This article discusses the complex dual diagnosis of HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) and substance abuse, which affects a growing number of individuals worldwide. A brief review of HIV/AIDS is provided and the connection between HIV/AIDS and substance abuse is described. Substance abuse complicates both HIV/AIDS and its management because of the effects that illicit drugs have on various body systems and because of the behavioral disturbances that accompany substance use. For a variety of reasons adherence to treatment is poor in this population and several factors that negatively impact adherence are outlined.
Treatment of drug abusers who are HIV-positive requires more flexibility than treating drug abuse and HIV separately. Because medication regimens can be complicated and demanding and nonadherence to treatment can cause mutation of the virus resulting in drug-resistant strains, it is essential to get the patient committed to treatment. The goals of treatment are abstinence from illicit drugs, adherence to a treatment regimen, suppression of viral load, improved CD4 count, and improved quality of life. The role of the case manager is critical to improving treatment adherence. Essential attributes include knowledge of disease processes, critical thinking, and the ability to navigate the healthcare system. Case management interventions to improve treatment adherence should be directed at the patient, the regimen, the client-patient relationship, and the healthcare system. Because HIV/AIDS is now classified as a chronic disease and is no longer viewed as a death sentence, people who are HIV-positive have hope for longevity and a cure. It is this hope for a longer life and possible cure that can be used to motivate substance abusers who are HIV-infected to improve their treatment adherence and quality of life.
Sandra B. Malone, PhD, RN, CS, is a clinical nurse specialist in the Drug Dependence Treatment Program at the Baltimore division of the Veterans Affairs Maryland Health Care System (VAMHCS) and a psychiatric clinical instructor at the University of Maryland School of Nursing. Dr. Malone also serves as liaison between the HIV clinic and substance abuse programs at the VAMHCS.
Juliet J. Osborne, MSN, RN, CRFNP, is a family nurse practitioner in the HIV clinic of the Infectious Disease Department at the Baltimore division of the Veterans Affairs Maryland Health Care System (VAMHCS). Ms. Osborne also precepts graduate nursing students from Johns Hopkins University in Baltimore.
Address for reprints: Sandra B. Malone, PhD, RN, CS, Clinical Nurse Specialist, Drug Dependence Treatment Program, Veterans Affairs Maryland Health Care System, 10 North Greene Street, Baltimore MD 21201; e-mail: Sandra.Malone@med.va.gov