Drug-related infectious diseases: health and social responses www emcdda.europa.eu

The instructions on the bottle stated that needles and syringes should be rinsed twice with the bleach and then twice with clean water. This procedure could be carried out very quickly (as compared with the previously recommended 10- to 15-minute procedure of soaking a needle and syringe in a 10 percent bleach solution). A large number of IV drug users in San Francisco—one half of the subjects in one study (Chaisson et al., 1987a) and two thirds of the respondents in another (Watters, 1987a)—rapidly adopted use of the small bottles of bleach. A large-scale program of antibody testing and counseling was also being conducted at the same time as the bleach distribution campaign. Either one or both of the programs together may have caused behavioral change or at least sensitized IV drug users to the need for such change (Moss and Chaisson, 1988).

Drugs, Brains, and Behavior: The Science of Addiction

At the individual level, susceptibility to respiratory viral infections may be impacted by exposure to local air pollution, which is a concern for rapidly urbanizing locations, where urban air pollution may disproportionately affect low-income communities and communities of colour48,49. For example, signs of drug use non-Hispanic Black and Hispanic populations in the USA were found to have higher exposure to certain PM2.5 components than non-Hispanic white populations49. At the same time, globally, a move to an urban location may bring benefits in terms of increased access to health care (Fig. 2).

Global change

Schlenger and Greenberg (1978) found that cities with high levels of heroin use did not differ from cities with low levels of use on such variables as racial composition, proportion of young men, violent crime rate, median income, and proportion of households headed by a woman. Greenberg and Roberson’s (1978) study found no support for the notion that the composition of race, sex, and age in cities and neighborhoods is correlated with heroin use. Gold and coworkers (1986) report that cocaine’s desired subjective effects are so rapid and short-lived that administration must be repeated every minutes to maintain the high. Direct estimates are based on surveys (e.g., the National Household Survey on Drug Abuse, conducted by NIDA), on back-extrapolation methods, or on dual-systems estimates. The altered translation process was found to be the underlying mechanism for the observed increase in drug resistance.

Side Effects of HIV Medicines

Although the area of research on risk reduction to prevent HIV transmission among IV drug users is only a few years old, there is already a rapidly accumulating body of knowledge that contradicts the common assumption that IV drug users are incapable of changing their behavior. This section traces the history of those studies, summarizes the current state of knowledge, and indicates directions for future research. When the HIV epidemic began in the early 1980’s, STI prevention and treatment became a lower public health priority and state policymakers and health departments have struggled to obtain adequate resources for STI screening and contact tracing. More recently, significant funding for prevention and treatment of HIV, TB and malaria has been re-directed towards the COVID-19 pandemic,133 which may further tighten resources for STI prevention and treatment. In addition to these competing health priorities, there are renewed concerns that Roe vs. Wade may be rescinded, making it more difficult for uninsured people to obtain STI testing and treatment, and harder for women to seek abortions.

Reported drug use among adolescents continued to hold below pre-pandemic levels in 2023

This shifting range likely caused Hendra virus to spill over into southern horse populations, and these horses subsequently infected humans19,20. Patterns of change are likely occurring in other bat populations globally but remain understudied — a clear cause for concern given the crucial role bat populations play as a reservoir host for several high-fatality pathogens21. For example, the elimination of smallpox led to the cessation of smallpox vaccination, which may have enabled the expansion of monkeypox12. More generally, globally ageing populations may provide an immune landscape that is more at risk of spillover, as ageing immune landscapes are less capable of containing infectious agents13. The intersection between declining function of immunity at later ages14 and globally ageing populations may increase the probability of pathogen emergence, but this remains conjectural and an important area for research. The changing global context may allow existing human pathogens to both evolve novel characteristics and expand in scope.

The sharing of injecting equipment increases the risk of transmitting and acquiring blood-borne infections, such as HIV and hepatitis B and C viruses (HBV and HCV). Marginalised groups, including people with serious drug problems, whether or not they inject, may also be at increased risk of contracting other infectious diseases, such as tuberculosis. Substance abuse treatment and community outreach programs that prevent substance abuse and promote safer drug-using habits can be extremely effective in preventing the spread of HIV and other infectious diseases, especially among injection drug users.

Direct and Indirect Influences of Substance Use on Sexual Behaviors

• The 2–3-day delay between infectiousness and symptom onset provides ample time for long-distance spread of the disease, given current transport networks (see the figure).
• A social structure that supports male dominance may make it difficult for women to propose behavioral changes (to say “no” to sex, to use condoms, or to refrain from certain types of sex).
• There is evidence that psychosocial interventions involving information, education, counselling or skills training, which are often implemented are effective in reducing injecting risk behaviours.
• However, the sterilization of injection equipment is not without problems, as some disinfectants may dissolve the silicone lubricant of the syringe plunger, thus making its operation quite stiff.
• For example, the numerator must be corrected for underreporting,13 and the denominator must take into account the uncertainties concerning the probability of progressing from HIV infection to AIDS.