clients to act in self-destructive or harmful ways.

Following are some of the milestones of HIV infection that counselors should learn to recognize.

Taking an HIV test



Receiving positive or negative HIV test results



Experiencing the first symptoms



Experiencing the first opportunistic infection



Experiencing the first AIDS-related hospitalization



Being diagnosed with AIDS



Losing a friend, or significant other who dies from AIDS



Beginning the medication regimen



Experiencing little or no response to various medication regimens



Decreasing CD4+ T cell count or increasing viral load



Alcohol and drug counselors may wish to suggest the following strategies to clients who are at

risk of relapse because of HIV-related stress:

Individual counseling



Participation in a peer support group



Medical attention to relieve physical discomfort and alleviate anxiety



Relaxation and stress management techniques



Recreational activities



Dealing with client relapse

The most successful relapse counseling is nonjudgmental. However, clients should understand

that preventing relapse is their responsibility. If a client relapses into a risk behavior for

substance abuse or HIV, the counselor's role is to help the client to understand the conditions that

caused the behavior to occur and to identify alternative behaviors that could have been

substituted to prevent the relapse. Relapse should be viewed as a learning experience and part of

the recovery process. Clients should not be dismissed from substance abuse treatment or

HIV/AIDS support groups because of a relapse. Rather, peer pressure may be constructively

used to help clients acknowledge the reasons for and the consequences of their actions.

However, if the client's relapse includes the risk of nonadherence to HIV medications, these

medications should be stopped entirely to prevent the emergence of resistance. Once the client is

recommitted to therapy, the regimen should be reevaluated.

Case Studies

Case Study 1

Frankie is a 21-year-old, self-admitted gay man. He has been injecting "crystal meth" off and on

for 3 years. He has also been a chronic marijuana and alcohol abuser since he was 12 years old.

He uses these substances particularly when he can't afford the "rig" and other drugs. He has sold