U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

CSAT’s 

Knowledge Application Program 

KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons 

With HIV/AIDS 

KAP Keys
 For Clinicians
 

Based on TIP 37 

Substance Abuse 

Treatment for Persons 

With HIV/AIDS 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Introduction 

These KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration. These KAP Keys are 

based entirely on TIP 37 and are designed to meet the needs 

of the busy clinician for concise, easily accessed "how-to" information. 

For more information on the topics in these KAP Keys, readers 

are referred to TIP 37. 

Other Treatment Improvement Protocols (TIPs) 

that are relevant to these KAP Keys: 

TIP 6, Screening Instruments for Infectious Diseases Among 

Substance Abusers (1993) BKD131 

TIP 9, Assessment and Treatment of Patients With Coexisting 

Mental Illness and Alcohol and Other Drug Abuse (1994) 

BKD134 

TIP 11, Simple Screening Instruments for Outreach for Alcohol 

and Other Drug Abuse and Infectious Diseases (1994) 

BKD143 

TIP 27, Comprehensive Case Management for Substance 

Abuse Treatment (1998) BKD251 

TIP 35, Enhancing Motivation for Change in Substance Abuse 

Treatment (1999) BKD342 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Interactions of HIV Medications 

with Street Drugs 

1 

Drug Interaction and Effects 

Ecstasy 3- to 10-fold buildup of 3,4-methylenedioxymethamphetamine (MDMA) in the 

blood, bruxism (teeth grinding), palpitations, joint stiffness, dehydration. 

Possibility of liver and kidney damage. 

May be deadly. 

Speed/ 

Methamphetamine 

2- to 3-fold buildup of methamphetamine in the blood, increased anxiety, 

manic behavior, shortness of breath, 

racing heart beat, and dehydration. 

Heroin Heroin is metabolized more quickly; 

less "hit," less "buzz," withdrawal symptoms. 

Special K (ketamine 

hydrochloride) 

Buildup of ketamine is likely; increased 

sedation, disorientation, and hallucinations. Effects last longer. 

Cocaine Little is known about cocaine's interaction with PIs as no studies have been 

conducted, but if an individual has HIV, 

smoking, shooting, or even snorting 

cocaine may compromise the immune 

system. In one test-tube study, cocaine 

made HIV reproduce 20 times faster 

than normal. 

GHB (gamma 

hydroxybutyric acid) 

Combining GHB with the antiprotease 

drugs is another unknown. Like many 

recreational drugs, GHB may suppress 

the immune system. 

Source: Adapted with permission from Horn 1998. 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Methadone Interactions 

with HIV Medications 

2 

Significantly Reduces Methadone Levels 

• Rifampin 

• Dilantin 

• Phenobarbital 

Reduces Methadone Levels 

• Carbamazepine 

• Ritonavir 

• Rifampin 

• Neviripine 

• Efavirenz 

May Raise Methadone Levels 

• Alcohol 

• Delavirdine 

• Fluconazole 

May Affect Methadone Levels 

• Nelfinavir 

No Significant Effect on Methadone Levels 

• Clarithromycin/Azithromycin 

• Didanosine 

• Lamivudine 

• Saquinavir 

• Stavudine 

• Trimethoprim/Sulfamethoxazole 

• Zalcitabine 

• AZT 

Source: Gourevitch and Friedland 1999. 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Universal Precautions for Substance Abuse 

Treatment Programs Treating HIV-Infected Clients 

3 

Transmission of HIV is highly unlikely within institutions such as 

health care facilities, residential facilities, correctional facilities, residences, and substance abuse treatment programs 

when universal precautions are observed. 

Because medical history and examination cannot reliably identify all HIV-infected patients, universal precautions should be 

used consistently with all patients. 

1. Barrier Precautions 

In any setting in which workers may come into contact with a 

patient's blood or bodily fluids, the following precautions 

should always be observed: 

• Gloves should be worn when touching blood or bodily fluids, 

mucous membranes, or nonintact skin; handling items or 

surfaces soiled with blood or bodily fluids; or performing vascular access procedures such as venipuncture (inserting a 

syringe into a vein to draw blood or administer fluids). 

• Gloves should be changed after each patient contact. 

• Masks and protective eyewear should be worn during any 

procedure likely to expose mucous membranes of the 

mouth, nose, and eyes to droplets of blood or other bodily 

fluids. 

• Gowns or aprons should be worn during procedures likely to 

generate splashes of blood or other bodily fluids. 

• Hands and other skin surfaces should be washed immediately and thoroughly when contaminated with blood or other 

bodily fluids and whenever gloves are removed. 

2. Use of Sharp Instruments 

The following precautions should be taken to prevent injuries 

when using, cleaning, disposing of, or otherwise handling 

syringes, scalpels, and other sharp instruments: 

• Do not recap syringes, bend or break them by hand, remove 

needles from disposable syringes, or otherwise handle them. 

• Place disposable "sharps" in puncture-resistant disposal containers immediately after use. 

• Place large-bore reusable syringes in puncture-resistant containers for reprocessing. 

Continued on back 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

3. Other Precautions 

• Ventilation devices such as mouthpieces and resuscitation 

bags should be available for use in areas where the need for 

resuscitation is predictable. 

• Workers with exudative (oozing) lesions or weeping dermatitis should refrain from all direct patient care and from handling patient care equipment until their condition resolves. 

• Pregnant workers should be especially familiar with, and 

should strictly adhere to, all of the above precautions. 

Source: CDC 1987. 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Guidelines To Minimize 

Cultural Clashes 

4 

• Plan to spend more time with clients holding values different 

from yours. The relationship is more complex, and it may 

take longer to establish trust. 

• Anticipate that past frustrations with insensitive or inappropriate providers may have made the client angry, suspicious, 

and resentful. 

• Acknowledge past frustrations. 

• Acknowledge the difference between your own experience 

and that of the client. 

• Individualize (the clear message of all treatment planning): A 

client is more than an "addict," an Asian, or a person with 

HIV/AIDS. Get to know the whole person. 

• Encourage disagreement and negotiation to ensure a workable plan. 

• Anticipate multiple needs: medical, legal, social, and psychological. 

• Be prepared to advocate for the client who may not have the 

resources, knowledge, or experience to negotiate the 

HIV/AIDS and substance abuse services systems. 

• Assist the client in getting other resources. 

• Involve friends and family. This can help ensure that the 

client receives other needed services. 

• Pay attention to communication: nonverbal, expressive style, 

and word usage and meaning. 

• Make use of providers from other cultures. 

• Learn the strengths of a culture. In Hispanic culture, for 

example, the value of "respeto," demonstrating appropriate 

social respect, can be used to support an intervention plan. 

• Expect differences in beliefs about help-seeking behaviors, 

caretaking/caregiving, cause of disease/illness, 

sexuality/homosexuality, death and dying, and making eye 

contact and touching. 

Source: University of Hawaii AIDS Education Project. 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Symptoms Checklist 5 

Symptom 

• Fever 

• Loss of appetite 

• Weight loss 

• Night sweats 

• Nausea 

• Diarrhea 

• Lymph node swelling 

Question/Action 

• HIV positive? Ask about the possibility of HIV. Get an HIV test. 

• Ask about change in diet. 

• Active drug use? Injection-related bacterial infections, 

cocaine use, and heroin withdrawal are possible causes. 

• Ask about tuberculosis (suggest the Mantoux Purified Protein 

Derivative [PPD] test). 

• Ask if the client is taking any new illicit drugs or medications; 

some symptoms may be side effects. See the medical professional before stopping medicines. 

• Is there another infection? See medical professional for diagnosis and treatment, especially if the CD4+ T cell count is 

low (< 200). 

Symptom 

• Cough 

• Chest pain 

• Shortness of breath 

Question/Action 

• HIV positive? Ask about the possibility of HIV. Get an HIV test. 

• Smoking of tobacco or drugs? 

• Exposure to TB? Cough lasting more than 3 weeks should be 

checked. 

• Fever and night sweats? Pneumonia usually causes these 

symptoms along with a fever, with or without chills and night 

sweats. 

Continued on back 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Symptom 

• Forgetfulness 

• Psychosis 

• Seizures 

Question/Action 

• HIV positive? Ask about the possibility of HIV. Get an HIV test. 

• Intoxication with drugs or alcohol? Withdrawal? 

• Head injury? Immediate medical attention may be needed. 

HIV-related infection or cancer in the brain may occur, especially if the CD4+ T cell count is low (< 200). 

• Ask about a history of depressive or dissociative symptoms. 

• Ask about a history of psychotic symptoms. 

Symptom 

• Numbness or tingling in the limbs 

Question/Action 

• HIV positive? Ask about the possibility of HIV. Get an HIV test. 

• Is didanosine (Videx), zalcitabine (Hivid), or stavudine (D4T) 

being taken? Contact medical professional immediately. 

• Is there long-term alcohol use or diabetes? See a medical 

professional. 

• If HIV positive, are antiretroviral medicines working well, are 

they being taken correctly? Medication resistance or failure 

to take medicines can make HIV symptoms worse. 

• If there is any numbness or tingling in the limbs, the client 

should see a medical professional. 

Symptom 

• Rash 

• Itching 

Question/Action 

• HIV positive? Ask about the possibility of HIV. Get an HIV test. 

• Hepatitis from drug or alcohol use? See a medical professional. 

• Injection site cellulitis? See a medical professional. 

• Ask if the client is taking any new medications; some symptoms may be side effects. See the medical professional 

before stopping medicines. 
KAP KEYS Based on TIP 37 

Substance Abuse Treatment for Persons With HIV/AIDS 

Reproductive Decisionmaking 

Questions 

6 

• Statistics and information are constantly changing. The latest research from NIH still supports the Pediatric AIDS 

Clinical Trials Group Protocol 076 study, which indicated that 

about 8 percent of women treated with AZT during pregnancy and delivery transmitted HIV to their infants. It is unclear 

to date what the long-term health ramifications are for children who received AZT in utero and at birth. 

• Are you willing to run the risk of having a child who is infected or has been affected by medications used to counter HIV 

infection? 

• Are you able and willing to love and care for a baby, whether 

or not it is infected? 

• How will pregnancy affect your health? In women with high Tcell counts, pregnancy has not been shown to make 

HIV/AIDS progress, but less is known about women who 

have AIDS or symptomatic HIV disease. 

• Do you have the support of a partner, family members, or 

friends who can help care for a child? 

• Who will care for your child if you become sick or die? Will 

there be people who will teach your child about his culture, 

help your child remember you, and raise your child according 

to your values? 

• In what ways (good or bad) will having a baby change your life? 

• What are the reasons that you want (or do not want) to have 

a child? 

• Do you have children now? How are things with them? 

• Do you feel pressured by others (partners, family, friends, 

your religion, cultural values) to have (or not have) a child? 

• Do you have a family physician or obstetrician who knows 

about HIV/AIDS and who can give you the health care that 

you need? 

• Do you have enough information to make an informed decision? If not, find someone who can give you information and 

who will not insist on telling you what to do. 

• Are you willing and able to go without substances for at least 

9 months? Do you know how their use will affect your unborn 

child? 

Source: Dennison 1998, p. 7. 
Ordering Information
 

TIP 37 

Substance Abuse Treatment for Persons
 

With HIV/AIDS
 

Easy Ways to Obtain Free Copies 

of All TIP Products 

1. Call SAMHSA’s National Clearinghouse for Alcohol and 

Drug Information (NCADI) at 800-729-6686, 

TDD (hearing impaired) 800-487-4889. 

2. Visit CSAT’s Web site at www.csat.samhsa.gov 

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services. 

DHHS Publication No. (SMA) 01-3606 

Printed 2001