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TIP 37: Substance Abuse Treatment for Persons with HIV/AIDS
Dr. Dawn-Elise Snipes, PhD, LMHC

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• Review current information about the prevention, transmission and treatment of HIV, Hepatitis and Blood Borne Pathogens
• Review current information about hepatitis transmission, symptoms and treatment.
• 650,000 to 900,000 in the U.S. with HIV
• Approximately 3.2 million people in the US are living with Hepatitis B or C
• Hepatitis A is spread by close personal contact with people or things contaminated with feces
• HIV & Hepatitis B & C are most easily transmitted by contaminated blood and body fluids
• The incidence of hepatitis C among people who are heavy consumers of alcohol (e.g. men that consume 4-5 alcoholic drinks a day) is 7x higher than in the general population.
• Vaccines exist for Hepatitis A & B
• Alcoholic hepatitis is caused by drinking too much alcohol and occurs in 20% of alcoholics or approximately 3 million people
• Severe alcoholic hepatitis can develop suddenly and quickly lead to liver failure and death.
Viral Hepatitis Symptoms
• Viral hepatitis symptoms are similar no matter which type of hepatitis you have. Symptoms include:
◦ Jaundice
◦ Fever
◦ Loss of appetite
◦ Fatigue
◦ Dark urine
◦ Joint and abdominal pain
◦ Diarrhea, nausea, and vomiting.
• Incubation period 15-180 days
Risk-Reduction Counseling
• Clinician’s goals
◦ Help and support understanding need for behavior change
◦ Assist addressing cultural practices, beliefs contributing to resisting change
◦ Assist skills development to sustain behavior change
Counseling and Testing
• Pre- and posttest counseling by a trained HIV and Blood borne pathogens clinician
• Counseling should:
◦ Explain limitations of tests (i.e. incubation period and false +/-)
◦ Help clients assess risks
◦ Encourage, reinforce behavior change
◦ Refer infected clients for medical care
Factors for Noncompliance
• Addiction or mental health relapse
• Living in an institution
• Side effects
• Affordability
Increasing Compliance
• 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
Avoiding Drug Resistance
Take all medications as prescribed
Drug Interactions
◦ General drug interaction checker
LEARN Sensitivity
• 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
Relapse Prevention
• Events which may initiate client relapse:
◦ Taking an HIV/Hepatitis test
◦ Receiving test results
◦ Experiencing first symptoms of the disease
◦ Experiencing first disease-related hospitalization
◦ Being diagnosed with AIDS or liver cancer / liver failure
◦ Friend or significant other dying from AIDS or hepatitis
◦ Beginning medication regimen for the disease
◦ Experiencing little or no response to various medications
◦ Decreasing CD4+ T cell count or increasing viral load
Relapse Prevention Interventions
• Nutrition (H)
• Relaxation and stress management (A)
• Grief management (A)
• Recreation (A/L)
• Peer support (L)
• Family Counseling (L)
• Sleep (T)
• Medical intervention for pain
Group Therapy