This TIP Treatment for HIV-Infected Alcohol and Drug Abusers presents guidelines for creating a comprehensive, integrated system of care for HIV-infected AOD abusers. The guidelines identify a spectrum of core services and treatment approaches that ideally should be available to this population regardless of the setting in which care is provided. Prevention and treatment of AOD abuse and HIV disease require a multidisciplinary approach that relies on the strengths of a variety of providers and treatment settings. For service providers who may not be familiar with the treatment system, the TIP provides an overview of AOD treatment settings. An extensive chapter is included, primarily for physicians, nurses, and other medical care providers, on the scope of medical care needed by HIV-infected persons. Another chapter describes the mental health and other counseling needs of HIV-infected substance abusers and provides guidelines for meeting the needs effectively. A chapter on social service needs addresses issues of housing, family support, and outreach services. The TIP describes linkages and collaborations that AOD programs must form with community service providers to provide an array of services. Finally a separate chapter addresses key legal issues, such as confidentiality, encountered in providing services to HIV-infected persons.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• Chapter 1 - The HIV Challenge to AOD Treatment
  • Role of the Consensus Panel
  • Epidemiology of HIV Infection in AOD Abusers
  • Obstacles to the Provision of Integrated Care to HIV-Infected AOD Abusers
  • Preferential Admission to AOD Abuse Treatment for HIV-Infected Patients
  • Cultural Competence of Providers
  • Conclusion
  • Contents of This TIP
  • Endnote
• Chapter 2—Overview of AOD Treatment Services
  • AOD Treatment Settings
  • Components of AOD Abuse Treatment
  • AOD Treatment Availability
  • Summary
• Chapter 3 - Primary Medical Care for HIV-Infected AOD Abuse Patients
  • Barriers to Care for HIV-Infected AOD Abuse Patients
  • Achieving Integration of Care
  • Models of Medical Care for An AOD Abuse Population
  • Medical Standards of Care
  • HIV-Related Primary Care
  • Prophylaxis Against Opportunistic Infections
  • Special Clinical Issues
  • Infection Control Issues for AOD Abuse Treatment Programs
  • Issues in Engagement and Adherence to Medical Care For AOD Abusers
  • Program and Policy Issues
• Chapter 4—Mental Health and Counseling Needs of HIV-Infected AOD Abusers
  • Linkages Between AOD Treatment And Mental Health Services
  • Common Mental Disorders in HIV-Infected AOD Abusers
  • Assessment and Diagnosis
  • Pharmacologic Treatment
  • Counseling
• Chapter 5—Social Services for HIV-Infected AOD Abusers
  • Housing
  • Family Support
  • Case Management
  • Outreach Services
• Chapter 6—Linkages and Services Integration: Policy and Implementation
  • Federal Initiatives
  • Enhancing Linkages Among Government Agencies
  • Enhancing Linkages at the State Level
  • Enhancing Linkages at the Local Level
• Chapter 7 - Key Legal Issues in HIV/AIDS and AOD Abuse Treatment
  • Access to Treatment
  • Confidentiality
  • HIV Counseling and Tuberculosis Testing
• Appendix A -- Bibliography
• Appendix B—Summary of Block Grants: Interim Final Rule (1993)
• Appendix C—Elements of a Needle Exchange Program
• Appendix D—Cultural Proficiency Questionnaire
• Appendix E - Information About the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (The CARE Act)
• Appendix F—Standards of Care
• Appendix G—National HIV/AIDS Organizations and Hotlines
• Appendix H—Sample Memorandum of Understanding
• Appendix I - Federal Resource Panel
• Appendix J—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 ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Anna Marsh, PhD, and Sandra Clunies, MS, served as the CSAT Government project officers. Duiona R Baker, MPH, was the Government content advisor. Carolyn Davis, Joni Eisenberg, Alan Gambrell, Randi Henderson, Coralee Hoffman, Mim Landry, and Deborah Shuman served as writers.

The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT 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 patient care and treatment decisions.