Voluntary Testing for HIV Antibodies among Clients in Long-Term Substance-Abuse Treatment

Abstract

Acquired immune deficiency syndrome tion, ARC, or AIDS, one out of every two in (AIDS) currently is among the foremost travenous drug abusers receiving treatment health concerns in the United States. Since already may have been exposed to HIV.7 the first cases of AIDS were reported in 1981, Drug treatment professionals confronted 56,212 cases of the disease have been re- with cases of asymptomatic HIV infection in ported to the Centers for Disease Control their client populations may need to con (CDC); consistently, one-fourth of those cases, sider, first and foremost, infection control or 13,881, have been diagnosed in individuals policies. Such policies protect HIV-negative who abuse drugs intravenously.1 Although clients and staff and, perhaps more critical sexually active homosexual and bisexual men ly, HIV-positive clients, who may be more continue to compose the largest group of in- susceptible to a variety of infections due to dividuals at risk for AIDS, totaling 66 percent their compromised immune status. of all reported cases, research suggests that In addition, there are numerous psycho intravenous drug abusers with human im- social issues involved in the treatment of in munodeficiency virus (HIV) infection may be travenous drug abusers with asymptomatic a critical link for the transmission of the HIV infection. The diagnosis of HIV infection virus to the general heterosexual popula- is, by its very nature, ambiguous, because tion.2 Fifty percent of 897 cases of pediatric knowledge is still limited regarding the AIDS have occurred in children who had at likelihood of progression from HIV infection least one parent who abused intravenous to ARC or AIDS. Estimates on the likelihood drugs; 73 percent of the 2,233 cases of AIDS of developing AIDS in HIV-infected individ in heterosexuals involved transmission of uals vary from 20 to 60 percent. One study HIV from an intravenous drug abuser to demonstrated that 36 percent of subjects with a spouse or lover.3 The impact of intravenous HIV infection developed AIDS over a period drug abusers on the spread of AIDS to other of 72 months.8 The HIV-positive diagnosis, heterosexuals may be greater in the future, therefore, may be particularly anxiety pro especially because many drug abusers work voking, and may undercut the commitment of as prostitutes to finance their addiction.4 intravenous drug abusers to remain in treat ment. Clearly, it is critical that HIV-positive clients remain in treatment, because a return Voluntary iesting to drug abuse is likely to lead to transmission The threat of HIV infection, AIDS-related of the virus to others, as well as to poor health complex (ARC), and AIDS in members of and further exposures to HIV for the seroposi this population pose special problems for tive individual—two factors that might ex residential substance-abuse treatment pro- acerbate the course of the illness.9 grams and other facilities that treat in- In response to a growing awareness of the