Consider the Following: How comfortable do I feel talking to my clients about HIV?
Approximately 10% of new HIV diagnoses are people who inject drugs. Nearly half of people who inject drugs aged 18-29 share syringes, which creates transmission potential. Despite this, only 55% of people who inject drugs have been tested for HIV in the past 12 months.
For individuals that are living with HIV and a substance use disorder (SUD), the progression of HIV can be accelerated and it can be harder to achieve viral suppression. Substances can weaken the blood-brain barrier, which normally works to keep things like viruses out of the brain. When this is weakened, HIV can more easily enter into the brain.
Diagnosing HIV and SUD together presents some challenges as they tend to share some symptoms. Below is a non-comprehensive list of these symptoms. Consider if you have worked with a client who presented any of these symptoms:
If HIV and substance use are not treated together, clients may by more likely to stop treatment due to stigma, fear, and frustration. For these reasons, SAMHSA recommends a unified approach to HIV and SUD treatment. Client education is key in this area. Education helps to reduce stigma and increase treatment retention. Clients should have access to basic HIV education, local and national resources, and access to PrEP referrals.
SAMHSA suggests 6 strategies to increase treatment and prevention service retention for individuals with HIV risk and SUD:
HIV counseling is part of substance use treatment, both before and after testing. Following up with clients after testing and after appointments is part of the unified treatment approach.
Engage in harm reduction if you are able to. PrEP and PEP are great, underutilized resources. Remember: PrEP adherence is the key to prevention.
HIV testing can be integrated into substance use treatment, and vice versa. Providers can work together to create a coordinated care plan, and monitor the client as they work through the process.
Included in HIV and SUD care is non-medical needs, such as housing, food access, and childcare. Ensuring these needs are met makes it much easier for a client to stay in treatment.
Utilizing HIV and SUD support groups, as well as stress management or mental health counseling can help an individual focus on their treatment.
Avoid stigmatizing language and judgement, and engage in person-first language (e.g., “person living with HIV”). Individuals in treatment often report feeling powerless, helpless, guilty, shameful, homophobia, anger, hostility, loss of control, frustration, racial/gender/economic inequalities, and burnout.
Check your knowledge:
✓ What is the cooccurrence rate of HIV and SUD?
✓ What unique challenges do people who use substances face in regards to HIV?
✓ What are some strategies to increase testing in this population?