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Interaction
between HIV/AIDS and Substance Abuse
New HIV-transmission rates attributable to injection drug use and to heterosexual activity with an infected partner (who often times is a drug user) continue to remain high in New Haven and Connecticut (HIV/AIDS Surveillance Report, Connecticut Department of Public Health, 1999). The strong connection between HIV transmission and substance abuse is not surprising when considering that substance abusers are more likely to engage in high risk behaviors such as sharing (contaminated) injection equipment, or participating in unprotected intercourse with a familiar or an unfamiliar partner. Because of the strong link between HIV transmission and substance abuse, it is useful to understand the prevalence of substance use and abuse in New Haven. Prevalence
of HIV/AIDS in the Injection Drug Use (IDU) Population:
Greater
New Haven continues to be severely impacted by HIV infection.
New Haven has also seen the shifting of the AIDS epidemic from
Men who have Sex with Men (MSM) to Injecting Drug Users (IDUs) and
MSM/IDUs. According to recent (12/8/99) epidemiological data issued from
the Connecticut Department of Public Health AIDS Epidemiology Unit, 58.9
% of diagnosed AIDS cases have been IDUs and MSM/IDUs.
During 1998, IDU minorities accounted for 63.8% of HIV
disease has been established as one of the most costly and complex
diseases to care for in the health care system.
This cost and complexity has increased dramatically with
patients’ maintenance on protease inhibitors and anti-retroviral
protocols that typically include 3 to 6 medications requiring multiple
daily doses. While the task
of providing basic care to HIV infected individuals--especially those
with a history of substance abuse--is clearly very challenging, co-
morbid features (including medical problems, psychiatric problems, and
social problems) in individual patients can make this task even more
difficult. For example,
patients with a history of substance abuse and HIV are also at risk for
tuberculosis, hepatitis, bacterial infections, sexually transmitted
diseases, certain cancers, and trauma.
All of these conditions have complex management regimens of their
own, some of which may interact with HIV therapies, and methadone
interacts with protease inhibitors in ways that require added
monitoring. In addition,
this population is at high risk for psychiatric disease including
depression, anxiety, and personality disorder--each of which can
interfere with patients’ cognitive functioning and judgment.
Basic HIV care, on the other hand, requires rather sophisticated
cognitive abilities. APT Research Studies
Related to HIV/AIDS
In
addition to HIV testing and counseling at The APT Foundation treatment clinics, the
Foundation offers a specialized methadone maintenance programs at the Orchard Hill
Clinic and Legion Clinic. The APT Foundation, in collaboration with Yale
University’s School of Medicine, sponsors a number of research studies
that relate to HIV/AIDS, and to reducing HIV risk behavior.
The studies are listed below and are funded under grants from the
National Institute for Drug Addiction (NIDA)
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