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

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


1
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

2
(No Transcript)
3
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

4
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

5
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

6
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
7
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

8
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

9
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

10
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

11
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

12
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

13
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

14
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

15
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

16
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

17
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

18
SAMHSA/CSAT Information
  • www.samhsa.gov
  • 800-729-6686 for publication ordering or
    information on funding opportunities
  • 800-487-4889 TDD line
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