Alcohol Abuse and AIDS
There are two reasons to investigate connections between alcohol,
HIV infection, and AIDS: alcohol adversely affects the immune system,
and alcohol influences high-risk sexual behavior.
AIDS Background
Human immunodeficiency virus (HIV) is widely accepted as the agent
that causes acquired immunodeficiency syndrome (AIDS).
However, a growing number of researchers in the scientific community
theorize that lifestyles featuring systematic and heavy drug and alcohol
abuse damages the immune system, leading to the syndrome known as AIDS.
These researchers point out that there is no scientific proof that a
virus is involved at all, or any proof that such a virus even exists—no
one has ever actually isolated and seen the so-called HIV virus.
Meanwhile, the accepted theory is that HIV, a virus, is transmitted
through sexual contact with an infected individual, through exchange of
infected blood or blood products, or to the newborn from an infected
mother. HIV-infected persons may harbor the virus for many years with no
clinical signs of disease. Eventually, the theory goes, HIV destroys the
body's immune system, mainly by impairing a class of white blood cells
whose regulatory activities are essential for immune protection.
As a result, people who have AIDS are prone to lung infections, brain
abscesses, and a variety of other infections caused by microorganisms
that usually do not produce disease in healthy people. Those who have
AIDS also are prone to cancers such as Kaposi's sarcoma, a skin cancer
rarely seen in non-HIV-infected populations. The diagnosis of AIDS
depends in part on the presence of one or a number of these infections
and cancers.
One million people in the United States are estimated to be infected
with HIV. At least 40,000 new HIV infections are thought to occur among
adults and adolescents, and an estimated 1,500 to 2,000 new HIV
infections are thought to occur among newborns each year. Currently, 8
to 10 million people worldwide are estimated to be infected with HIV. Of
these, 50 percent are expected to develop AIDS within 10 years, and 90
percent may develop AIDS within 20 years of initial infection. The
prognosis for persons with AIDS is grim: AIDS-associated mortality may
approach 85 percent within 5 years of diagnosis.
Alcohol and the Immune System
Alcohol can impair normal immune responses that protect the body from
disease. Chronic alcohol consumption has been shown to reduce the number
of infection-fighting white blood cells in laboratory animals and in
humans. Chronic alcohol ingestion or alcohol dependence can depress
antibody production and other immune responses in animals and in humans.
Alcohol can suppress activities of certain immune system cells, called
macrophages, that help keep the lungs free from infection. In addition,
alcoholics appear to be more susceptible to bacterial infections and
cancer than are non-alcoholics. Studies in animals and in humans
indicate that consuming alcohol during pregnancy can decrease immune
resistance in the offspring.
Alcohol's generally immunosuppressive effects could mean that:
- Drinking may increase vulnerability to HIV infection among people
exposed to the virus, and that
- among people who are already HIV infected, alcohol-induced
immunosuppression might add to HIV-induced immunosuppression, and
speed the onset or exacerbate the pathology of AIDS-related illness.
These are complex ideas and areas of intense investigation, but so
far only a few studies have been published.
Researchers have learned that alcohol can impair white blood cell
responses to HIV. A provocative study that warrants replication found
that a single drinking episode depressed certain immune responses of
white blood cells taken from healthy volunteers. In addition, white
blood cells isolated after this drinking episode were more susceptible
to HIV infection than were cells isolated from subjects who did not
drink, hinting that even occasional alcohol consumption may increase the
likelihood of infection upon exposure to HIV.
Whether alcohol use influences the progression of AIDS in persons
already infected with HIV has been explored in a recent study of
homosexual men. While these researchers found that neither alcohol nor
other drugs seem to influence the progression of HIV infection or the
development of AIDS, their results await confirmation. Clearly, more
research is needed to understand alcohol's role in HIV infection and the
course of ensuing disease.
Alcohol and Sexual Behavior
Sexual practices considered to be high risk for acquiring HIV from an
infected individual include vaginal or anal intercourse without a
condom; other sexual practices that facilitate exchange of blood, semen,
or other body secretions; and unprotected sexual activities with
multiple partners. The frequency with which sexual partners engage in
such practices also influences the risk for exposure to HIV.
Alcohol's relationship to high-risk sexual behavior may be explained
in two ways. First, alcohol use may be a marker for a risk-taking
temperament: those who drink alcohol may also engage in a variety of
high-risk activities, including unsafe sexual practices, as a part of a
"problem behavior syndrome". Second, alcohol may influence
high-risk behaviors at specific sexual encounters by affecting judgment
and disinhibiting socially learned restraints. These are not mutually
exclusive interpretations.
In addition, these two explanations have different implications for
the prevention of high-risk sexual behavior. Among people who have a
risk-taking temperament, reducing alcohol consumption may not reduce
high-risk sexual behavior. However, among those who are more likely to
take sexual risks when they are drinking than when they are not,
reducing alcohol consumption should also reduce high-risk sexual
behavior.
There are two approaches to studying alcohol's relationship to sexual
behavior that may result in HIV infection. One approach examines whether
alcohol use in general is correlated with sexual risk-taking behavior in
general. In this approach, an observed association between drinking and
high-risk sexual activity could imply that these two behaviors are part
of a larger risk-taking tendency, or that alcohol itself influences
sexual risk-taking, or both. Another approach examines the consequences
of alcohol use during specific sexual encounters. An observed connection
between alcohol use and sexual risk-taking during specific encounters
suggests a direct influence of alcohol on such behavior.
A number of studies have identified associations between drinking and
high-risk sexual activity. These studies also have found that an absence
of or a reduction in alcohol use is associated with a decrease in
high-risk sexual behavior. A study of heterosexual drinking habits and
sexual behavior found that women and men who frequently combined alcohol
use with sexual encounters were generally less likely to use condoms
during intercourse. Similarly, a study of homosexual men found alcohol
or other drug use combined with sexual activity to be strongly
associated with high-risk sexual behavior: even those who drank only
occasionally at the time of sexual encounters were twice as likely to be
categorized as "high risk," based on the frequency of
involvement in a range of sexual practices within nonmonogamous
relationships, than were those who did not drink. Further, those men who
did not drink during sexual encounters were three times more likely to
be classified in a "no risk" category than were men who
combined drinking with sexual activity. Recently, a reduction in alcohol
use among homosexual men has been associated with a reduction in
high-risk sexual behavior.
Other studies that examine the consequences of alcohol use at
specific sexual encounters also have demonstrated a connection between
alcohol use and high-risk sexual behavior. Scottish adolescents who
drank at the time of first intercourse were less likely to have used a
condom than those who did not drink. A survey of adolescents in
Massachusetts revealed that teens were less likely to use condoms if
sexual activity followed drinking or other drug use. Similarly, adult
homosexual men and heterosexual women (but not heterosexual men)
reported that they were less likely to use a condom during those sexual
encounters in which they felt intoxicated. These reports of simultaneous
alcohol use and high-risk sexual behavior suggest that alcohol can
directly influence sexual risk-taking. However, these combined behaviors
may still reflect a risk-taking tendency in some individuals.
Further research is needed to define conditions under which alcohol
use is linked to high-risk sexual activity. Information generated from
such studies will be vital for developing and improving programs to
prevent HIV transmission.
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