The HIV epidemic is intimately linked to substance use and addiction. Injection drug use is a major risk factor for HIV, and alcohol and substance use are strongly linked to sexual risk. People who inject drugs account for 30% of all people living with AIDS in the United States, and African Americans and Latinos face disproportionately high rates of HIV due to injection drug use. Pervasive stigma towards drug use among health care providers results in unequal treatment for people with a history of drug injection, leading to suboptimal care. HIV-positive people who inject drugs face high barriers to medical care and antiretroviral treatment, and increased mortality from AIDS-related illnesses and other causes, including liver disease and overdose.

 
"Oakland and HIV: Putting the Urgency Back in Emergency" from 2006 HRC conference: Speakers L to R: Joy Rucker, Casa Segura; Carla Dillard-Smith, CalPEP, Rachel Robinson, HRC; Desley Brooks, Oakland City Council; Marye L. Thomas, Alameda County; Dr. Diana Sylvestre, O.A.S.I.S. Clinic

Prevention and care efforts must strengthen evidence-based, non-judgmental strategies grounded in the principles of harm reduction to engage people who use drugs, reduce sexual and drug-related risks, expand access to effective addiction treatment, provide high-quality HIV care, and reduce ethnic and racial disparities in infection rates, disease, and death. HIV-positive current and former drug users must have a meaningful voice in HIV policy, program design, and funding decisions.