HIV and BloodbornePathogens for LPC, LMHC, and Addiction Counselors

TIP 37: Substance Abuse Treatment for Persons with HIV/AIDS(28 Hours)
Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC

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Identify the scope of the problem
Discuss how addiction impacts transmission and treatment of HIV
Identify questions to ask in a risk assessment
Delineate the components of a comprehensive care plan for someone with HIV
Identify the types of tests
Highlight the types of pre-test counseling topics that should be covered
Identify factors that commonly lead to treatment noncompliance (and ways to address them)
Review interactions between HIV medications and methadone

650,000 to 900,000 in the U.S. with HIV
Many don’t know it
Most easily transmitted by exposure to contaminated blood
Drug use results
poor judgment, unprotected sex, sharing needles
Substance Abuse and HIV/AIDS
Alcohol and drug use can:
Interfere with HIV medications
Inhibited immune system
Lead to poor health behaviors further compromising immunity
Medical providers
Mental health
Substance abuse
Public health
Social support groups

Risk Factors and Prevention: Myths
Doesn’t matter what you do
Avoid HIV if careful and don’t repeat risky behaviors
Can tell if your sex, or injection, partners are infected
Treat STDs and you won’t get HIV
Washing after sex prevents HIV
Not sharing syringes prevents HIV
Risk Assessment Checklist
Ask: Unprotected in the last 3 to 6 months:
Vaginal sex?
Anal sex?
Oral sex?
Sex for money or drugs?
Sex with more than three people?
Sex with an injection drug user?
Sex with someone you think has HIV/AIDS?
Ask: When you have sex, do you sometimes or never use condoms?
Risk Assessment Checklist cont…
Ask: Do you use drugs before or after sex?
Ask: When you use drugs, do you:
Use syringes?
Share syringes?
Clean your works?
Use crack or powder cocaine?
Use several drugs at the same time?
Positive answers for half or more equals high risk of having or getting HIV
Preventive Measures
Use condoms
Don’t share syringes
Use new syringes
Disinfect drug paraphernalia
Medical care before, during, after pregnancy
Elective cesarean delivery
Avoid reinfection
Observe universal precautions, as directed
If exposed, begin PEP
Risk-Reduction Counseling
Clinician’s goals
Help and support understanding need for behavior change
Assist addressing cultural practices, beliefs contributing to resisting change
Assist skills development to sustain behavior change