By Mary Ellen Hettinger

"You almost ruined my marriage!" a client growls angrily at his counselor.

"What are you talking about?" asks Lee Kearney, MA, president and founder of the AIDS and Substance Abuse Speakers Network (ASASN).

John, an IV drug user who regularly went on binges and disappear for days was infuriated because Kearney had warned his wife that he could transmit diseases such as HIV to her if she was still having unprotected sex with him.

Sharing needles for drug infection is a well-known route for HIV transmission, yet injection drug use contributes to the epidemic's spread far beyond the circle of those who inject, the Centers for Disease Control and Prevention reports.

Since the AIDS epidemic began, injection drug use has directly and indirectly accounted for more than one-third (36 percent) of AIDS cases in the United States, and according to the CDC this disturbing trend appears to be continuing.

Just as in addiction, "denial about the chances of getting HIV runs very deeply in the heterosexual, Caucasian community," says Kearney. She founded the ASASN in 1990 as a nonprofit corporation in Atlanta when her son, a drug addict, contracted HIV. "We get out there to high schools, colleges, businesses, nurses, doctors, teachers, synagogues and churches, to show people the face of AIDS and to educate them."

Speakers are matched as closely as possible to the population they're addressing. Some are HIV positive, others have AIDS, and many are in recovery from substance abuse. Until recently, speakers were provided at virtually no cost, but cutbacks in funding mean this is changing. Racial and ethnic minority populations in the United States bear the heaviest burden of HIV-disease related to drug injection, the CDC notes. Among women, AIDS is more strongly related to intravenous drug abuse than among men, with at least 61 percent of AIDS cases attributed to IV drug use or sex with partners who inject drugs. (This is as opposed to 31 percent of cases among men.)

Bernadine Healy, MD, president of the American Red Cross, told CBS News recently that: "We are seeing a change in what AIDS looks like today, as opposed to 20 years ago. We used to think that AIDS was all about homosexuality, that you never saw it in women and rarely in children. What we now see is an increase in the number of women who have HIV and a shift in to the African-American and Hispanic populations that we didn't see years ago. In this country, it is mainly IV drug abuse and promiscuous and unsafe sex that is the driver."

Another factor is drugs that are not injected, such as crack cocaine.

			Important Contacts and AIDS Information:
			To learn more about resources for HIV/AIDS information or HIV testing in your area, call: The National AIDS Hotline at 800-432-2437; Spanish: 800-344-7432; deaf 800-243-7889. The National Aids Clearinghouse at 800-458-5231, or write P.O. Box 6003, Rockville, MD 20849-6003. On the Internet, contact: The American Foundation for AIDS Research at www.amfar.org

"We are seeing more cases of AIDS among people in their mid-thirties because IV drug abuse is higher than ever. Some are IV drug users, but not all," says Mel Pohl, MD, medical director of substance abuse services, Behavioral Healthcare Options, Inc. in Las Vegas. "For women the primary risk factor in HIV is drug addiction," Dr. Pohl continues, "their own or their partner's, and it's the same for babies. But you don't have to be an IV drug addict to contract or transmit the disease.

"Stimulant drugs such as crack and methamphetamine can also lead to infection because they are notorious for prolonging sexual activity. If someone can't ejaculate, his sexual exposure to disease is prolonged and irritation is increased. Crack smokers, who may swap sex for money and drugs, develop burns and abrasions in their mouths, leaving them vulnerable to blood-transmitted diseases.

"Then there are the other dangerous behaviors that go along with drug abuse. Sex is not only likely to be unprotected; users seeking fixes or who are already high often engage in behaviors they might not otherwise practice when sober, increasing their risk of HIV this way," Pohl adds.

"In one study of more than 1,000 young adults in three inner-city neighborhoods, the CDC reports, crack smokers were three times more likely to be infected with HIV than nonsmokers were.

In 1998, for the first time, there were more new cases of HIV in heterosexuals than homosexuals, especially in women and in particular women of color, through IV drug use or by having sex with IV drug users," says Scott H'Doubler, 42, of Atlanta. A recovering alcoholic who was diagnosed with HIV in 1985, he volunteers with the AIDS and Substance Abuse Speakers Network in Atlanta.

"I go to treatment centers and talk about HIV and recovery, to teach them that having HIV is no excuse to relapse or stay drunk," says H'Doubler, who has had "full-blown" AIDS since 1994. "I get a very positive reception from people, most tell me they wouldn't know I had AIDS. But I am trying to scare them into safe behavior."

Kearney adds, "Our message is, it isn't who you are, it's what you do that transmits AIDS. You have a choice."

If addicts didn't reuse and share needles, HIV and other diseases such as hepatitis C would not be spread as readily among the drug-using population or among those in intimate contact with drug users.

Although the Speakers Network does not take a position on needle exchange programs, H'Doubler is all for it.

"Not that I'm promoting the use of IV drugs, but it's a form of harm reduction and I know it works. It also presents an opportunity to talk about recovery and behaviors with the users."

"Needle exchange — that is, quality syringe and needle access — is long overdue," says Pohl. "In some states, addicts can buy syringes legally because they have decriminalized pharmaceutical access to them. Any measure that decreases the incidences of disease via injection is needed, and such programs have clearly been shown to decrease incidence and risk of HIV transmission, as do substitution programs, such as methadone for heroin addicts. In Europe, there are several levels of services at one site that increase access to different forms of treatment as well as abstinence-based recovery. I support harm-reduction sites for users to go to, where they are counseled while they are there, can receive methadone, etc. Any and all techniques to decrease the rate of transmission of HIV are long overdue in this country."

In Contra Costa County, in the San Francisco Bay area of California, they have the highest rate of AIDS cases caused by IV drug use in the area, county officials found. So the Board of Supervisors has declared a public health emergency in the county for AIDS and hepatitis C so county residents can participate in a needle exchange program called Exchange Works.

"Needle exchange programs do not increase injection drug use," county supervisor John Gioia says. "A well-run program, combined with substance abuse counseling, actually decreases drug use."

Supporters of this program say the annual cost of needles for one person is about $75, while one year of treatment for AIDS can cost $34,000. As of last summer, 30 percent of the people infected with AIDS in Contra Costa County were believed to have contracted the disease through drug injections.

In Connecticut, pharmacists are empowered to decide whether they want to sell 10 syringes at a time without a prescription being presented.

Beth Weinstein, director of the AIDS Division at the Connecticut Department of Public Health, says this law led to a 39 percent decrease in needle sharing statewide in one year. Because the law simply decriminalizes syringe sales, she says, this needle sharing decrease was accomplished without any public money or any public program.

In Minnesota they've implemented another approach. Fifty percent of the pharmacies statewide participate in ongoing collection of used syringes. They also distribute materials on the proper disposal of needles and refer customers to an AIDS line where they can find syringe exchange programs.

"Minnesota is extraordinary because in one sweep they removed the paraphernalia law penalties, got the pharmacists involved in syringe sales and made big steps on safe disposal of used syringes," says Steve Jones, a medical epidemiologist for the CDC.

Handling syringe sales and disposal at pharmacies also eliminates the stigma of being seen at a substance abuse/needle exchange center, as well as keeping the problem out of the public's critical eye. Drug stores aren't likely to get protesters lining up outside complaining that they're bringing riff-raff into the neighborhood.

Critics of needle exchange programs often recommend "rapid detoxification" for addicts as a way of eliminating the addiction and risk of HIV in one fell swoop, but others say this just isn't practical. For one thing, after detox, addicts return to their neighborhood — and their local drug dealer — who may offer their drug of choice free to get the customer back.

"Substance abuse is a culture, a way of life," says Laura Moraldo, director of a methadone clinic in New York City. "Three-hour detox is a bunch of crap. It's not going to happen." Furthermore, such quick-fix programs are expensive and only effective for addicts who are "highly motivated to quit Dr. Pohl adds." "And only those addicted to opiates."

"Having access to sterile injection equipment is important, but it is not enough," the CDC reports. "Preventing the spread of HIV requires a wide range of approaches, including programs to prevent initiation of drug use, to provide high-quality substance abuse treatment options, to provide outreach services to drug users and their sex partners, to provide prevention services in jails and prisons, and to educate those at risk about preventive options.

How to prevent transmission of the disease through sex must be addressed, since such education has greatly increased the practice of safer sex among participants. This includes the use of condoms and avoiding unprotected sex. According to current CDC statistics, about half a million slots are available for drug abuse treatment at any given time. However, "there are an estimated 1.5 million active intravenous drug users" (and many others who use noninjection drugs or alcohol).

"Clearly the need for substance abuse treatment vastly outstrips our capacity to provide it," the CDC reports.

For IV drug users who cannot or will not stop injecting drugs, the once-only use of sterile syringes and needles remains the safest, most effective approach for limiting HIV transmission. Of course, they (and their partners, whenever possible) must be educated about not spreading or contracting the virus through sex as well.

Other than abstinence from sex, Dr. Healy says, staying away from IV drug abuse is a must to prevent AIDS: "Even one experimentation in a college dorm [with a dirty needle] is enough to transmit HIV. And for young people, the safest sex is no sex."

Many factors influence whether someone exposed to HIV will contract the virus. A stronger immune system not only reduces the chances of getting the disease, it lessens the risk of complications due to the virus. Living an unhealthy lifestyle — smoking, drinking alcohol, poor diet, lack of exercise and fitness, stress, using recreational drugs — may all contribute to making someone vulnerable. Good nutrition is "always a problem in addicted populations," says Pohl, so most drug abusers tend to start off with this strike against them. Being malnourished not only contributes to the wasting that can occur as the disease of addiction and/or HIV progresses, it makes people more vulnerable to opportunistic infections, such as those that may become serious and potentially fatal to AIDS patients.

On the traditional Western medicine front are the many anti-viral drugs available, often given in combination or "cocktail" form. They work by decreasing the virus's ability to replicate. However, the multiple meds must be taken on strict schedule, some require refrigeration, are costly and come with side effects.

"The key is patient compliance and adherence to regimen," says Pohl. Some drug addicts do follow the protocols carefully, but sometimes their active drug use gets in the way. It's really important for people with HIV to get into treatment and stop using drugs, to reduce their high risk of infection, including exposure to hepatitis C and other infectious agents. But improved meds are becoming available, including ones that attack the virus in different ways. On all fronts, things are getting better in terms of treatment.

• Azidothymidine (AZT)
  

  This drug has helped some, not helped others, but is very effective in lessening the viral load in pregnant women with HIV, so not all babies born to HIV-positive mothers are infected with the virus.

  "A good study showed that mothers on AZT prior to delivery cut the incidence of HIV in infants by a third," Pohl adds.

• Recovery and complete abstinence from drugs
  

  Lee Kearney notes that, for active drug users who take drugs to treat their AIDS, "chemical warfare" is going on in their bodies. "At the Speakers Network, we promote recovery and complete abstinence."

• Antiretroviral therapy
  

  Researchers at the University of Maryland School of Medicine in Baltimore report that antiretroviral therapy early in the course of HIV infection improves the clinical outcome of patients with nephropathy associated with HIV. One of the patients studied had a history of IV drug abuse, was HIV-positive and had hepatitis C. But after nine months of treatment with several drugs, the condition of his kidneys improved markedly.

  "HIV-associated nephropathy may be the direct result of active viral replication," the researchers concluded. "Early treatment with potent antiretroviral therapy can ameliorate these changes with improvement in clinical outcome."

  Other researchers are studying the timing of treatment with antiretrovirals, recommending intermittent treatment with occasional "drug holidays" to reduce the circulating virus in the blood to lower and even undetectable limits, in some cases.

• Gene therapy
  

  Whereby patients are injected with doctored-up versions of their own genes, is being tested at the City of Hope cancer hospital in Duarte, California, by infectious disease specialist John Zaia, M.D.

• Alternative medicines
  

  Some former IV drug abusers are turning to alternative (sometimes called complementary) medicine to treat HIV infection. This can range from acupuncture to massage to using Chinese herbs to a variety of stress-reduction strategies. Proponents of so-called natural or alternative treatments note that, even if the remedies can't be considered a cure, they often improve the quality of life among HIV positive and AIDS patients. Plus, these remedies rarely have the side effects of synthetic drugs.

  Bastyr University's AIDS Research Center (BUARC) in Kenmore, Washington, was founded in 1994 with a grant from the National Institute of Health's Office of Alternative Medicine to "describe forms and patterns of use of alternative medicine for the treatment of AIDS/HIV.

  Homeopathy, whereby the body musters its own defense system through a healthful lifestyle and the use of natural therapeutics such as homeopathic medicines and herbs, is being used against AIDS in the Netherlands by 50 percent of physicians, a Dutch medical journal reported in 1994.

  Lawrence Badgley, MD, a homeopath in San Francisco, studied 36 patients with HIV or AIDS over six months. After treating them with natural and homeopathic medicines, he observed a 13 percent increase in T4 "helper" cells and an average weight gain of two pounds, he reported in The Journal of American Homeopathy. In Littleton, Colorado, The Yoga Group, a nonprofit organization, offers free yoga classes to people living with HIV/AIDS, and recommends certain postures as beneficial to the infected population. As Mary Schatz, MD, told Yoga Journal over ten years ago, "There is no evidence that yoga's salutary effects on the immune system would also work in an immune system already ravaged by the AIDS virus.

  Nor is there evidence that yoga practices can act as a preventative. Still, yoga does have something positive to offer to someone with AIDS: anxiety reduction, stress management, and a form of exercise that can be adapted to one's level of energy and stamina. Finally, yoga practice offers something positive or the AIDS patient to do to help counteract feelings of depression, helplessness and despair."

• Ibogaine
  

  Finally, there is news about a drug made from an African shrub that reportedly rids addicts of drug craving. Called ibogaine, the drug is available outside the United States only and reportedly suppresses painful symptoms of withdrawal from drugs such as heroin, amphetamine and others. Even more intriguing, it stops cravings for weeks to months at a time, as people given the drug experience hours of visions, which provide insight into their lives, helping them stay sober.

  Deborah C. Mash of the University of Miami School of Medicine has studied almost 100 addicts who have taken ibogaine to kick addiction in the Caribbean. She notes that it is "extremely effective" and is "a very gentle detox" from opiates such as morphine and heroin, and cocaine and amphetamine. Because it lifts depression for a time, addicts are more open to counseling as well after taking it. But, because of two deaths in people taking it and brain damage reports from some animal studies, the National Institute on Drug Abuse recommended against investigating ibogaine for humans in 1995.

  It's way too early to predict what will come of this drug, which was the subject of a conference at the New York University School of Medicine in late 1999. According to Dr. Kenneth Alper, who directed the conference, ibogaine has been written up about 150 times in medical journals. But at this time, anyone interested in trying the alleged addiction fighter must go outside this country.

At what they called a "turning point in the epidemic," the CDC published "Trends in the HIV and AIDS Epidemic, 1998." The report noted that: "New treatments have slowed the progression from HIV to AIDS and from AIDS to death for people infected with HIV. Consequently, both AIDS cases and deaths have dropped dramatically, and an increasing number of people with HIV are living longer and healthier lives."

However, AIDS incidence is increasing among injection drug users by about 5 percent each year. This is behind the rise in HIV and AIDS in women, and minorities.

In just over a decade, the proportion of all AIDS cases reported among adult and adolescent women tripled, from 7 percent in 1985 to 22 percent in 1997," according to the Trends paper.

Many people are letting their guard down, Dr. Bernadine Healy warns: "As long as those behaviors continue -— risky sex, prostitution, IV drug abuse — this virus will be transmitted.

Mary Ellen Hettinger is a freelance
writer in Coral Springs, Florida.

Comments

Add New Search RSS

Write comment
Name:
Email:	do not notifynotify
Title:
	Please input the anti-spam code that you can read in the image.

Powered by !JoomlaComment 3.26

3.26 Copyright (C) 2008 Compojoom.com / Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved."

---