Nicole Vilar

Mr. Mathews
ENC 2135
22 March 2016
Effectiveness of HIV Positive Rehabilitation Programs
HIV is a human immunodeficiency virus that causes an Acquired Immunodeficiency Disease
Syndrome commonly referred to as AIDS. The AIDS epidemic began in the 1980's when 5 cases
of gay men in Los Angeles, were reported of having multiple strange infections. The epidemic
continued with a growing number of gay men acquiring other "opportunistic infections" as well
as an aggressive cancer known as Kaposi's Sarcoma. This cluster of cases concerned many
prominent doctors as well as the Center for Disease Control and Prevention, also known as the
CDC. After a year of intense research and studies, the CDC finally named the unknown disease,
AIDS, and defined it "a disease at least moderately predictive of a defect in a cell-mediated
immunity, occurring in a person with no known case for diminished resistance to that disease"(A
Timeline of HIV/AIDS). After many presented cases and research, the CDC finally concluded
that acquiring HIV eventually lead to the acquisition of AIDS not long after. They also included
that contraction of the virus does not always lead to AIDS; in the cases of latent stages of HIV. A
well-known cause for acquiring HIV is the injection of drugs; using unsanitary needles and
sharing injecting equipment (HIV and Injection Drugs).
Over the years, the injection of drugs has prominently increased, leading to an increase in the
transmission of HIV. This epidemic caused an awareness within public health officials which
eventually expanded the objective of many substance abuse rehabilitation programs that were
already treating solely substance abusers. There are several different substance abuse

Vilar 2
rehabilitation programs that mainly consist of general substance dependency programs for
Injecting Drug Users (IDUs) and step-by-step programs that are substance specific. The main
goal of these programs is to wean the patient completely off their drugs while switching them
over to HIV medication which will significantly lower their viral loads. However, the lack in
accessibility of these programs makes it difficult for many HIV positive IDUs to seek support.
Therefore, one questions whether or not the accessibility of the program is a factor of its
effectiveness. Nevertheless, with the limited data provided, how effective have these programs
proven to be to HIV positive IDUs?
In the late 1900s and early 21st century, HIV was one of the most prominent viruses in the
United States due to the inflation of drug use and unsafe sexual activity. To this day HIV is still
very prominent and research has proven successful in finding not necessarily a cure but a therapy
that suppresses the virus, which has left many with the opportunity at a longer life. The story of
HIV is one of the greatest successes in modern medicine (Prohaska). When HIV was discovered
in the early 1980s, no one knew how to approach the virus, therefore unsuccessful in preventing
and treating it. Today there are several programs that provide support for substance abusers to
help prevent and treat their addictions, which increases their chances of not acquiring or
moderately dealing with the virus. Since the initial cases of HIV consisted of primarily
homosexual males, many thought that this virus was strictly limited to homosexual males or
males that slept with other males (MSM). However, research done by the CDC found that Men
accounted for 62% (2,400), and women accounted for 38% (1,500) of all IDU-associated HIV
infections in 2010 (HIV and Injection Drugs). This data found by the CDC demonstrates that
although the HIV infection is prominently concentrated within the gay and bisexual community,
HIV can still be contracted by anyone who is sexually active or shares unsanitary syringes or

Vilar 3
injecting equipment with someone who has already acquired the virus. The most common
substances abused by IDUs include most of the illicit drugs (i.e. cocaine, heroin, amphetamines,
and hallucinogens). These are highly addictive and abused drugs that increase the risk of
acquiring HIV and HIV risk behaviors. Although these are not the only abused substances that
affect the acquisition of HIV, these are the drugs mostly abused within the IDU population
(Treatment Statistics).
As mentioned earlier the ultimate achievement of these substance rehabilitation programs, is
to decrease the use of drugs and slowly initiate the patient into antiviral therapy, which will
therefore initiate the road to recovery. Even before the discovery of the highly active antiviral
therapy known as HAART, the goal for earlier rehabilitation programs has maintained the same
throughout the years, adjusting to the new research and medications. The Samaritan Village in
New York, opened in the early 1960s, has counseling programs for adolescent substance
abusers, and has now expanded to forty different locations and provides services for HIV
positive IDUs (History). Rehabilitation programs began accepting and providing more services
for HIV prevention and treatment once the disease became more apparent in the late 1970s,
early 1980s. The rehabilitation programs that are available today vary on their treatment and
services provided, as well on their discernment on who they treat. However, many HIV
rehabilitation programs work hand in hand with rehabilitation programs that focus solely on
substance abuse treatment.
One of the first and most recognized organizations that provides a substance abuse program,
is the Substance Abuse and Mental Health Service Administration, better known as SAMHSA.
When more extensive research on the HIV virus was released, SAMHSA realized that HIV
caused more the just AIDS, it was also a cause to several viral diseases; such as the hepatitis A,

Vilar 4
B, and C. Once this became a public health issue, SAMHSA has made it more of a priority to
accept more HIV/AIDS and viral hepatitis patients... (Kresina 96). SAMSHAs Center for
Substance Abuse Program, is one of many rehabilitation programs that is grant based, which
makes it more affordable and available for many IDUs. The IDUs that are able to participate in
the program and withstand the full length of it are more successful in decreasing their usage of
drugs than those that are not (Kresina 98). Being in programs such as SAMHSAs Center for
Substance Abuse Program allows the abuser to not only seek treatment for his/her addiction to
drugs but become knowledgeable in how to prevent relapsing once they leave the program.
SAMHSA is one of the many rehabilitation programs that has demonstrative the effectiveness of
substance abuse rehabilitation programs in association to HIV positive IDUs. This grant based
program demonstrates that they are willing to support the many HIV infected drug abusers that
are likely to be poorand have suboptimal social support networks (Celentano S321).
Programs that are grant based, or programs that accept HIV positive IDUs no matter the
circumstance, are the programs that demonstrate how effective rehabilitation programs can be if
made available to a larger population of IDUs. However, not all programs are like SAMHSA.
Many rehabilitation programs are limited in locations and do not provide grant programs
which makes it very difficult for many HIV positive IDUs to reach out for support. Those that
have tried to seek support have had a negative experience with health care professionals and
health care systems which may also impact their adherence to antiviral therapy (AVT)
(Celentano S321). Although strictly based treatment programs have proven effective in lowering
the viral count in many IDUs, according to Celentano, Integrated care for HIV drug abusers
should be aimed at bringing multiple treatment modalities, including HIV specific care and
general medical care, substance abuse and psychosocial intervention, and case management. Dr.

Vilar 5
Edward Machtinger, strongly agree with that statement, given the fact that he directs one of the
only clinics in the country that provides not only treatment for HIV but tackles their
pervasive health and social issues. The patients that are presented to Dr. Machtinger in the
clinic are never really surprised with their diagnosis of HIV. Sadly STDs, abuse, drugs,
prostitution is a common bond between many members of the communities that these patients
are a part of. So to them, a diagnosis is often just another trauma in their lives (Machtinger).
This womens clinic in San Francisco works hand in hand with gynecologist, therapists, social
workers, pharmacists, and doctors to not only treat the patient physically but mentally as well.
Like Machtinger, Jerry Flanzer believes that case management and referral to other medical,
psychological, and social services are crucial components of treatment for many people (S440).
This combination of components tends to lead to the best programs that provide services
specifically structured to the individual.
Unlike SAMHSA that proved to be effective in treating and offering services to prevent
acquiring the virus, these type of programs like the UCSFs womens HIV program, provide
more than treatment and prevention, they provide a support system to help the fragile and lost
IDU stand on their own two feet again. Vicky Blake, a now recovered HIV positive IDU, is a
perfect example of the success of this program. After being diagnosed with HIV in 1994, Vicky,
living in an abused relationship, immediately turned to drugs to cope with her situation. At one
point she found herself calling her doctor saying I have had five beers and injected twenty
ounces of crack, help me doc (Palomino). Throughout her first few weeks in the clinic, she was
still using drugs and didnt find the point. Half of the patients report to be depressedforty
percent actively use drugs through treatment (Palomino). Thankfully Dr. Mechtinger suggested
a support group for Blake, which significantly saved her life, That was the first time I knew I

Vilar 6
was not alone and that I had a chance to live (Palomino). This personal statement along with
data from controlled trials of integrated programs demonstrate that although not many, the
effectiveness of these programs has been increasingly positive for most of the HIV positive
IDUs.
So far, the effectiveness of substance abuse rehabilitation programs has proven to have a
successful rate in treating HIV positive IDUs. However, how many substance abuse programs
are out there like SAHMSA and UCSFs Womens HIV Program, that professionally provide
accurate knowledge on how to efficiently treat and prevent HIV in IDUs? Flanzer believes that
the problem with health care in the United States, is not that there are not enough programs or
that studies have not proven them to be successful, he believes it is the lack of current research
within practitioners and physicians that prevents a successful recovery for many IDUs in such
programs. He states that although there has been successful organizational prevention and
treatment interventions to aid patients with HIV and drug abuse identified and studied, few of
these make their way into the day-to-day practice arena (Flanzer S439). This discovery is just
another indicator as to why many rehabilitation programs that have recently initiated the
extension of their services to HIV positive IDUs havent had a successful run compared to the
rehabilitation programs that are integrated with a variety of different services. He then goes on to
explain that while health services research is exploring effective and efficient ways to inform
and train practitioners and physicians on new, proven drug abuse treatments (Flanzer S439),
the practitioners are simply unaware of this research which ultimately affects the overall
experience of the patient undergoing treatment.
This point that Flanzer rises, can formerly be tied into the fact mentioned earlier, that many
IDUs do not fully complete their treatment simply because of the fact that they have had a bad

Vilar 7
experience with health services provided to them. Health services research has demonstrated that
matching a program or treatment service to patient need is a major concern (Flanzer S440).
This demonstration leads to the conclusion that each treatment service should be based off of the
needs of each different population. This is especially true when it comes to the access and quality
of treatment for HIV positive IDUs. The information provided within this paper demonstrates
that although there is no doubt that there is work to be done to matriculate the advances of HIV
therapy and patient care within the rehabilitation programs, the programs themselves have
proven to have a greater effectiveness on the HIV positive IDU community than believed.

Vilar 8
Work Cited
"A Timeline of HIV/AIDS". A Timeline of HIV/AIDS. N.p., n.d. Web. 23 Feb. 2016.
Celentano, D. D., and G. Lucas. "Optimizing Treatment Outcomes in HIV-Infected Patients with
Substance Abuse Issues." Clinical Infectious Diseases 45. Supplement 4 (2007): S318323. Academic Search Complete [EBSCO]. Web. 21 Feb. 2016.
Farrell, Michael, Linda Gowing, John Marsden, Walter Ling, and Robert Ali. "Effectiveness of Drug
Dependence Treatment in HIV Prevention."International Journal of Drug Policy 16 (2005): 6775. Science Direct. Web. 19 Feb. 2016.
Flanzer, Jerry. "Health Services Research: Drug Use and Human Immunodeficiency Virus in the
United States." Clinical Infectious Diseases 37. Blood borne and Sexually Transmitted Infections
in Drug Abusers in the United States, Latin America, the Caribbean, and Spain / Infecciones
Transmitidas Por La Sangre Y Aquellas Transmitidas Sexualmente Entre Usuarios De Drogas
Intravenosas (UDI) Y Sus Parejas En El Hemisferio Occidental: Un Intercambio De Las
Experiencias Y Las Lecciones Aprendidas (2003): S439-444. JSTOR. Web. 18 Feb. 2016.
"History." Samaritan Village -. N.p., 2016. Web. 29 Feb. 2016.
"HIV and Injection Drug Use in the United States." Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention, 27 Oct. 2015. Web. 29 Feb. 2016.
Kresina, Thomas F. "Integrating Hepatitis Services into Substance Abuse Treatment Programs: New
Initiatives from SAMHSA." Public Health Reports (1974-) 122. (2007): 96-98. JSTOR. Web. 17
Feb. 2016.
Palomino, Joaquin. "For Many Women, HIV Is a Byproduct of a Lifetime of Trauma." San Francisco
Chronicle. San Francisco Chronicle, 27 Feb. 2016. Web. 29 Feb. 2016.
Prohaska, Thomas J. "Needle Exchange Program Plans Expansion into Niagara County - The Buffalo
News." Www.buffaloNews.com. N.p., 28 Feb. 2016. Web. 29 Feb. 2016.
"Treatment Statistics." DrugFacts. National Institute on Drug Abuse, Mar. 2012. Web. 23 Feb. 2016.