Counseling Clients With HIV And Substance Abuse Disorders
The pandemics of substance abuse and HIV/AIDS are clearly moving along similar paths, and
each continues to present unique, yet interrelated, challenges. First, both disorders are considered
to be chronic--that is, lifelong diseases. Second, substance abuse is a primary risk behavior for
HIV infection. Third, a diagnosis of HIV infection or related conditions can be a stressor for an
individual already in recovery from a substance abuse disorder. However, the diagnosis of HIV
infection may motivate a client to enter substance abuse treatment. Injection drug users who test
positive for HIV are more likely to enter treatment than those who test negative (Bux et al.,
1997). The diagnoses of a substance abuse disorder and HIV/AIDS require extensive physical
and mental health care and counseling in conjunction with extensive social services. To deal with
the myriad issues surrounding substance abusers who are HIV positive, substance abuse
treatment professionals must continually update their skills and knowledge as well as reexamine
their own attitudes and biases.
Staff Training, Attitudes, And Issues
Before conducting any screening, assessment, or treatment planning, counselors should reassess
their personal attitudes and experiences in working with HIV-infected substance abusers. This
section discusses several ways in which counselors can accomplish this, including formal
training within counselors' programs, examining personal attitudes (e.g., countertransference and
homophobia), examining fears of infection, and avoiding burnout. It is important to reassess
comfort levels with each client because each client will vary in demographic and cultural
background. For instance, a service provider may feel comfortable working with a young Asian
American male with a history of alcohol use, yet the same provider may not be at all comfortable
with a pregnant Hispanic woman who is an active injection drug user and wishes to have her
baby. Figure 7-1 provides an example of a comfort checklist for counselors to use as a routine
self-evaluation.
Training
Staff members must have the proper training to screen, assess, and counsel clients. Achieving
staff competency is an ongoing process. The complexities related to people with HIV/AIDS and
substance abuse disorders are constantly changing and do not allow staff members to defer
learning or training or even to maintain a "status quo" attitude about their competency.
Examples of methods to help staff grow in the areas of assessment, screening, and treatment
planning include the following (see also the section "Cultural Competency Issues" later in this
chapter):
Model skills and competencies. Less experienced staff can observe supervisors or more
tenured staff who demonstrate desired qualities.
Peer training and feedback. Peer teams can provide feedback through direct observation
