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

422 IV. SPECIAL POPULATIONSthe immune compromised, some opportunistic infections can be preventedwith pharmacotherapy; others can be prevented through environmental manipulations(e.g., avoidance of undercooked or contaminated food or water).The CDC (1997, 2001) has extensive recommendations on the use ofART in HIV-positive pregnant or nursing women to reduce mother-to-infanttransmission (MIT). In the United States, the number of reported MITacquiredAIDS cases fell 43% from 1992 to 1996, likely because of providingzidovudine (AZT) to HIV-infected mothers, better guidelines for prenatal HIVcounseling and testing, and changes in obstetrical management (Centers forDisease Control and Prevention, 1997; Wilfert, 1999). Management of theHIV-positive pregnant woman who is undergoing treatment for an SUD is bestdone with a specialty team or in a specially designed program (Lindberg, 1996).HIV Testing: Guidelines for CounselingPretest Counseling• Get written informed consent.• Assess knowledge, attitude, and past experience with HIV/AIDS andHIV testing.• Assess individual risk factors.• Determine substance use (what, how, where, with whom, how muchand how often?).• Determine sexual behaviors, barrier use (condoms, gloves, dentaldams).• Explain antibody test in clear, easy-to-understand language.• Assess degree of risk.• Inform of the risk status.• Counsel on specific, effective means of reducing future risk behavior.Posttest Counseling: Positive Result• Anticipate emotional and behavioral responses to a positive test result.• Evaluate social support systems and coping strategies.• Advise of treatment options and available services.• Make referrals.• Medical evaluation.• Psychiatric evaluation: acute reaction, risk for suicide, past or currentdepression, other mental disorder, positive family history for mentaldisorder.• Provide opportunity to ask questions, respond to the results.• Provide information about symptoms associated with altered immunityand the effects of alcohol and drugs on the immune system (Stimmel,1988).