"During my heavy using phase, when I was a drinker and a user of cocaine and heroin, I slept with eight or nine women," says Bill S. "One night I had oral sex with a girl who did not know she had HIV. We were high and drunk. Did we stop to ask questions: What have you done sexually? And who have you done it with? Of course not."

Eventually Bill hit bottom with alcohol and other drug abuse and received treatment for his addiction. Early in his recovery he started dating again. "During that time I was with a woman, and we were at that point in our relationship when physical intimacy was a focus," Bill recalls. "One night she said to me, 'Before we go any further, what's your status?' In my mind I was asking myself what she meant: What's my marital status? Financial status? Sobriety status? But her real question was: What's your HIV status, especially considering your history with drugs?"

Bill had no answer, so he got a full round of blood tests. "I still remember the nurse walking into my room to give me the results," he says. "She looked upset. I thought, 'Oh my God, I bet she had to tell someone in the other room that they have HIV.' That's when she looked at me and said, 'Bill, your HIV test came back positive.'"

Bill says the most important lesson he learned is that HIV infection can happen to anyone, including those who abuse alcohol or other drugs. A report released in September 2002 by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) outlines the evidence for that conclusion.

In the public mind, HIV infection and AIDS is still associated largely with the sexual behavior of gay men. But according to the NIAAA, the number of people infected with HIV during heterosexual contact is steadily increasing. Today that figure rivals the number of HIV diagnoses due to drug injection. AIDS cases reported among women have also tripled since the mid-1980s, the primary causes being sexual behavior and drug injection.

Research links heavy alcohol use with several high-risk sexual behaviors, such as:

• Multiple sex partners
• Unprotected intercourse
• Sex with injection drug users or prostitutes
• The exchange of sex for money or drugs
• Needle sharing

What's more, alcohol and drug abuse complicates the treatment of HIV infection. Alcohol use can make people more susceptible to several infections that occur with AIDS. One is pneumonia caused by the bacterium Streptococcus pneumoniae. Another is hepatitis C, a viral disease and leading cause of death among people with HIV. Alcohol may also increase the severity of AIDS-related brain damage.

Complications go beyond the added risk of infection. For instance, people who drink heavily may forget to take their HIV medication. In fact, these people have poorer response to HIV therapy in general.

All this suggests that one way to prevent HIV infection is to prevent alcohol and other drug abuse and treat addicted people. Again, research supports this conclusion. Outcomes of HIV therapy improve significantly among alcoholics who stop drinking. Lowering alcohol use among people with HIV also decreases other drug use along with associated HIV transmission.

"Since I'm heterosexual and never injected drugs, I quite frankly never considered HIV a risk for me," says Bill. "But when is it that you're most likely to engage in risky behaviors? When you're high, wasted, tripping, or dumb drunk. As people who abuse substances, we're the ones who take risks. That's our nature, and that's our problem."

For more information on the alcohol link to HIV/AIDS, see the Alcohol Alert titled "Alcohol and HIV/AIDS," published in September 2002 by NIAAA.

--Published June 16, 2003