People who use drugs
Print as a PDFOverview
- Some people who use drugs report higher rates of condomless sex.
- In particular, injecting and non-injecting use of methamphetamines and gamma hydroxybutyrate (GHB) have been shown to confer a higher risk of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) due to an association with condomless sex and group sex.
- Illicit drug use among men who have sex with men, and sexualised drug use in particular, has been associated with HIV, syphilis, lymphogranuloma venereum (LGV) and hepatitis C.
|
Infection |
Consideration |
|---|---|
|
Consider self-collection of samples for testing. | |
|
Consider self-collection of samples for testing. | |
|
Syphilis is increasingly prevalent among people who use drugs, hence syphilis screening should be considered. | |
|
HIV status should be confirmed in anyone reporting a history of injecting drugs or non-injecting methamphetamine use and these people should be offered HIV pre-exposure prophylaxis (PrEP). | |
|
Vaccinate if not immune. | |
|
Hepatitis B (HBV) |
People who use drugs may be at risk of HBV acquisition, if not immune. |
|
Hepatitis C (HCV) |
Confirm HCV status for all people reporting a history of injecting drugs and non-injecting use of methamphetamines or GHB. |
NAAT – nucleic acid amplification test
The optimal frequency for STI screening (chlamydia, gonorrhoea, syphilis) for people who use drugs will depend on factors other than their drug use, and should be guided by sexual history. People who use drugs, especially stimulants, in the context of sex will likely require 3-monthly STI screening. People who use drugs differently, for example people who use opioids and not in the context of sex, may need STI screening less frequently, such as annually. Annual HCV and HIV testing is recommended for people who use drugs and this provides an opportunity for a full STI screen for those who are sexually active.
Specimen collection guidance
Clinician collected | Self-collection
Clinical indicators for testing:
Testing for HIV, hepatitis C and syphilis (and hepatitis B if not immune) should be offered to all people who inject drugs, men who have sex with men, and people who participate in sexualised drug use. It is not recommended to routinely test for herpes or genital warts with serology.
If test results are positive, refer to STI management section for advice on:
Even if all test results are negative, use the opportunity to:
- Educate about condom use, contraception, HIV PrEP/PEP, safe injecting practices and needle syringe programs (NSP), consent, CST and vaccinations for HAV, HBV and HPV as indicated.
- For anyone who uses heroin or other opioids, educate about the use of naloxone and provide a PBS prescription if indicated.
- Vaccinate for hepatitis A and B, if susceptible.
- Refer to harm reduction services such as needle and syringe programs (NSPs), alcohol and other drug services, or relevant community organisations (e.g. peer-based services).
- Discuss and activate SMS text reminders for regular testing according to risk, especially if their behaviours indicate the need for more frequent testing.
- People with ongoing risk factors for HCV should be advised to have ongoing HCV screening, either 6-, or 12-monthly depending on their level of risk.
- People who share needles may also need HIV PreP or PEP.
100% of people reporting a history of ever injecting drugs or sexualised drug use have a documented hepatitis B, hepatitis C, HIV and syphilis test, and a documented recent (within last 12 months) hepatitis C test.
- Centers for Disease Control and Prevention (CDC). Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services. MMWR Recomm Rep 2012;61(RR-5):1-48. Last updated May 2021. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr6105.pdf (last accessed 20 October 2021).
