level of care, motivation and coping resources of client, and treatment agency and philosophy.
This program flexibility is crucial to improving treatment outcomes. Because HIV is a pandemic
that has spread across the globe over the past two decades and remains a public health crisis of
epic proportions, an "abstinence-only approach" will not be effective. The goal for treatment
programs that serve HIV-infected substance abusers must be to initiate treatment--HAART, if
available--for these individuals as soon as possible. Awareness of and education in HIV-related
issues can help treatment providers recognize potential barriers to effective treatment, such as
homophobia and irrational fears of infection, that can occur in both counselors and clients.
What programs should try to achieve in treating the HIV-infected substance abuser is a base of
clients who are as healthy as available treatment can make them. A client who has stabilized his
illness has a better chance of decreasing his substance use than one who has not.
Continuum of Care: Different Treatment Strategies for Different Levels of Care
Detoxification
Most of the client work during this stage of care is directed to surviving the physical and
psychological traumas of separation from addictive substances. The degree and range of trauma
will vary greatly depending on the substance used. Often clients will benefit from an initial
placement in a 12-Step program to begin the long process of breaking through denial,
consciousness raising, and discussing feelings.
Medical supervision during this process is critical. Detoxification of HIV-infected clients
presents considerations not usually encountered in other clients. Many HIV-infected clients
either are on, or will soon be on, a complicated schedule of medications to which strict adherence
is necessary. These clients may also suffer from medical conditions that have occurred as a result
of the disease, which can interfere with the detoxification process. Thus, while the counselor
focuses on the client's psychosocial issues, it is imperative that an experienced physicia n monitor
her closely and supervise treatment during this process.
Inpatient and residential treatment
Care strategies during inpatient treatment consist of consciousness raising, contemplation of
behavior and personal changes around risky behaviors, and developing plans for action. It is
recommended further that clients begin to discuss the problems of relapse and interaction of
competing problems from sex and drug domains.
Individual therapy is often used to clarify comments and observations raised by clients who
participate in group therapy, which in turn usually reinforces personal gains achieved in
individual sessions. Group therapy is optimal for consciousness raising and convincing clients to
move toward a more consistent level of safe behaviors. During this initial period, efforts should
be made simply to get the client to begin thinking about safer behaviors and activities.
Individual therapy strategies
