Body Positive can be congratulated for once again providing an excellent HIV treatment update in Auckland. As a follow-up to the seminar, let’s explore how substance use impacts on HIV.

The advent of combination antiretroviral therapy is a wonderful thing; people dear to my heart are living long and productive lives – something we only dreamt about in the early days of HIV/AIDS.

Antiretroviral therapy however does not give immunity to the risks associated with alcohol and other drug use. I hate to state the obvious, but getting totally out of it increases your chances of risky sexual behaviour and HIV infection. Continual partying also does not fit with a healthy lifestyle, eating and sleeping well – all things that are good for a strong immune system.

Alcohol is still New Zealand’s number one drug of choice for getting trollied. Alcohol anaesthetises our higher brain functions, the ones that stop us from doing really dumb things… The more we drink the riskier our behaviour. Not only can heavy alcohol use lead to situations where contracting HIV is a real possibility, it also adversely affects the immune system.

A stimulant like methamphetamine is highly potent and risky. A US study (see express Aug 2011) found that for young men between 12-24 years, the use of meth (P) predicted a higher likelihood of having sex with an HIV-infected individual.

The other drug associated with riskier sexual practices is amyl nitrate and heavy use impacts negatively on the immune system.

Last, but not least, there is injecting drug use. HIV is just one of many viruses that can be transmitted by blood. At least two people were infected with HIV from injecting in New Zealand in the last year. It is essential that needles and other injecting equipment are not shared.

The message I hear most about combination antiretroviral medication is that it must be taken every day; otherwise there is the possibility of reduced effectiveness. Recreational drugs can impact on this significantly. Drugs associated with decreased likelihood of adherence are marijuana/hashish, cocaine/crack/freebase, sedatives, and amphetamines.

It is really important to consider the possible interactions recreational drugs can have with antiretroviral drugs. There can be unpredictable interactions if opioids are used with some antiretroviral drugs; the effect of methadone for example is decreased with some antiretrovirals.

The truth is that interactions between recreational drugs and the many different HIV medications is very complex, so the best advice I can give is to talk to your health practitioner about the specifics.

| Diana Rands
If you have concerns about your own or someone else’s drug use, or if you’d like more information, contact CADS on 09 845 1818 or www.cads.org.nz. If you live outside Auckland, contact Alcohol and Drug Helpline 0800 787 797.