Part 3: The Connection between Substance Use Disorders and HIV National Institute on Drug Abuse NIDA

This procedure could be carried out very quickly (as compared with the previously recommended 10- to 15-minute procedure of soaking a needle and syringe in a 10 percent bleach solution). A large number of IV drug users in San Francisco—one half of the subjects in one study (Chaisson et al., 1987a) and two thirds of the respondents in another (Watters, 1987a)—rapidly adopted use of the small bottles of bleach. A large-scale program of antibody testing and counseling was also being conducted at the same time as the bleach distribution campaign. Either one or both of the programs together may have caused behavioral change or at least sensitized IV drug users to the need for such change (Moss and Chaisson, 1988). In cities with relatively few IV drug users, the equivalent of a shooting gallery may be the dealer’s apartment, a rented room, or a hotel room in which the dealer makes “house works” available to inject drugs at the time of purchase. The house works are borrowed, used to inject the drugs, and returned to the dealer for the next user—again, often without adequate cleaning or sterilization.

• The papers reported improved virological results in patients receiving HAART and following DAART introduction, reported patient preference for mobile site treatment.
• One abstract described counselling without HIV screening in an MMT program in Taiwan [82].
• Geographic variation in the number of AIDS cases indicates that there are still important opportunities to prevent the further spread of the disease.
• The total number of drug users was a moot issue in many cities; whatever that number was, it exceeded the number who could be served.

Side Effects of HIV Medicines

Contrary to popular myth, the first injection of heroin does not necessarily lead to addiction, and not all heroin users are addicts (Powell, 1973; Robins et al., 1975; Gerstein, 1976). Some individuals experiment with it for a period of time and then quit; others are intermittent users, injecting only on weekends (so-called “weekend warriors”) or on isolated occasions (“chippies”) (Zinberg et al., 1977). Continued use over time involves both an acquired sense of pleasure and a differential tolerance for heroin’s various effects. There is a particular need for research on integration approaches using model 3 whereby services are offered at diverse locations. While many studies described HIV testing initiatives, only one described a substance misuse screening initiative. Further research is required on sensitive approaches, such as community based or mobile service delivery, for specific needs of often vulnerable, transient and hard to reach populations.

• However, estimates of the total number of individuals at risk of HIV infection from injecting illicit drugs are subject to considerable error; this problem is treated in detail in the last section of this chapter.
• This study leveraged qualitative and quantitative methods to guide implementation of health programs for PWID in Rwanda.
• Indeed, despite decreasing global HIV transmission, PWID in many regions are experiencing marginally increasing HIV infections and worldwide an estimated 1.7 million PWIDs live with HIV [6–9].

Toward Better Quality Data

• NIDA is a biomedical research organization and does not provide personalized medical advice, treatment, counseling, or legal consultation.
• This review explores different approaches to integrated HIV and substance use services based on patient entry points, synthesizing integration evidence at HIV, substance use and other facilities, as well as patient perspectives.
• D This includes HIV infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
• One study reported only substance use screening within an HIV clinic in the USA, where electronic medical record scanning identified patients misusing substances and clinic staff referred them for substance or mental health evaluation [60].
• Any attempt to improve the estimation process will require major efforts in each of these areas.

The main program output was a strategic plan offering joint assistance and provider training, coordination and information access, as well as joint procurement processes and contracting services. Studies that met inclusion criteria for this review were in English, French and Spanish language. No studies were excluded based on degree of assessed bias, although this was noted in interpreting the findings. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. The emergency and referral resources listed above are available to individuals located in the United States and are not operated by the National Institute on Drug Abuse (NIDA).

• Our study was also limited in that it did not collect information on the behaviors of injection partners.
• As the findings from studies of model 3 show, people living with HIV and substance use have diverse interactions with the health system and it is important to understand how to screen, refer or treat substance use in a variety of service provision settings.
• Calls to integrate HIV services with services for other health needs, such as the growing burden of non-communicable diseases (NCDs) in ageing populations living with HIV, have been relatively uncontentious.
• Illicit drugs and their markets also vary from city to city (Person et al., 1976; Schlenger and Greenberg, 1978) and from neighborhood to neighborhood (Greenberg and Roberson, 1978).
• Gold and coworkers (1986) report that cocaine’s desired subjective effects are so rapid and short-lived that administration must be repeated every minutes to maintain the high.
• Some HIV medicines can be taken with or without food, because food does not affect their absorption.
• However, the sterilization of injection equipment is not without problems, as some disinfectants may dissolve the silicone lubricant of the syringe plunger, thus making its operation quite stiff.

Type 2: HIV treatment at a substance use facility

Furthermore, those ex-users who are now asymptomatic may already be infected from prior needle-sharing. Other studies reported in 1987 indicate some limitations on the AIDS prevention efforts aimed at IV drug users. An evaluation of an ex-addict outreach program in Baltimore showed that IV drug users in the city were changing their behavior to reduce the risk of AIDS; however, the change could not be attributed to the efforts of the outreach workers (McAuliffe et al., 1987). In this sample, information and even perceived self-susceptibility were insufficient to alter behavior.

Measures of effectiveness of integration

Three states reported that only guesstimates were used; four states indicated they used a combination of methods. Adding the state-plan estimates for the other 33 states, Puerto Rico, and the District of Columbia produces an estimated total of 1,447,000 IV drug users. Intravenous drug use comprises a complex set of behaviors that are enacted in diverse social situations. Drug use is a social problem that is rooted in a network of other problems; most students of drug use believe that only complex, far-reaching solutions that take into account all aspects of that network will ultimately be effective. Such solutions require the attention of a range of agencies—law enforcement, social service, health, housing, and education.

In 1987 reports were published on the increasing use of the syringe exchange program in Amsterdam (van den Hoek et al., 1987; Buning et al., in press) and the bleach distribution program in San Francisco (Chaisson et al., 1987a; Watters, 1987a). The Amsterdam program had actually been established prior to concerns iv drug use about AIDS, but it was greatly expanded when AIDS cases were diagnosed in the city. In another study conducted in Amsterdam (van den Hoek et al., 1987), increased use of the needle exchange program occurred simultaneously with reductions in the reported frequency of drug injection among the respondents.

Policy guidelines for collaborative TB and HIV services for injecting and other drug users