroviral Therapy Discontinuation Among HIV-Positive Illicit Drug Users. AIDS Behav 18(4): 740-746.
Altice FL, Bruce D, Lucas GM, Lum PJ, Korthius PT, Flanigan TP, et al. (2011). HIV Treatment Outcomes Among HIV-Infected, Opioid-Dependent Patients Receiving Buprenorphine/Naloxone Treatment within HIV Clinical Care Settings: Results From a Multisite Study. JAIDS 56(1): S22-S32.
About Adam Viera, MPH
CBA Provider Network
Adam C. Viera has been with the HIV Capacity Building Assistance (CBA) Program at Harm Reduction Coalition since 2008, but has been working in the field of HIV prevention since 2003. In his current role as Co-Director of Capacity Building Assistance, Mr. Viera oversees both the HIV Capacity Building Initiative for CBOs as well as the Harm Reduction Training Institute. Mr. Viera supplements his training and curriculum writing skills with experience as a prevention educator, case manager, and HIV counselor/tester. Mr. Viera earned an M.P.H. with a specialty in Sexuality and Health from Columbia University’s Mailman School of Public Health, and a B.A. in Psychology, with a concentration in Behavioral Neuroscience, from Yale University.