Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

19. HIV/AIDS and Substance Use Disorders 421tural competency presents the primary hurdle in altering risk behaviors, particularlysince community-based outreach programs have proved to be the mosteffective (Kwiatowski, Booth, & Lloyd, 2000). For the users who cannot or willnot enter treatment, specific counseling methods can be employed to communicateeffective harm reduction techniques. IDUs must learn the hazards ofneedle sharing and, for those who do not stop injecting, emphasis must beplaced on use of a new, sterile needle for each injection to prevent blood-borneinfections. Methods of needle decontamination, such as flushing with bleach,can reduce some exposure risk, but are not as safe as using a sterile, unused needlefor each injection (Gostin, Lazzarini, Jones, & Flaherty, 1997).Counseling for noninjecting substance abusers is no less important—especially when sex partners may be IDUs (see “Prevention and Public Health”).Alcoholics, especially females and stimulant users, should be specifically targetedfor counseling on sexual practices during intoxicated states. Commercialsex work, often found linked with drug use to support habits (Edlin et al., 1994)or bartering sex to obtain drugs, further adds to risk by introducing multiplepartners (Catania et al., 1992, 1995) and circumstances where safe sex practicesare unlikely to be easily maintained.HIV TESTING: CLINICAL CONSIDERATIONSThe Centers for Disease Control and Prevention (CDC) has suggested since1988 that all patients admitted to substance abuse treatment programs bescreened for the presence of the HIV antibody. Screening and treatment forHIV infection are often linked to substance abuse programs. Literature on thebehavioral impact of HIV testing is mixed. For some who are HIV positive,testing and notification are catalysts for needle use risk reduction among IDUsin treatment (Casadonte, Des Jarlais, Friedman, & Rotrose, 1990) or otherforms of behavioral change (Cleary et al., 1991). Comprehensive counselingmust accompany testing. For some individuals, either a positive or negativeHIV test can be a powerful motivating factor for continued treatment for theaddictive disorder (Perry, Fishman, Jacobsberg, Young, & Frances, 1991).Health professionals can help facilitate positive motivation by stressing thebeneficial effects that drug abstinence and other healthy lifestyle changes canhave on the course of HIV infection, particularly in the context of effectiveART regimens. Watkins, Metzger, Woody, and McLellan (1993) found thatknowledge of HIV status was an important determinate of condom use amongIDUs.Information on HIV status can aid physicians in evaluating patients withnonspecific medical, neurological, and psychiatric symptoms and assist in theprompt recognition and treatment of infection (Stimmel, 1988). CD4+ lymphocytecounts and lymphocyte subsets, and viral load and viral resistance testingcan be used to stage treatment protocols for antiretroviral medications. In