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The Medical Monitoring Project is an annual survey giving **nationally
representative estimates** for US adults with diagnosed HIV. During
2015–2017 it asked about injection practices and sexual behaviour among
those who had injected drugs in the preceding 12 months — numbers that had not
existed nationally before.
The gap
| Received no substance use treatment | 80% |
| Self-reported needing drug or alcohol treatment | 57% |
Those two figures side by side describe an unmet demand, not a refusal. The
majority said they needed treatment; four in five did not get any.
What that means for transmission
| Inject drugs | Do not inject | |
|---|---|---|
| Detectable viral load | 48% | 35% |
(p = 0.008)
An undetectable viral load means HIV is not transmitted sexually. Nearly half
this group had a detectable one — so the treatment gap is also a viral
suppression gap, and the two compound.
They were also more likely to engage in high-risk sexual behaviours
(p<0.001), which matters because the risk is not confined to injecting
partners.
Injection specifics
About 10% engaged in distributive injection equipment sharing — giving
used equipment to someone else. That is the direction that transmits from this
group outward, and it is the one the recommendation targets first.
And two things described simply as common: **acquiring non-sterile
syringes**, and unsafe disposal.
Neither is a choice in any meaningful sense. A person who cannot obtain a
sterile syringe uses a non-sterile one; a person with nowhere to dispose of it
safely does not.
What is recommended
Three things, each matching one of the findings:
- Increase access to sterile injection equipment — for the acquisition and
disposal problem - Increase access to drug treatment services — for the 80% against 57%
- Education around harm reduction and condom use — for the sexual
transmission risk
And the sentence that ties the health of this group to everybody else's:
**successful substance use treatment could lower the risk of transmission and
overdose through reduced injection.** One intervention, two outcomes, and the
second one saves the life of the person receiving it.
In 2016, 6% of new US HIV diagnoses were attributed to injection drug use.
Source: Centers for Disease Control and Prevention, MMWR.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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