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People Who Inject Drugs and HIV

Education Packet

People Who Inject Drugs and HIV – This packet is a compilation of several recent fact sheets and other resources. You may wish to customize it to meet the needs or interests of particular groups, such as event participants, providers, patients, clients, or the general public. So please feel free to distribute all or part of this packet as either a printout or PDF.

Fact Sheets and Background Information

HIV and People Who Inject Drugs (CDC) – This web page has information about HIV risk behaviors, prevention, testing, HIV diagnoses, prevalence, deaths, and the HIV care continuum among people who inject drugs (PWID). Selected data breakdowns are provided by race/ethnicity, gender, and transmission category.  This page also covers prevention challenges and what CDC is doing to address HIV risk among PWID. Also available in Spanish.

HIV and Injecting Drugs 101 (CDC) – This bilingual fact sheet discusses how people may become infected from injecting drugs, how they can lower their risks of infection, and where to get new, clean needles and syringes. Page 1 is in English, and page 2 is in Spanish.

HIV and Injection Drug Use (CDC) – This publication focuses on risks of HIV infection, other infections, and overdose associated with injection drug use (IDU). Steps for reducing the risk of HIV infection from IDU are also described.

Drug Use and Viral Infections (HIV, Hepatitis) (National Institute on Drug Abuse – NIDA) – This fact sheet examines the relationship between drug use and viral infections, including HIV and viral hepatitis. Information is provided about the effects of drug use on HIV symptoms and progression, as well as steps people can take to reduce HIV transmission risk. Also available in Spanish.

The Intersection of HRSA’s Ryan White HIV/AIDS Program and the Opioid Epidemic Consultation Overview (HRSA HIV/AIDS Bureau – HAB) – This is a summary of an expert panel’s review of the intersection of the Ryan White HIV/AIDS Program (RWHAP) and the opioid epidemic and how services for people with HIV who have substance use disorder could be bolstered to improve health outcomes.

Engaging People with HIV Through Innovative Models of Care (HRSA CAREAction Newsletter, 2020) – This issue includes information about engaging hard-to-reach populations affected by HIV, including people who inject drugs, people who face homelessness, and justice-involved individuals. Also included are two brief case studies of RWHAP-funded agencies’ efforts to engage hard-to-reach populations in care.

Drugs, Alcohol, and HIV (U.S. Department of Veterans Affairs) – This publication provides an overview of drugs, alcohol, and HIV. It examines their effects on the immune system, drug interactions between substances and HIV medications, safer sex, and injection drug use.

Harm Reduction Hacks: A Syringe Services Program (SSP) Provider Basic Operations Handbook (National Alliance of State and Territorial AIDS Directors) – This document includes informal guidance for SSPs, including tips on leadership, organizational design and planning, community relations, advocacy, legal and fiscal structure, fundraising, workforce development, and other topics.

Navigating the Harm Reduction Funding Landscape (National Alliance of State and Territorial AIDS Directors) – This guidance document was designed to assist a variety of harm reduction programs – ranging from small-scale grassroots organizations to larger harm reduction programs – with navigating the funding landscape and fulfilling the requirements laid out in grant proposals and their application process.

Harm Reduction Saves Lives and related video (UNAIDS) – These materials focus on trends in injection drug use worldwide and UNAIDS recommendations for reducing the harm associated with injection drug use.


HIV Surveillance Reports and Data Analyses

Diagnoses of HIV Infection in the United States and Dependent Areas, 2020 (CDC) – This surveillance report includes detailed information about new HIV diagnoses, prevalence, and deaths among PWID, as well as persons in other transmission categories. Breakdowns are also provided by gender, age, race/ethnicity, and geographic region. The report includes a series of Special Focus Profiles highlighting six populations of particular interest to HIV prevention programs in state and local health departments, including PWID. In addition, Tables 5a, 5b, 6a, and 6b focus specifically on HIV diagnoses attributed completely or in part to injection drug use, and many other tables include data breakdowns by transmission category.

Estimated HIV Incidence and Prevalence in the United States, 2015-2019 (CDC) – This report provides estimates of the number of new HIV infections and the total number of persons living with HIV during each year from 2015 through 2019. It begins with a commentary section that summarizes highlights of the report, followed by tables that present data on HIV incidence and prevalence among adults and adolescents, with breakdowns by sex at birth, age, race/ethnicity, transmission category, and region of residence. The transmission category data include statistics for injection drug use alone, as well as for injection drug use combined with male-to-male sexual contact. An appendix focuses on the estimated incidence and prevalence of HIV infection among adults and adolescents living in Ending the HIV Epidemic (EHE) Phase 1 jurisdictions.

Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data United States and 6 Dependent Areas, 2020 (CDC) – This report presents the results of focused analyses of U.S. HIV surveillance data to measure progress toward ending the HIV epidemic. The report also includes a series of Special Focus Profiles highlighting six populations of particular interest to HIV prevention programs in state and local health departments, including PWID. For some measures, data are broken down by transmission category, race/ethnicity, area of residence, gender, and age.

Estimated HIV Incidence and Prevalence in the United States, 2010-2019 (CDC) – This slide set summarizes trends in HIV incidence during the 2010s, with breakdowns by transmission category, age, sex, race/ethnicity, and region. Data for 2019 is also provided on knowledge of HIV status, as well as HIV prevalence in the 50 states, District of Columbia, and Puerto Rico.

HIV Infection, Stage 3 (AIDS), 2020 (CDC) – This slide set summarizes trends in AIDS diagnoses and deaths from 1985 to 2020, with breakdowns by age, sex, race/ethnicity, transmission category, and region. Data on cumulative AIDS diagnoses and deaths through 2020, and AIDS data for Metropolitan Statistical Areas are also provided.

HIV in the United States and Dependent Areas (CDC) – This fact sheet includes information on the disproportionately high number of new HIV diagnoses among PWID, as well as trends in HIV diagnoses in recent years. Also available in Spanish.

HIV Surveillance – Persons Who Inject Drugs 2018 (Preliminary) (CDC) – This slide set presents HIV surveillance data focusing on PWID in a series of charts and graphs. Slides include data on multi-year trends in new HIV and AIDS diagnoses; recent HIV prevalence figures and death rates, with breakdowns by race/ethnicity; and new HIV and AIDS diagnoses, with breakdowns by age, gender, race/ethnicity, and region.

HIV Surveillance in Urban and Nonurban Areas 2018 (Preliminary) – This slide set presents regional variations in diagnoses of HIV and AIDS among adults and adolescents in the United States. Some slides in this set focus on HIV diagnoses by transmission category, including injection drug use, in large metropolitan areas, smaller metropolitan areas, and nonmetropolitan areas.

Clients Served by the Ryan White HIV/AIDS Program, 2020: Clients with HIV Attributed to Injection Drug Use (HRSA) – This slide set summarizes the demographic characteristics of these clients, including their distribution by age, race/ethnicity, gender, housing status, poverty level, and viral suppression rates.

AIDSVu – AIDSVu is an interactive online mapping tool that visualizes the impact of the HIV epidemic on communities across the United States. State-by-state data and limited county data for each New England state are available at the following links: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. The state data include information on new HIV diagnoses and HIV prevalence by transmission category, including injection drug use. Detailed data are also available for the following areas: Boston; the Hartford-East Hartford-Middletown metropolitan statistical area (MSA); the Bridgeport-Stamford-Norwalk MSA; and the New Haven-Milford MSA.

HIV Infection Risk, Prevention, and Testing Behaviors Among Persons Who Inject Drugs: 23 U.S. Cities, 2018 – This surveillance report summarizes data gathered from approximately 11,400 PWID surveyed in 23 major U.S. cities during 2018.  Data are provided on: HIV prevalence among PWID by age, race/ethnicity, and gender; recent and lifetime HIV testing; condomless sex; sharing of syringes and injection equipment; recent diagnoses of sexually transmitted infections; hepatitis C testing and diagnoses; receipt of HIV prevention, including PrEP; and receipt of HIV care and treatment.

UNAIDS Key Population Atlas – This interactive resource provides extensive information on HIV worldwide. Data breakdowns are provided for key population groups, including PWID.  Global data for PWID available on this resource include: the number of people living with HIV, HIV prevalence, knowledge of HIV status, antiretroviral therapy coverage, condom use, coverage of HIV prevention programs, safe injecting practices, coverage of opioid substitution therapy, viral hepatitis, and avoidance of health care because of stigma and discrimination.

Guidelines, Recommendations, and Reports

National Drug Control Strategy (White House Office of National Drug Control Policy, 2022) – This recently adopted strategy is designed “to bend the curve on overdose deaths in the immediate term and reduce drug use and its damaging consequences over the longer term.” The strategy includes seven general goals and twenty specific objectives for reducing the demand for and availability of illicit drugs, as well as the consequences of illicit drug use.

Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV: Considerations for Antiretroviral Use in Special Patient Populations – Substance Use Disorders and HIV (

Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment, and Care for Key Populations: 2016 Update (World Health Organization – WHO)

HIV Prevention, Treatment, Care, and Support for People Who Use Stimulant Drugs: Technical Guide (WHO and multiple international agencies)

Implementing Comprehensive HIV and HCV Programmes with People Who Inject Drugs: Practical Guidance for Collaborative Interventions (WHO and multiple international agencies)

Seizing the Moment: Tackling Entrenched Inequalities to End Epidemics (UNAIDS)

Health, Rights, and Drugs – Harm Reduction, Decriminalization, and Zero Discrimination for People Who Use Drugs (UNAIDS)

Managing HIV and Hepatitis C Outbreaks Among People Who Inject Drugs: A Guide for State and Local Health Departments (CDC)

Summary of Considerations for Management of HIV and Hepatitis C Outbreaks Among People Who Inject Drugs – A Checklist for State and Local Health Departments (CDC)

Harm Reduction (National Association of County and City Health Officials – NACCHO)


Compiled Resources: HIV and PWID

Resources from CDC for Consumers (not previously listed)

Resources from CDC for Providers and Public Health Partners (not previously listed)

Selected Resources from AIDS Education and Training Centers (AETCs)

Implementing Substance Use Disorder (SUD) Services in HIV Care Settings Toolkit (AETC National Coordinating Resource Center and others, August 2022) – This toolkit of linked resources was created to help multidisciplinary healthcare team members improve SUD-related health outcomes for people with HIV with SUD in all stages of recovery.

PrEP for PWID: Challenges and Opportunities (Mountain West AETC, May 2022) – This training reviews challenges (lack of awareness, interest, and risk perception), and opportunities (improving uptake, sustainability, and adherence) for PrEP among people with injection drug use disorder.

Fentanyl: A Hidden Epidemic (Mountain West AETC, April 2022) – This training summarizes drug overdose mortality trends in HHS Region 10, describes core infrastructure states are using to respond to the overdose epidemic, and identifies approaches to improve overdose responses.

SSPs in Public Health – Mobile Innovations to Reach Rural Communities (New England AETC, April 2022) – This webinar examines existing data and public health challenges in HIV/HCV prevention and SSP access in rural areas and reviews innovative models for bringing services to most at-risk communities.

Strategies and Lessons Learned from Data Utilization to Improve Patient Care (New England AETC, April 2022) – This webinar describes how data utilization techniques can be applied to UDS quality metrics, quality improvement projects, and provides strategies to use the data to improve patient care in a homeless population with a high prevalence of substance use disorders.

Myth-Busting HCV Treatment: Demystifying HCV Treatment in At-Risk Populations (New England AETC, January 2022) – This part of the “Myth-Busting HCV Treatment” series explores how advances in HCV treatment have affected the clinical management of PWID and persons with SUD. It also examines various monitoring strategies that can be used during HCV treatment and follow-up for hard-to-reach populations.

Myth-Busting HCV Treatment: Interdisciplinary HCV Screening, Treatment and Follow-up (New England AETC, December 2021) – This part of the Myth-Busting HCV Treatment series focuses on the role of an interdisciplinary team in completing the essential components of HCV treatment assessment, service delivery for marginalized populations, and outreach to individuals experiencing SUD.

Harm Reduction in the Continuum of Care for Substance Use Disorders (Northeast/Caribbean AETC, December 2021) – These training slides review the importance and utility of providing harm reduction services for people with substance use disorders and identify various types of harm reduction services available and how to determine which service will be the most beneficial to clients.

Myth-Busting HCV Treatment: Integrated Models of HCV Care Delivery (New England AETC, November 2021) – This part of the “Myth-Busting HCV Treatment” series describes the process of care and patient outcomes in a practice serving young injection drug users with integrated HCV treatment services with opioid use disorder services.

Being Triply Diagnosed While Black During the COVID-19 Pandemic (Northeast/Caribbean AETC, November 2021) – These training slides examine mental illness through a cultural lens to review the impact of COVID-19 on the Black community while facing the challenges of mental illness, substance use disorder, and HIV infection. Various treatment options are also addressed.

Methadone Patient Journey Demystified Video Series (New England AETC, October 2021) – This four-part video series follows a patient’s journey into methadone treatment to demystify the process for healthcare providers treating people with substance dependence. It is part of a larger curriculum from the Connecticut Regional Partner. You must create an account on the Connecticut AETC website to get access to these free resources.

Recovery Support Services Along the Continuum of Substance Use and HIV Treatment (Pacific AETC, September 2021) – This online course is designed to help participants understand the Recovery Support Services available for people with HIV and co-occurring substance use disorders. This training offers information and interactive activities to help integrate effective recovery support services at different stages along a continuum of care to improve patient retention and engagement.

Substance Use Disorder Curriculum (Southeast AETC and others, September 2021) – This curriculum offers 6 hours of free CME, CNE, and CPE credit on the following topics: addiction as a brain disease, motivational interviewing and substance use disorder, challenging behaviors of addiction, trauma-informed care, and substance use disorder.

Treating Hepatitis C Among People who Use Drugs (Mountain West AETC, July 2021) – These training slides review the epidemiology of hepatitis C (HCV) among people who use drugs, review treatment as prevention, dispel myths about HCV treatment among people who use drugs and discuss special considerations about HCV treatment for this population.

Supervised Consumption Sites (New England AETC, July 2021) – This webinar on supervised injection sites discusses the successes of safe consumption site programs and the benefits of establishing a program in the U.S. amidst an overdose epidemic.

Prevention and Treatment of Hepatitis C Infection among People who Use Drugs (Mountain West AETC, April 2021) – These training slides provide information about the importance of treating people with HCV who use drugs to eliminate hepatitis C as a public health threat, dispels common myths about HCV treatment among people who use drugs, and describes key features of a typical treatment course for HCV infection.

Suicide and Overdose Among People with HIV During the COVID-19 Pandemic: Updates and Opportunities for Mitigation (Mountain West AETC and New England AETC, March 2021) – This webinar covers overdose death rates throughout the U.S. during COVID-19, identifies risk factors for suicidal ideation in people with HIV, identifies how COVID-19 impacts the mental health of people with HIV, and reviews steps providers can take to address overdose risk in people with substance use disorder.

Combating Discrimination Based on HIV or Opioid Use Disorder (New England AETC, February 2021) – In this webinar, speakers outline the civil rights of people with HIV, HCV, and substance use disorder. The right to health care, protections under the Americans with Disabilities Act, legal rights of people with substance use disorder, relevant laws and regulations in Massachusetts, and language to advocate for client rights are also discussed.


Selected Recent Reports from CDC’s Morbidity and Mortality Weekly Report

Each of these recent reports includes data on, or a discussion of, HIV testing, prevention, care or other health issues (such as the COVID-19 pandemic), including information for PWID.

HIV Services and Outcomes During the COVID-19 Pandemic – United States, 2019-2021

Clusters of Rapid HIV Transmission Among Gay, Bisexual, and Other Men Who Have Sex with Men – United States, 2018-2021

HIV Testing Before and During the COVID-19 Pandemic – United States, 2019-2020

Association Between Social Vulnerability and Rates of HIV Diagnoses Among Black Adults, by Selected Characteristics and Region of Residence – United States, 2018

Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs – Kanawha County, West Virginia, 2019-2021

HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs – 23 Metropolitan Statistical Areas, United States, 2018

HIV Preexposure Prophylaxis Awareness and Referral to Providers Among Hispanic/Latino Persons – United States, 2019

Estimated Annual Number of HIV Infections, United States, 1981–2019

Care Outcomes Among Black or African American Persons with Diagnosed HIV in Rural, Urban, and Metropolitan Statistical Areas – 42 U.S. Jurisdictions, 2018


The contents listed on this page are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, the New England AIDS Education and Training Center.