Alcohol, Tobacco and Other Drugs
Many PLHIV use alcohol, tobacco and other drugs for a wide range of reasons. This section aims to provide useful information for people living with HIV who choose to use these substances.
Other drugs includes illicit (illegal) substances as well as prescription and over-the-counter drugs that are used in ways other than as prescribed.
Unlike alcohol, there are no health-based guidelines for safer use of illicit drugs so it can be difficult to find useful information. When drugs are illegal they cannot be regulated so they vary in quality and purity and may contain other ingredients which have other harms.
There is lots of information out there about the harms of drugs. However, similar to alcohol, its important to recognize that many cultures of drug use are social in nature and focusing on harms only can mean we ignore that people might experience greater social connection and better quality of life associated with their drug use.
As with alcohol, substance use can make it difficult to remember to take meds, use condoms or get and use clean injecting equipment.
In Australia, the safe recommended drinking level in is the same for people with HIV as it is for everyone. The Australian guidelines recommend no more than 10 standard drinks a week and no more than 4 in a day. Guidelines for safe drinking are different in different countries.
Alcohol can be harmful. It also is a part of our social world and it is available in many community spaces. For many people, alcohol can help with social connection and we know that social connection is part of good quality of life.
Some studies have shown that drinking at higher levels can result in health problems for PLHIV, and suggest that the more a person drinks the greater the risk. There is no increased risk of these problems if people with HIV are drinking at the recommended levels.
Drinking can make it harder to remember to take medications. Some studies have shown that PLHIV who drink at higher levels are more likely to struggle to remember their medication.
Some HIV drugs can interact with alcohol. Protease Inhibitors (Atazanavir, Darunavir, Lopinavir/Ritonavir) can slow the breakdown of alcohol in the body, leading to higher blood alcohol levels and potential side effects like increased intoxication, liver toxicity, and gastrointestinal issues.
Some side-effects from NNRTIs, such as dizziness, and liver toxicity, may be worsened by drinking alcohol.
There are no drug interactions with alcohol and other classes of treatment drugs, but drinking, especially at higher levels, can put strain on the liver which would mean more side effects or more difficulty processing drugs.
Smoking and vaping
Smoking rates among PLHIV are decreasing but they are still much higher than the general population.
Smoking doesn’t directly affect the HIV virus or the number of CD4 cells but there is no question that PLHIV who smoke are at higher risk of many health complications when compared to HIV-negative smokers. Smokers with HIV are more likely to experience severe health problems from smoking than from HIV. These include more inflammation, higher rates of heart disease, lung disease, increased likelihood of all cancers (not just lung cancers) and pregnancy loss.
Stopping smoking results in immediate benefit, but quitting smoking is not easy. PLHIV can safely use nicotine replacement medications to help with quitting.
Vaping is relatively new. While the research shows that most people who use vapes to quit continue to smoke, it also shows that vaping is more effective as a quitting tool than other types of nicotine replacement like patches and gum.
In Australia it is illegal to vape without a prescription, and Australia also does not recommended vaping as a tool for quitting smoking. Recommendations about the use of vaping for quitting and for harm reduction are different in different countries.
For people who aren’t ready to quit, there is lots of evidence to show that it is less harmful to vape than to smoke cigarettes.
If you want to learn more about stopping smoking, talk to your doctor or call QUIT Victoria 137 848
While there is much we still don’t know, there is a lot of research showing possible benefits of cannabis for PLHIV including relief from pain and nausea, and reductions in weight loss and nerve pain. Studies also show associations with improved quality of life and greater adherence to ART. There are also some possible increased risks for PLHIV, especially when cannabis is smoked. Smoking is definitely riskier for lung problems and respiratory illnesses which can further weaken the immune system. Several studies show evidence of association with reduction in inflammation but other evidence shows that that use with tobacco negates this.
Amphetamines and/ or cocaine
Lots of studies suggest that the use of amphetamines and/ or cocaine impacts HIV disease progression and viral suppression, as well as people’s ability to take their meds and maintain their usual prevention strategies. There are also some studies that suggest that there is an increased risk among PLHIV or neurocognitive impairment (memory, attention) as well as exacerbation of inflammation related to HAND risk.
Crystal meth is drug that is used by people across all communities, including people with HIV. According to research, gay (cis) men living with HIV are more likely to engage in crystal use for sex compared to HIV-negative peers. Like all drugs (legal and illicit), frequent patterns of use of crystal can lead to dependence. If you are no longer having fun or you believe your relationships, finances, or work/study are being impacted by your use, it might be time to reassess things.
Injecting drug use is more common among PLHIV than in the general population. Injecting drug use is highly stigmatised, and this can be compounded for PLHIV.
Science has proven that HIV cannot be passed on during sex if the person with HIV is virally suppressed. Unfortunately this is not the case for injecting, there just isn’t enough research. Viral suppression significantly lowers the risk of transmission, however it hasn’t been proven that people who are virally suppressed cant pass on HIV through shared injecting equipment. Using sterile injecting equipment is the only way to prevent HIV transmission.
People who inject drugs most often learn from peers or other people in the same circles of drug use. While you might think someone is confident sharing their knowledge and skills about injecting, it is a good idea learn the basics of safe injecting as there is the potential to do serious damage to your body.
If you’re interested in learning more about this, Harm Reduction Victoria can help – Visit their website, HERE
More information and assistance:
Harm Reduction Victoria – Offers connections to a range of support services and information centres for all people living in Victoria.
Touchbase – drug and alcohol information for LGBTI Australians and PLHIV
Thorne Harbour Health Alcohol and Other Drugs Services – If you are from an LGBTIQ background you can access individual counselling, therapeutic groups and one-on-one support for care recovery and coordination. Thorne Harbour Health also provide general counselling services for all PLHIV.
Australian alcohol guidelines – HERE
Alcohol information for PLHIV – HERE
Article from NAPWHA about quitting smoking, vaping and PLHIV – HERE
Paper about PLHIV and injecting from HIV Futures data (Australian, 2023) – HERE
Drug-drug interactions between recreational drugs and ARTs – HERE
Cannabis and Inflammation in HIV: A Review of Human and Animal Studies – HERE
Turning Tina – peer-developed harm reduction resource for gay, bi, trans men living with HIV who use crystal meth AKA tina – HERE