TIP 37 Substance Abuse Treatment for Persons With HIV/AIDS

1 Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Substance Abuse Treatment for Persons With HIV/AIDS Treatment Improvement Protocol (TIP) Series 37 Substance Abuse Treatment for Persons With HIV/AIDS Treatment Improvement Protocol (TIP) Series 37 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857 Acknowledgments This publication was prepared under contract number 270 95 0013 for the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (HHS).

2 Sandra Clunies, , ICADC, served as the Contracting Officer s Representative. Disclaimer The opinions expressed herein are the views of the consensus panel members and do not necessarily reflect the official position of SAMHSA or HHS. No official support of or endorsement by SAMHSA or HHS for these opinions or for the instruments or resources described are intended or should be inferred. The guidelines presented should not be considered substitutes for individualized client care and Treatment decisions. Public Domain notice All materials appearing in this volume except those taken directly from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors.

3 Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. Electronic Access and Printed Copies This publication may be ordered from or downloaded from SAMHSA s Publications Ordering Web page at Or, please call SAMHSA at 1 877 SAMHSA 7 (1 877 726 4727) (English and Espa ol). Recommended Citation Center for Substance Abuse Treatment . Substance Abuse Treatment for Persons With HIV/AIDS .

4 Treatment Improvement Protocol (TIP) Series, No. 37. HHS Publication No. (SMA) 12 4137. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2000. Originating Office Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment , Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. HHS Publication No. (SMA) 12 4137 First Printed 2000 Revised 2002, 2003, 2006, 2008, 2011, 2012, and 2014 Contents What Is a TIP?

5 Vii Editorial Advisory Consensus xiii Executive Summary and Recommendations .. xv Summary of xvii Chapter 1 Introduction to Overview of Changes in the Epidemiology of HIV/AIDS Since 1995 ..11 Chapter 2 Medical Assessment and Adherence to Medical Care ..23 Barriers to Care for HIV-Infected Substance Abuse Disorder Models of Integrated Care ..27 Medical Standards of Pharmacologic Aspects ..43 Prophylaxis Against Opportunistic Chapter 3 Mental Health Treatment ..69 Linkages With Mental Health Common Mental Disorders in HIV-Infected Clients.

6 70 Assessment and Diagnosis ..74 Pharmacologic Treatment for Psychiatric Disorders ..77 Mental Health and Substance Abuse Disorder Chapter 4 Primary and Secondary HIV Prevention ..91 HIV/AIDS Risk Assessment ..92 Risk-Reduction Infection Control Issues for Substance Abuse Treatment Programs ..99 Chapter 5 Integrating Treatment Services ..103 HIV/AIDS Services in Substance Abuse Issues of Integrated Examples of Integrated Treatment ..113 Chapter 6 Accessing and Obtaining needed The Use of Case Management To Coordinate Care.

7 117 Resources for HIV-Infected Substance Abusers ..120 Finding and Funding Services ..124 iii Contents Income and Other Financial Hospice Suggestions on Finding Resources ..129 Chapter 7 Counseling Clients With HIV and Substance Abuse Staff Training, Attitudes, and Issues ..131 Screening ..137 HIV/AIDS -Specific Substance Abuse Counseling Issues ..139 Case Studies ..170 Chapter 8 Ethical Ethical Issues for Treatment Providers ..173 Basic Ethical Ethical Issues in Working With HIV-Infected Substance A Step-by-Step Model for Making Ethical Additional Resources for Ethical Problemsolving.

8 183 Chapter 9 Legal Issues ..185 Access to Treatment Issues of Discrimination ..185 Confidentiality of Information About Conclusion ..211 End Notes ..211 Chapter 10 Funding and Policy Considerations ..213 Keys to Successful Grantseeking ..213 How To Identify Potential Funding State and Federal Policy Shifts ..215 Federal State and Local Special Grantwriting Strategies To Ensure Ongoing Appendix A Appendix B Glossary ..267 Appendix C 1993 Revised Classification System for HIV Infection and Expanded AIDS Surveillance Case Definition for Adolescents and Adults.

9 271 Appendix D Screening Instruments ..275 Symptoms Checklist ..275 Amsler Grid Appendix E Sample Codes of Code of Ethics for Programs Treating Persons With HIV/AIDS and Substance Abuse Disorders ..279 Code of Ethics for Therapists and Counselors Who Treat Persons With HIV/AIDS and Substance Abuse Appendix F State and Territorial Health Agencies/Offices of 285 Appendix G Mini Mental State Examination (MMSE) ..295 Appendix H Standards of Care: Clie nt Assessment/ Treatment Protocol ..297 iv Contents Appendix I Resource 303 Appendix J Field Figures 1-1 Parts of HIV.

10 4 1-2 Diagram of HIV Entering Cell and 1-3 Male Adult/Adolescent AIDS Annual Rates per 100,000 Population, for CasesReported From July 1998 Through June 1999, United 1-4 Male Adult/Adolescent HIV Infection and AIDS Cases Reported From July 1998 Through June1999, United 1-5 Female Adult/Adolescent AIDS Annual Rates per 100,000 Population, for CasesReported From July 1998 Through June 1999, United 1-6 Female Adult/Adolescent HIV Infection and AIDS Cases Reported From July 1998 Through June1999, United 1-7 New Male AIDS Cases (1993 1998) From Heterosexual Exposure by 1-8 New Female AIDS Cases (1993 1998) From Heterosexual Exposure by Ethnicity.