acupuncture, meditation, massage, yoga, chiropractic, homeopathic medicine, megadosing, tai

chi, qigong, and various religious practices.

Dental care

Substance-abusing clients typically have poor histories of routine dental care, which can lead to

extreme physical pain and incapacitation. Persons living with HIV/AIDS usually require

extensive dental care, up to and including tooth extraction, jawline reconstruction, and dental

plate replacement.

Ancillary services

The steady increase in the number of women living with HIV/AIDS is creating a great demand

for ancillary services such as child care, housing, and transportation. Families needing housing

may face long waiting lists for Section 8 housing or may receive Section 8 certificates only to

find few landlords willing to accept Section 8 housing payments. Another concern for substance

abusers, whether currently using or in recovery, is the fact that most low-cost housing tends to be

in areas known for high drug traffic and crime.

Disclosure Issues

Disclosure issues are difficult for all HIV-infected clients. For substance-abusing clients, these

issues take on additional challenges. For example, disclosure of positive HIV status may lea d to

personal threats or harm to both client and family. A client's family may refuse to associate with

him upon learning of his HIV/AIDS status. Particularly for clients whose culture reflects

definition of self within a community or self in relation to a clan (as opposed to individual

definition), separation from community can serve as a trigger for lapse or relapse into risky

substance use and sex-related behaviors. Therefore, providers must use caution when notifying

clients of test results and should comply with regulations to ensure that a client's confidentiality

is preserved. Providers should refer to Chapter 9 for guidance in this area.

Also, during group therapy clients often feel an obligation to reveal their HIV status to the rest of

the group. Counselors should caution clients about the impact of such disclosure and consider

discouraging them from making it. Clients who wish to disclose their HIV status generally do so

in response to treatment themes of honesty and openness and are not completely aware of the

consequences. Of course, in treatment settings where all patients are HIV positive, there is no

need for this concern.

HIV/AIDS-Specific Substance Abuse Counseling Issues

There are many counseling issues specific to HIV/AIDS that providers should be familiar with

when treating HIV-infected, substance-abusing clients.

Cultural Competency Issues

Culture is the integrated pattern of human behavior that includes thoughts, speech, actions, and