Are HIV positive addicts and alcoholics treated equally?

In honor of World AIDS Day 2008, we explore the ethical issues surrounding addiction treatment of patients diagnosed with HIV. Are these patients subject to discrimination? How possible is it really to treat ALL addicts equally? We explore if and how clinicians limit contact with HIV+ substance abusers and what we can do about it.

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In any health care setting, personal ethics play a role in the quality of care and treatment a patient will receive. Case workers, administrators, psychologists and counselors, nurses, and treatment center aids may feel entirely comfortable working with someone diagnosed with a substance abuse disorder. However, many mental health care workers may not understand, or feel awkward working with, someone with HIV/AIDS.

The U.S. Department of Health and Human Services* has created a few administrative bodies to explore these issues and to recommend best practices in addiction treatment for HIV/AIDS patients. SAMHSA (the Substances Abuse and Mental Health Services Administration) and CSAT (the Center for Substance Abuse Treatment) are the umbrella organizations who have issued the incredibly helpful TIPS, or Treatment Improvement Protocol Series, as best-practice guidelines for the treatment of substance abuse. Treatment Improvement Protocol # 37 for Substance Abuse Treatment for Persons with HIV/AIDS states:

“The principle of justice assumes impartiality and equality. It means that a clinician will treat all clients equally and give everyone their due portion of services. …Yet, given human nature, how possible is it really to treat everyone equally? Can it be honestly said that a clinician does not have “favorite” clients? Are there clients with whom a clinician instinctively wants to limit contact?”SAMHSA/CSAT Tip 37

The solution to possible discrimination in a treatment setting, TIP 37 explains, is an understanding of countertransference. In other words, medical officers need to be aware of their conscious and unconscious reactions to clinical situations. And they need to know their own limits, to call in a supervisor when personal bias stands in the way of equal and just treatment.

I believe that each person is a bundle of past experiences, neurological pathways and repeated behaviors. Until we understand ourselves and break down the cycles and programming we’ve learned, we cannot really view others with the truth that we are not separate. “I am you and you are he and he is me and we are all together.” Let alone in a clinical setting! Let alone with the fear and the misunderstanding of the disease of AIDS! The truth is that we ARE equal…be it man or woman or addict or junkie or HIV+. We just need to get to the point in our personal evolution where we FEEL this and RADIATE this truth.

In my opinion, addiction treatment centers should require that staff members actively explore issues of self-awareness as a condition for employment. Something similar to Naropa University‘s requirement that graduate students maintain a daily self-reflective, contemplative practice. This is to train professionals in the practice of look inward before looking outward. Be it meditation, counseling, mentorship or home-based study…the people who are guiding mental health institutions MUST also be practicing what they preach. Treatment centers might also require in-house training to coach staff on becoming aware of personal triggers and reactions in an effort to re-program and unlearn our unjust behaviors.

What do you think? Have you ever experienced discrimination in a treatment setting? Should addiction treatment institutions operate from a higher spiritual-psychological plane? Is this type of ideal attainable? And can you personally view someone who is an HIV+ addict as you view yourself: with love and compassion? Plus, What discriminations do you now carry within yourself? Be honest.

*Washington always seems to need more hierachy and less simplicity.
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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