Substance Abuse and HIV Prevention: How Substance Abuse Exacerbates Risk Behaviors for HIVAIDS

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Substance Abuse and HIV Prevention How
Substance Abuse Exacerbates Risk Behaviors
for HIV/AIDS

• H. Westley Clark, M.D., J.D., M.P.H.
• Director
• Center for Substance Abuse Treatment
• Substance Abuse and Mental Health Services
  Administration
• U.S. Department of Health and Human Services

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Snapshot of the ProblemAIDS Cases per 100,000
population in certain U.S. Metropolitan Areas

• 32.8 cases per 100,000 in DC in 2001
• 118.7 per 100,000 among minority population
• 34.6 cases per 100,000 in San Francisco
• 164 per 100,000 among minority population
• 65.9 cases per 100,000 in New York
• 176.6 per 100,000 among minority population

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Substance Use and HIV Transmission

• Injection drug users represent the largest
  HIV-infected substance-using population in U.S.
• Sexual contact within closed sexual networks
  among injection drug users
• Multiple sex partners
• Unprotected intercourse
• Exchange of sex for drugs

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Effect of HIV/AIDS and Substance Use

• 57 of reported AIDS cases among women involve
  injection drug use
• 52 of reported pediatric AIDS cases
• 31 of total male AIDS cases

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Designated States for FY 2003 SAPT Block Grant
Application
AK
ND
I
MT
VT
WA
NH
MN
ME
WI
SD
OR
WY
V
ID
MI
NY
MA
IA
OH
IN
NE
IL
RI
PA
CT
UT
CO
NJ
CA
NV
WV
MO
KS
VA
DE
Puerto Rico
MD
KY
TN
OK
AZ
Virgin Islands
NC
D.C.
AR
NM
SC
MS
AL
TX
LA
HI
GA
FL
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Integrated Treatment

• Reduction in prevalence of HIV and Hepatitis B
  and C and in sexually transmitted diseases (STDs)
  and tuberculosis
• Substance use treatment must be linked to primary
  care, mental health, AIDS-specific care and
  related services such as counseling, testing,
  partner notification and social services

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Treatment Improvement Protocol 37Substance
Abuse Treatment for Persons With HIV/AIDS

• What is needed for medical assessments
• How to determine mental health needs
• Issues for substance use disorder counselors
• How to integrate services
• Using a case manager
• Legal, ethical and privacy issues
• Funding and policy considerations

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Examples of SAMHSA Initiatives

• Treatment center for African American women who
  engage in sexual activity for the exchange of
  drugs and/or money
• Family Group, Wellness and Healthy Living and
  Relapse Program strengthen health care services
  to homeless and addicts, including injection drug
  users and men release from prison or jail

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Examples of SAMHSA Initiatives cont.

• Mobile van to bring potential clients of
  substance use disorder and HIV/AIDS prevention
  education, free testing, assessment for
  residential programs or day treatment, primary
  medical care, referral for follow-up services and
  Medicaid and/or Medicare referral
• Work with health department to ensure relative
  HIV, STD, and Hepatitis B and C education is
  provided to adolescents in state-run treatment
  facilities

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Examples of SAMHSA Initiatives cont.

• Emphasize respect for heritage and tradition,
  relapse prevention, and breaking addictive cycles
  in chemical dependency and mental health
  treatment programs for hard-to-reach Native
  American youth
• Recruit adolescents at high risk for HIV and
  substance use disorders to perform one-act plays
  for their peers that address HIV and substance
  use disorder prevention and other issues for a
  teen theatre company

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Improvements Needed

• Discuss patients symptoms that suggest HIV
  infection and the need for testing
• Get patients into HIV treatment early to extend
  lives
• FDA-approved rapid HIV test should be made
  routinely available so potential clients can be
  tested as they are being screened for substance
  use disorders
• Counselor has opportunity to discuss risk factors
  and need to change behaviors with uninfected
  clients

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Improvements Needed cont.

• Patients need to understand that sexually
  transmitted diseases increase the risk of
  contracting HIV
• Women need to realize that HIV will increase the
  risk of cervical cancer

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Improvements Needed cont.

• Physicians and counselors need to know the
  symptoms of HIV, AIDS and substance use disorders
• Counselors and medical personnel need to
  understand the changing demographics of the
  HIV/AIDS pandemic

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Physicians Need Knowledge

• HIV patients who also have a substance use
  disorder, when provided an intravenous line for
  infusion therapy can use the materials to
  administer heroin, cocaine and other drugs
• Medications used to treat HIV/AIDS can affect
  treatment for hepatitis
• Clients may relapse and become non-compliant with
  medical regimes for HIV/AIDS

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Physicians Need Knowledge cont.

• Patients using opiates, amphetamines or cocaine
  probably are not eating regularly and therefore
  HIV/AIDS medications that need to be taken with
  food is not the best option
• Street drugs can interact and affect medications
  used to treat HIV
• Use of ecstasy with HIV medications can cause
  liver and kidney damage and may be deadly

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Recovery MonthNational Alcohol and Drug
Addiction Recovery Month

• Induce all levels of American society and the
  nations public and private sectors to work
  towards enhancing addiction treatment access,
  availability and quality
• Join the Voices for Recovery Celebrating Health
• www.recoverymonth.gov

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SAMHSA/CSAT Information

• www.samhsa.gov
• 800-729-6686 for publication ordering or
  information on funding opportunities
• 800-487-4889 TDD line