Tip 37 HIV and Addictions

650,000 to 900,000 people in the U.S. are

living with HIV
 Many people who are infected don’t
know it
 HIV is most easily transmitted by exposure
to contaminated blood
 Drug use can result in poor
judgment, unprotected sex and to
sharing needles

Alcohol and drug use can:

› interfere with HIV medications
› inhibit the body’s immune system
› lead to poor health behaviors further
compromising immunity


Medical providers

 Mental health
 Substance abuse
 Public health
 Social support groups


Myth: If you are HIV positive, it does not

matter what you do.
Myth: You can avoid HIV if you are careful

and avoid repeated risky behaviors.
Myth: You can tell whether your sex (or

injection) partners are infected.
Myth: As long as you get treated for any

sexually transmitted diseases, you won’t get
HIV.
Myth: Washing after sex will prevent HIV.

Myth: If you don’t share syringes, you can’t

catch HIV.

Within the past 3 to 6 months, have you

had unprotected:
Vaginal sex?
›
Anal sex?
›
Oral sex?
›
Sex for money or drugs?
›
Sex with more than three people?
›
Sex with an injection drug user?
›
Sex with someone you think has HIV/AIDS?
›
When you have sex, do you sometimes

or never use condoms?

Do you use drugs before or after sex?

 When you use drugs, do you:
Use syringes?
›
Share syringes?
›
Clean your works?
›
Use crack or powder cocaine?
›
Use several drugs at the same time?
›
If your client answers positively for half or

more of these questions, then your client
has a high risk of having HIV or getting
HIV.

Use condoms

Don’t share syringes

Use new syringes

Disinfect drug paraphernalia

Get proper medical care before, during

and after pregnancy
Elect to have cesarean delivery

Avoid reinfection

Observe universal precautions as directed

If exposed, begin postexposure prophylaxis



In promoting risk reduction, the clinician’s

goals are to:
› Help and support the client in understanding
the need for behavior change
› Assist the client in addressing cultural
practices or beliefs that might contribute to
resisting change
› Assist the client in developing skills to sustain
behavior change


Pre- and posttest counseling should be

performed by a trained HIV clinician
 Counseling should:
› Explain the limitations of HIV tests
› Help clients assess their risks
› Encourage and reinforce behavior change
› Refer infected clients for medical care


ELISA (enzyme-linked immunosorbent assay)

› typically used as a first test
Western blot

› typically a second test
Rapid HIV tests

 Home sample collection tests
 Positive result
› a second test is needed to confirm
Negative result

› a second test is needed in about 6 months to
make rule out a false-negative


All States require AIDS cases to be

reported
 Some States also require that new cases
of HIV infection be reported
 Reports are forwarded to the CDC
 State laws vary regarding whether
reports must include client-identifying
information


Testing is needed to determine the

disease progression
› The CD4+ T cell count (More info)
› The viral load count


First combination of medications

prescribed for the patient will be the
most effective
 Adherence leads to:
› a healthier, longer life
› prevention of the development of drug-
resistant strain(s) of HIV


Addiction or mental health relapse

 Living in an institution
 Side effects
 Affordability


Write down instructions

 Use a timer to ensure proper dosing
 Use a check-sheet to notate dosage
 Provide positive feedback
 Empathize and advocate regarding
medication side effects
 Use visual cues for persons with impaired
language/cognitive abilities

Take all medications as prescribed


Socioeconomic status

› level
› whether it impacts client’s illness
Degree of acculturation

 Heterogeneity of cultural, racial and
ethnic groups


Role of the family in treatment

 Importance of spirituality in treatment
 Degree of trust in the health care system
 Views toward injection drug use and
unprotected sex
 Reliance on verbal communication in
medical treatment
 Ways in which safer sex practices are
negotiated

Identity as caregiver is a powerful factor

in her reluctance to seek testing
 Reproductive decision making
 Gay, lesbian, bisexual and transgender
clients deal with the social stigma


Listen with empathy and understanding

 Elicit cultural information from the client
 Acknowledge and discuss differences
and similarities between cultures
 Recommend action, treatment and
intervention that incorporate cultural
knowledge
 Negotiate agreements and differences
with the client

Events which may initiate client relapse:

› Taking an HIV test
› Receiving HIV test results
› Experiencing the first symptoms of HIV
› Experiencing the first AIDS-related hospitalization
› Being diagnosed with AIDS
› A friend or significant other dying from AIDS
› Beginning the medication regimen for HIV
› Experiencing little or no response to various
medications
› Decreasing CD4+ T cell count or increasing viral
load

Peer support

 Medical intervention for pain
 Relaxation and stress management
 Recreation


Consider organizing separate groups for:

› Clients who are newly aware of their positive
HIV status
› Clients who are asymptomatic or mildly
symptomatic
› Clients with more advanced disease


Issues:

› Loss
› Unfinished business
› Pain management
› Religious and cultural traditions
Clients can be encouraged to:

› Make a will
› Arrange for child custody
› Decide about health care directives


5 stages when coping with death or loss

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Normalize their reactions



Acknowledge deaths

› attendance at memorial services, if appropriate
Encourage the expression of grief both

verbally and nonverbally
› art therapy
Provide grief group support

› for clients and significant others
Help clients leave a legacy of living

memories
› video or cassette recordings for others

Medical

Dental

Hospice

HIV organizations and support groups

Local health departments

Legal assistance providers

Agencies providing housing, financial

assistance, medical care funding
 Mental health providers
 Members of the criminal justice community
 Spiritual caregivers


Equal access to health care and

substance abuse treatment is
guaranteed
 State laws regulate the disclosure of
patient information related to HIV/AIDS
which differ from other health
information
 If in doubt, always consult your legal
counsel

HIV/AIDS as a second, third or fourth

diagnosis to be integrated into
comprehensive treatment
 HIV/AIDS counseling and education
should be available at every treatment
facility or detoxification unit
 Patients who receive adequate early
intervention can live longer, healthier
lives

The Ryan White CARE Act

› HRSA Grant Application Center
 (877) 477-2123
 http://www.hrsa.gov
› Title I Information (301) 443-9086
› Title II Information (301) 443-6745
› Title III Information (301) 443-0735
› Title IV Information (301) 443-9051
› See TIP 37 Appendix F for further information


Significantly reduces May affect methadone
 
methadone levels levels
› • Rifampin › • Nelfinavir
› • Dilantin
No significant effect on

› • Phenobarbital
methadone levels
Reduces methadone levels › • Clarithromycin /

Azithromycin
• Carbamazepine
›
• Didanosine
›
• Ritonavir
›
• Lamivudine
›
• Rifampin
›
• Saquinavir
›
• Nevirpine
›
• Stavudine
›
• Efavirenz
›
• Sulfamethoxazole
›
May raise methadone
 • Zalcitabine
›
levels • AZT
›
› • Delavirdine
› • Fluconazole

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Tip 37 HIV and Addictions

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