Since the first moments that the human immunodeficiency virus (HIV) and its biological conclusion—the acquired immune deficiency syndrome (AIDS)—have been included in the American public’s consciousness about public health, most conversations surrounding the virus/syndrome have gravitated at some point toward a linkage with some type of detrimental or widely-unaccepted behavior (Batki, 1990; MacGowan et al., 1997). Whether this discourse is focused upon sexual behavior, illicit drug consumption or anything in between, the reason for this is as much a matter of perception as fact, and as a result the helping community is frequently presented with a tremendous number of challenges in garnering the required public support and resources required in order to provide care to those individuals whose lives are affected by both a substance abuse disorder and HIV/AIDS (Batki, 1990; MacGowan et al., 1997). Regardless of the credence behind the public’s perceptions about the linkage between HIV/AIDS and problematic consumption, the helping professional must keep in mind that the connection does indeed exist.
It would appear that this has been true as long as the HIV/AIDS pandemic has existed, although many of the trends associated with the relationship do not really speak to the origins of the disease itself. Instead, what most research points to is a mutually-reinforcing and highly destructive dichotomy where drug consumption is routinely a result of having the disease (Batki, 1990), and also conversely where the disease is both spread and intensified as a result of drug use (McCusker et al., 1994). The former is typically a matter of self-medication as the HIV/AIDS sufferer seeks to remove him or herself from the realities associated with having a terminal illness for which there is no known cure. The latter is generally a matter of drug users sharing HIV-infected needles, engaging in promiscuous behaviors (i.e. unprotected sex or sex with unfamiliar partners), or seeing their conditions worsen as the result of drug-toxicity further damaging an already frail immune system.
Despite the ease with which academic research can define the causal, almost cyclical nature of the connectivity between drug use and HIV/AIDS, the author feels that much of the associated prevalence should not necessarily be attributed to this alone. Certainly the cause-and-effect must be considered heavily, but not exclusively. This is especially true where prevention efforts are concerned. If the helping community fails to understand that such a cyclical dynamic cannot simply exist in a vacuum—which is to say that either HIV/AIDS or problematic drug consumption must come first—then targeted prevention will not be effective (Batki, 1990; Holmberg, 1996). The author believes, for instance, that if an individual frames the problem in terms of the original issue (either the disease or an addiction) then he or she can get the best idea of where to focus prevention efforts in any given region or community. If an individual sufferer developed HIV because of engaging in unprotected, risky sex (as opposed to sharing a needle) then a more effective focus of prevention might be community-based sexual education or condom distribution. If the primary contributor to an HIV/AIDS outbreak in a given region was due to intravenous drug users sharing needles, then prevention efforts would be best served by focusing on needle exchanges and drug cessation efforts.
Why is it important to point out such distinctions? The author feels that this is where the prevalence factor (of drug abuse amongst HIV/AIDS sufferers) finds it best expression. If an individual can break the problem into its separate parts and examine them independently, there are a tremendous number of lessons that can be learned about the trends behind each—trends which ultimately form a composite substance abuse disorder. Throughout this process, an emerging counselor can also begin to develop the best perspective about why simultaneous drug addiction and HIV/AIDS infection is a matter of comorbidity. The cognitive degenerations, typical mental health issues of an average sufferer, and socio-economic factors which can lead to either separate condition are all open to examination, and when this takes place the question of prevalence is answered (Holmberg, 1996; Langford et al., 2003).
Problematic drug consumption and addiction have—since time out of mind--been inextricably linked to the HIV/AIDS pandemic worldwide. For too long, many in both the helping community and in lay America believed that this was due to intravenous drug use and needle sharing, or just simple deviance on the part of the infected individual. However, framing the problem this way greatly undervalues not only the impact that drug abuse can have on the spread of HIV/AIDS through the unsafe behaviors it engenders, but also the parallel problem of how drug abuse and addiction can facilitate the advancement of HIV/AIDS infection because of how it further compromises the human immune system. Considering causation is critically important, and is perhaps the most important aspect of how the helping professional will perceive a larger interconnectedness between disease and addiction.
Batki, S.L. (1990). Drug abuse, psychiatric disorders, and AIDS: Dual and triple diagnosis. Western Journal of Medicine, 152(5), 547-552.
Holmberg, S.D. (1996). The estimated prevalence and incidence of HIV in 96 large U.S. metropolitan areas. American Journal of Public Health, 86(5), 642-654.
Langford, D., Adame, A., Grigorian, A., Grant, I., McCutchan, J.A., Ellis, R.J., Marcotte, T.D., and Masliah, E. (2003). Patterns of selective neuronal damage in methamphetamine-user AIDS patients. Journal of Acquired Immune Deficiency Syndromes, 34(5), 467-474.
MacGowan, R.J., Brackbill, R.M., Rugg, D.L., Swanson, N.M., Weinstein, B., Couchon, A., Scibak, J., Molde, S., McLaughlin, P., Barker, T., and Voigt, R. (1997). Sex, drugs and HIV counseling and testing: A prospective study of behavior-change among methadone-maintenance clients in New England. AIDS, 11(2), 229–235.
McCusker, J., Bigelow, C., Stoddard, A.M., and Zorn, M. Human immunodeficiency virus type 1 antibody status and change among drug abusers. (1994). Annals of Epidemiology, 4, 466-471.
It would appear that this has been true as long as the HIV/AIDS pandemic has existed, although many of the trends associated with the relationship do not really speak to the origins of the disease itself. Instead, what most research points to is a mutually-reinforcing and highly destructive dichotomy where drug consumption is routinely a result of having the disease (Batki, 1990), and also conversely where the disease is both spread and intensified as a result of drug use (McCusker et al., 1994). The former is typically a matter of self-medication as the HIV/AIDS sufferer seeks to remove him or herself from the realities associated with having a terminal illness for which there is no known cure. The latter is generally a matter of drug users sharing HIV-infected needles, engaging in promiscuous behaviors (i.e. unprotected sex or sex with unfamiliar partners), or seeing their conditions worsen as the result of drug-toxicity further damaging an already frail immune system.
Despite the ease with which academic research can define the causal, almost cyclical nature of the connectivity between drug use and HIV/AIDS, the author feels that much of the associated prevalence should not necessarily be attributed to this alone. Certainly the cause-and-effect must be considered heavily, but not exclusively. This is especially true where prevention efforts are concerned. If the helping community fails to understand that such a cyclical dynamic cannot simply exist in a vacuum—which is to say that either HIV/AIDS or problematic drug consumption must come first—then targeted prevention will not be effective (Batki, 1990; Holmberg, 1996). The author believes, for instance, that if an individual frames the problem in terms of the original issue (either the disease or an addiction) then he or she can get the best idea of where to focus prevention efforts in any given region or community. If an individual sufferer developed HIV because of engaging in unprotected, risky sex (as opposed to sharing a needle) then a more effective focus of prevention might be community-based sexual education or condom distribution. If the primary contributor to an HIV/AIDS outbreak in a given region was due to intravenous drug users sharing needles, then prevention efforts would be best served by focusing on needle exchanges and drug cessation efforts.
Why is it important to point out such distinctions? The author feels that this is where the prevalence factor (of drug abuse amongst HIV/AIDS sufferers) finds it best expression. If an individual can break the problem into its separate parts and examine them independently, there are a tremendous number of lessons that can be learned about the trends behind each—trends which ultimately form a composite substance abuse disorder. Throughout this process, an emerging counselor can also begin to develop the best perspective about why simultaneous drug addiction and HIV/AIDS infection is a matter of comorbidity. The cognitive degenerations, typical mental health issues of an average sufferer, and socio-economic factors which can lead to either separate condition are all open to examination, and when this takes place the question of prevalence is answered (Holmberg, 1996; Langford et al., 2003).
Problematic drug consumption and addiction have—since time out of mind--been inextricably linked to the HIV/AIDS pandemic worldwide. For too long, many in both the helping community and in lay America believed that this was due to intravenous drug use and needle sharing, or just simple deviance on the part of the infected individual. However, framing the problem this way greatly undervalues not only the impact that drug abuse can have on the spread of HIV/AIDS through the unsafe behaviors it engenders, but also the parallel problem of how drug abuse and addiction can facilitate the advancement of HIV/AIDS infection because of how it further compromises the human immune system. Considering causation is critically important, and is perhaps the most important aspect of how the helping professional will perceive a larger interconnectedness between disease and addiction.
References
Batki, S.L. (1990). Drug abuse, psychiatric disorders, and AIDS: Dual and triple diagnosis. Western Journal of Medicine, 152(5), 547-552.
Holmberg, S.D. (1996). The estimated prevalence and incidence of HIV in 96 large U.S. metropolitan areas. American Journal of Public Health, 86(5), 642-654.
Langford, D., Adame, A., Grigorian, A., Grant, I., McCutchan, J.A., Ellis, R.J., Marcotte, T.D., and Masliah, E. (2003). Patterns of selective neuronal damage in methamphetamine-user AIDS patients. Journal of Acquired Immune Deficiency Syndromes, 34(5), 467-474.
MacGowan, R.J., Brackbill, R.M., Rugg, D.L., Swanson, N.M., Weinstein, B., Couchon, A., Scibak, J., Molde, S., McLaughlin, P., Barker, T., and Voigt, R. (1997). Sex, drugs and HIV counseling and testing: A prospective study of behavior-change among methadone-maintenance clients in New England. AIDS, 11(2), 229–235.
McCusker, J., Bigelow, C., Stoddard, A.M., and Zorn, M. Human immunodeficiency virus type 1 antibody status and change among drug abusers. (1994). Annals of Epidemiology, 4, 466-471.
No comments:
Post a Comment