This TIP, Substance Abuse Treatment for Persons With HIV/AIDS, is a revision of TIP 15, Treatment for HIV-Infected Alcohol and Other Drug Abusers (CSAT, 1995b). It is intended to help a wide range of providers become familiar with the various issues surrounding clients with both substance abuse and human immunodeficiency virus (HIV) and to foster a better understanding of the roles of other providers.

Chapter 1 provides a basic overview of HIV/AIDS, including the latest available epidemiological data from the Centers for Disease Control and Prevention. Chapter 2 discusses medical assessment and treatment of HIV/AIDS. Chapter 3 discusses the treatment of mental health disorders in substance abusers with HIV/AIDS. Chapter 4 explains HIV/AIDS prevention, and Chapter 5 provides information about how to integrate treatment services via collaboration, so that all the needs of HIV-infected clients with substance abuse disorders can be met. Chapter 6 discusses case management and how to access the services that clients need. Chapter 7 provides information about counseling clients with HIV/AIDS and substance abuse disorders, including information on staff issues, screening, and cultural competency. Chapter 8 discusses ethical issues, and Chapter 9 presents legal issues, including confidentiality and clients' access to services and programs. Chapter 10 provides information about funding sources for programs treating clients with HIV/AIDS and substance abuse treatment. The appendixes in this TIP provide additional information on several topics and include the 1993 Revised Classification System for HIV and AIDS, Federal and State codes of ethics, AIDS-related Web sites, and a list of State and Territorial health agencies and AIDS hotlines.

Contents

• What Is a TIP?
• Editorial Advisory Board
• Consensus Panel
• Foreword
• Executive Summary and Recommendations
• Chapter 1-- Introduction to HIV/AIDS
  • Overview of HIV/AIDS
  • Changes in the Epidemiology of HIV/AIDS Since 1995
• Chapter 2—Medical Assessment and Treatment
  • Adherence to Medical Care
  • Barriers to Care for HIV-Infected Substance Abuse Disorder Clients
  • Models of Integrated Care
  • Medical StandardsOf Care
  • Pharmacologic Aspects
  • Prophylaxis Against Opportunistic Infections
• Chapter 3—Mental Health Treatment
  • Linkages With Mental Health Services
  • Common Mental Disorders in HIV-Infected Clients
  • Assessment and Diagnosis
  • Pharmacologic Treatment For Psychiatric Disorders
  • Mental Health and Substance Abuse Disorder Counseling
• Chapter 4—Primary and Secondary HIV Prevention
  • HIV/AIDS Risk Assessment
  • Risk-Reduction Counseling
  • Infection Control Issues For Substance Abuse Treatment Programs
• Chapter 5—Integrating Treatment Services
  • HIV/AIDS Services in Substance Abuse Treatment
  • Issues of Integrated Care
  • Examples of Integrated Treatment
• Chapter 6—Accessing and Obtaining Needed Services
  • The Use of Case Management To Coordinate Care
  • Resources for HIV-Infected Substance Abusers
  • Finding and Funding Services
  • Income and Other Financial Concerns
  • Hospice Programs
  • Suggestions on Finding Resources
• Chapter 7—Counseling Clients With HIV And Substance Abuse Disorders
  • Staff Training, Attitudes, And Issues
  • Screening
  • HIV/AIDS-Specific Substance Abuse Counseling Issues
  • Case Studies
• Chapter 8—Ethical Issues
  • Ethical Issues for Treatment Providers
  • Basic Ethical Principles
  • Ethical Issues in Working With HIV-Infected Substance Abusers
  • A Step-by-Step Model for Making Ethical Decisions
  • Additional Resources for Ethical Problemsolving
• Chapter 9—Legal Issues
  • Access to Treatment--Issues of Discrimination
  • Confidentiality of Information About Clients
  • Conclusion
  • End Notes
• Chapter 10—Funding and Policy Considerations
  • Keys to Successful Grantseeking
  • How To Identify Potential Funding Sources
  • State and Federal Policy Shifts
  • Federal Initiatives
  • State and Local Initiatives
  • Special Populations
  • Grantwriting Information
  • Strategies To Ensure Ongoing Funding
• Appendix A -- Bibliography
• Appendix B—Glossary
• Appendix C—1993 Revised Classification System For HIV Infection and Expanded AIDS Surveillance Case Definition For Adolescents and Adults
• Appendix D --Screening Instruments
• Appendix E—Sample Codes of Ethics
• Appendix F—AIDS-Related Web Sites
• Appendix G—State and Territorial Health Agencies/Offices of AIDS
• Appendix H—Mini Mental State Examination (MMSE)
• Appendix I—Standards of Care: Client Assessment/Treatment Protocol
• Appendix J -- Resource Panel
• Appendix K—Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number 270-95-0013 with The CDM Group, Inc. (CDM). Sandra Clunies, MS, ICADC, served as the CSAT government project officer. Warren W Hewitt, Jr, MS, served as CSAT content advisor. Rose M Urban, LCSW, JD, CCAS, served as the CDM TIPs project director. Other CDM TIPs personnel included Raquel Ingraham, MS, project manager; Jonathan Max Gilbert, MA, managing editor; Susan Kimner, editor/writer; Cara Smith, production editor; Erica Flick, editorial assistant; and Y-Lang Nguyen, former production editor.

The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of CSAT, SAMHSA, or the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized client care and treatment decisions.