Comprehensive care may be required for substance abusers with HIV/AIDS

Comprehensive and creative strategies may be required for treating patients with HIV/AIDS who deal with substance abuse issues, according to findings presented at the 2009 Meeting of the International Association of Physicians in AIDS Care, held in New Orleans this week.

Evelyn Tomaszewski, MSW, project director for the National Association of Social Workers HIV/AIDS Spectrum, and Diana L. Sylvestre, MD, assistant clinical professor of medicine at the University of California San Francisco said that the onus for developing strategies to overcome the barriers created by substance abuse falls largely on the shoulders of health care providers.

“Developing a cultural competency and understanding the cultural contexts of our patients can help us understand their worldview,” Tomaszewski said. “Even asking simple questions about where and how they found out about HIV can tell us quite a bit about how they might approach the disease. All of this can then impact the way we treat them.”

Sylvestre said that people with HIV who abuse drugs or alcohol typically have difficulties adhering to HIV drug regimens and may lack trust in their health care providers.

Sylvestre said that before it is possible to begin treating infections such as hepatitis and HIV; more options may be needed for first dealing with substance abuse.

“Clinicians who treat other chronic conditions such as hypertension and diabetes have a whole range of treatment options,” she said. “This is not the case for caretakers of people with addiction. Because of that, it often feels like a miracle when someone stops using. We need to deal with this problem before we can begin discussing how to best treat HIV and hepatitis.” — by Rob Volansky