Acquired Immunodeficiency Syndrome (Aids): A Survey of Substance Abuse Clinic Directors' and Counselors' Perceived Knowledge, Attitudes and Reactions

• Author: Mary Ellen Krems,Evelyn Denton,Rebecca A. Hiatt,Cheryl L. Mejta
• Published date: 01 July 1988
• Date: 01 July 1988
• DOI: http://doi.org/10.1177/002204268801800307
• Subject Matter: Article

The

Journal

of Drug Issues, 18(3),403-419, 1988

ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS):

A SURVEY

OF

SUBSTANCE ABUSE CLINIC DIRECTORS'

AND COUNSELORS'

PERCEIVED

KNOWLEDGE,

ATTITUDES AND REACTIONS

Cheryl

L.

Mejta

Evelyn

Denton

Mary

Ellen

Krems

Rebecca

A.

Hiatt

As Acquired Immunodeficiency Syndrome (AIDS)

continues to affect intravenous drug abusers, provid-

ing AIDS-related counseling to this population is

becoming increasingly critical. Substance abuse

clinic directors

and

counselors within the Chicago

area were surveyed to examine, respectively, clinic

policies

and

practices concerning

AIDS

and

self-

reported knowledge, attitudes,

and

reactions associ-

ated with AIDS. Across clinics, policies

and

practices

were found to be inconsistent

and

frequently incom-

plete, inadequate

and

at times, questionable. Many

directors either would not

admit

or were uncertain

if

they would admit persons with

AIDS

(PWAs) for

treatment. Most

had

incomplete

AIDS

infection con-

trol policies; a few had questionable

and

several

had

none. Clearer

and

nondiscriminatory federal

and

state

AIDS

guidelines need to be established

and

implemented at the clinic level. Counselors, similar

to the general population, held apprehensions con-

cerning AIDS. Unlike the fearsof the general popula-

tion, these fears did not translate into negative

attitudes, prejudices, or active discrimination, but

they did seem to translate into inaction

and

indeci-

sion. Many counselors reported not being knowledge-

able nor comfortable enough to counsel PWAs.

AIDS

counselor education needs to deal with these AIDS-

elicited emotional reactions.

~,!l

L.

MeJta,

Ph.D.• Is a University Professor In Alcoholism Sciences at Governors

State

University.

Uni~rslty

Park,

Par

oa

60466.

Evelyn

Denton

Is a

graduate

student

In Alcoholism Sciences at Governors

State

University, University

Ell

k, Illinois 60466. She also Is employed with Interventions/Crossroads as a substance abuse

nurse

and counselor.

Mary

en

,Kre1lUl

Is program director of Chicago House and Social Service

A,ency

located In Chicago, Illinoia. Rebeccoa A.

Hiatt

IS a social worker who provides counseling and supportive services to persons with AIDS.

CI

Journal

of Drug Issuea, Inc. 0022·04261881031403-419 $1.00

403

MEJTA

Cu

rr

entl y, Acquired Immunodeficiency Syndrome (AIDS)

has

an 80% fatality

rate within two years of diagnosis; over 21,000 people diagnosed with AIDS

have died (Centers for Disease Control, 1987). It is projected

that

179,000 AIDS-

related deaths will have occurred by 1991

(Koop,

1986). With no known cure or

vaccine for AIDS, public health efforts have focused on controlling

the

spread of

AIDS among high-risk groups through education

and

counseling aimed at

modifying behaviors likely to

transmit

the

Human

Immunodeficiency Virus

(HIV),

the

suspected causal virus of AIDS (Centers for Disease Control, 1984).

Modifying high-risk behaviors of drug abusers is critical to

our

AIDS preven-

tion efforts. Through sharing contaminated needles

and

drug paraphernalia,

intravenous (IV) drug users

are

involved in

the

direct transmission

and

primary

spread of

the

AIDS-associated virus; 72% of

the

IV drug users entering

treatment

in

the

Chicago

area

shared needles

and

"works" (Interventions, 1987).When all

diagnosed AIDS cases

are

examined, IV drug use is a primary factor in 17%

(Centers for Disease Control, 1986)

and

a co-factor in

an

additional 8% (Ginzburg,

1984; Ginzberg et al., 1985) of

the

cases. Among heterosexuals diagnosed with

AIDS, over 60% of these people abuse drugs intravenously (Gold et al., 1982;

Marmor et al., 1984; Des Jarlais et al., 1985).

Through sexual contacts with uninfected

non-IV

drug users, IV

drug

users

also are involved in

the

secondary transmission ofHIv. Most cases of heterosexual

transmission of AIDS involve sexual contacts with infected IV drug abusers

(Friedman et aI., 1986; Herron, 1985). Because most male IV drug users

appear

to

have primary sexual relationships with

non-IV

drug using women (Des Jarlais et

al., 1984)

and

female IV drug users often use prostitution as a way to secure

money for

their

drugs (Ellinwood et al., 1966), heterosexual transmission ofAIDS

through sexual contact with infected IV

drug

users probably will continue to

increase. Finally, over one-half of

the

pediatric AIDS cases involve infants born to

an infected IV

drug-using

mother (Friedman

et

al., 1986).

It is suspected

that

drug use, with

its

direct immunosuppressant effects

and

indirect lifestyle-associated immunosuppressant effects, may increase suscep-

tibility to HIV infection

and

the

likelihood of progression from HIV infection to

the

clinical syndrome of AIDS (National Institute on Drug Abuse, 1986a). When

all forms of drug use

are

examined, it is found

that

about 75%of

the

persons with

AIDS

(PWAs)

had

used

street

drugs at least once a week for several years

and

79%

had

ahistory of immunosuppressant alcohol

and

drug use before exposure to HIV

(National

Institute

on Drug Abuse, 1986b).

Finally, drug use

has

been found to be associated with noncompliance of risk-

reduction measures. In a study of 1,550 homosexual

and

bisexual men in

San

Francisco, Stall et al. (1986)found

that

combining drinking and/or other drug use

with sexual activity increased

the

likelihood of participation in sexual practices

likely to

transmit

the

AIDS-associated virus. Similar results were found in a

study of homosexual

and

bisexual men in Chicago (Ostrow, 1986).

The drug abuse

treatment

delivery system, with both

its

expertise in drug

abuse

and

contact with drug abusers, is perhaps

the

best vehicle to deliver AIDS-

related prevention

and

risk-reduction programs to

the

drug using population.

However, to effectively address

the

AIDS-related issues of drug users,

the

drug

abuse

treatment

system

must

be willing to work with those

at

risk

or with AIDS,

must

be kriowledgeable about AIDS,

and

should possess attitudes which facilitate

404 JOURNAL OF DRUG ISSUES