TIP 37 Addictions Treatment with Persons with HIV

 650,000 to 900,000 in the U.S. with HIV
 Many don’t know it
 Most easily transmitted by exposure to
contaminated blood
 Drug use results
› poor judgment, unprotected sex, sharing
needles


 Alcohol and drug use can:
› Interfere with HIV medications
› Inhibited immune system
› Lead to poor health behaviors further
compromising immunity


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


 HIV positive, doesn’t matter what you do
 Avoid HIV if you’re careful and don’t
repeat risky behaviors
 You can tell whether your sex (or
injection) partners are infected
 Treat any sexually transmitted diseases
and you won’t get HIV
 Washing after sex will prevent HIV
 Not sharing syringes so can’t catch HIV

 Ask: Unprotected in the last 3 to 6 months:
› 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?
 Ask: When you have sex, do you
sometimes or never use condoms?

 Ask: Do you use drugs before or after
sex?
 Ask: 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 client answers positively for half or
more, client has a high risk of having or
getting HIV

 Use condoms
 Don’t share syringes
 Use new syringes
 Disinfect drug paraphernalia
 Medical care before, during, after pregnancy
 Elective cesarean delivery
 Avoid reinfection
 Observe universal precautions as directed
 If exposed, begin postexposure prophylaxis


 Clinician’s goals in promoting risk-reduction:
› Help and support client understanding need for
behavior change
› Assist client address cultural practices or beliefs
that contribute to resisting change
› Assist client develop skills to sustain behavior
change


 Pre- and posttest counseling by a trained
HIV clinician
 Counseling should:
› Explain 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
› second test needed in about 6 months to rule
out a false-negative


 All states require reporting AIDS cases
 Some states also require reporting new
cases
 Reports forwarded to CDC
 State laws vary regarding client-
identifying information


 Testing needed to determine disease
progression
› CD4+ T cell count (More info)
› Viral load count


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


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


 Write instructions
 Use timer, ensuring proper dosing
 Use check-sheet, notating dosage
 Provide positive feedback
 Empathize / Advocate regarding
medication side effects
 Visual cues for persons with impaired
language/cognitive abilities

Take all medications as prescribed


 Socioeconomic status
› Level
› Impact on client’s illness
 Degree of acculturation
 Heterogeneity of cultural, racial, ethnic
groups


 Family role in treatment
 Spirituality in treatment
 Trust in the health care system
 Views toward injection drug use and
unprotected sex
 Reliance on verbal communication in
medical treatment
 Negotiating safer sex practices


 Identity as caregiver, reluctant to seek
testing
 Reproductive decision making
 Gay, lesbian, bisexual, transgender
clients’ social stigma


 Listen with empathy and understanding
 Elicit cultural information
 Acknowledge and discuss cultural
differences and similarities
 Recommend
action, treatment, intervention
incorporating cultural knowledge
 Negotiate agreements and differences
with client

 Events which may initiate client relapse:
› Taking an HIV test
› Receiving HIV test results
› Experiencing first symptoms of HIV
› Experiencing first AIDS-related hospitalization
› Being diagnosed with AIDS
› Friend or significant other dying from AIDS
› Beginning 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 newly aware of their positive HIV
status
› Clients 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 expression of grief both verbally
and nonverbally
› art therapy
 Provide grief group support
› 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 guaranteed
 State laws regulate disclosure of patient
information related to HIV/AIDS; differ
from other health information
 If in doubt, always consult your legal
counsel


 HIV/AIDS as a second, third or fourth
diagnosis integrated into comprehensive
treatment
 HIV/AIDS counseling and education
available at every treatment facility or
detoxification unit
 Patients receiving adequate, early
intervention 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
› • Phenobarbital
 No significant effect on
methadone levels
 Reduces methadone levels › • Clarithromycin /
› • Carbamazepine Azithromycin
› • Ritonavir › • Didanosine
› • Rifampin › • Lamivudine
› • Nevirpine › • Saquinavir
› • Efavirenz › • Stavudine
› • Sulfamethoxazole
 May raise methadone › • Zalcitabine
levels › • AZT
› • Delavirdine
› • Fluconazole

TIP 37 Addictions Treatment with Persons with HIV

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