America Living With AIDS

Caring for People with

role they play in impairing judgment
about sexual risk taking.
Health care workers in primary
care roles must be able to recognize
substance use problems and provide
care in a compassionate and nondiscriminatory manner. Substance users
have often been "unwelcome guests"
in the health care system and may
have problems attaining care.
Providers fear that they may leave the
hospital against medical advice and
may seek or use drugs while hospitalized. Intravenous drug users often
have no private insurance or even
public medical assistance. In addition,
medical problems related to their substance use may be difficult to treat,
e.g., collapsed veins, cirrhosis, or other
liver diseases. The failure to obtain
compassionate and needed care may
in turn foster negative attitudes
among substance users about the
health care system, which in turn may
result in a reluctance on the part of
substance users to seek care in the
future.
Attention to how to care for drug
users and deal with substance use
issues has been a major gap in both
medical and nursing education.
Physicians should be able to take a
drug use history and to understand
the care needs of substance users. Primary care providers do not necessarily
have to become chemical dependency
treatment experts, but they should be
familiar with treatment options and
know how to make appropriate diagnoses and referrals. Most drug treat
ment, including methadone maintenance, detoxification, twelve-step programs, and therapeutic communities,
takes place outside of traditional
health care settings. The AIDS epidemic underscores the importance of
integrating such services with primary
care. Such integration should be a top
priority.
S UP P 0 R If (I l
C ONTRIBU I10NS 01
VO LUNTEERS, FRI ED,
AND FAMI L
One of the most remarkable features
of the HIV epidemic has been the
extent to which services needed by
people living with HIV disease have
been provided by volunteers. Many
people with HIV disease need assistance in activities of daily living-help
with cooking, cleaning, and other
household chores and with transportation to appointments. At times
the assistance involves helping with
the administration of medications or
providing medical services that can be
accomplished by lay people with minimal training. These services are either
provided informally or through community-based organizations that utilize volunteer services. Much unpaid
work on behalf of people living with
AIDS is not thought of as "volunteering," because it happens in the context
of kinship relationships.
Volunteer labor is not equally available in all regions of the country or to
all people. As the epidemic continues,
the supply of volunteers may prove
inadequate. It may prove more difficult to enlist volunteers on behalf of
people who use drugs or to find peo
I he percentage
of AIDS cases
related to injection
drug use has
increased sharply,
from 18 percent
before 1985 to
nearly 33 percent
in 1990-1991.