People who abuse drugs and/or alcohol are at greater risk of contracting or transmitting HIV and viral hepatitis; lack of treatment can lead to mental health issues.
In the United States, about 1.1 million people live with HIV, and about one in six (more than 180,000) do not know they are infected. According to the Centers for Disease Control and Prevention (CDC), people with substance use disorders are at greater risk of contracting or transmitting an HIV infection because the misuse of drugs and/or alcohol can impair judgment and contribute to poor decision making (for example, sex without condoms or unprotected sex with multiple partners). According to The National Survey on Drug Use and Health (NSDUH) Report on HIV/AIDS and Substance Use – 2010 (PDF | 336 KB), one-fourth of people ages 12 and older who had been told by a doctor they had HIV/AIDS engaged in binge drinking in the past month, and nearly one-third used illegal drugs in the past month. Injection drug use and needle sharing are responsible for about 10% of HIV cases annually, and one in six people with HIV/AIDS have used an illegal drug intravenously in their lifetime. In particular, studies have shown a strong link between methamphetamine use and the transmission of HIV among men who have sex with men, a population group disproportionately affected by HIV and AIDS.
Since the prevalence of HIV among people in mental health care is four times higher than for the general population, those with HIV and their family members require appropriate access to supports and information. Mental health conditions may be of concern prior to as well as after HIV infection. Depression is the most commonly reported mental health condition, and when treated, can significantly improve health overall. Depression can be associated with non-adherence to HIV care, and treatment of depression can improve the health of people with HIV. Additionally, reducing viral load or the amount of HIV in the body through HIV medication treatment provides benefits that include reducing the impact of HIV on the central nervous system, as well as reducing the potential of transmitting the virus to others.
Discrimination against people with illnesses such as mental and substance use disorders or HIV infection can deter them from seeking health care, reducing the opportunity for better health through the use of the latest methods for treatment and prevention. When left untreated, mental illness as well as substance use can create additional health and psychosocial problems, beyond non-adherence to HIV care. Mental health care and treatment for substance use disorders can have a significant, positive impact on achieving the goals of HIV care and treatment, and improve the health of people with HIV.
Viral hepatitis (including hepatitis B and hepatitis C), like HIV, can be transmitted through the use of injection drugs, at birth from an infected mother, and unprotected sexual contact with an infected person. A vaccine is available to prevent infection with hepatitis B, and this vaccine is routinely included in childhood vaccination regimens, but the vaccination status of anyone with a mental and/or substance use disorder should be checked to assure that they cannot be infected. If needed, the hepatitis B vaccine should be offered to anyone entering behavioral health treatment. The CDC recommends that people who inject drugs get vaccinated against hepatitis A and hepatitis B. Currently, there is no vaccination against hepatitis C.
Co-infection with hepatitis C occurs in a quarter of Americans living with HIV. Among injection drug users and needle sharers, rates of co-infection are even higher (80%). Most people with hepatitis C are unaware of their infection and, for many, this can result in significant damage to the liver including the development of life-threatening conditions such as cirrhosis or hepatocellular carcinoma. Among people living with HIV, liver disease due to hepatitis C is the most common cause of non-AIDS related death.
Controlling the epidemic of viral hepatitis infection in injection drug users requires:
- The development and implementation of prevention interventions
- Engagement strategies that will result in retaining individuals in care such as increased access to medication-assisted treatment both for treatment of substance use disorders and for treatment of viral hepatitis
Another specific strategy to prevent liver disease is to vaccinate individuals against hepatitis A, a viral infection that can occur as a result of eating contaminated food.
Cultural Awareness and Competency
People with HIV infection, AIDS, and viral hepatitis come from all walks of life and represent every racial and ethnic group, sexual orientation, and socioeconomic status. That’s why it is necessary to incorporate culturally relevant and community-based values, traditions, and customs into research, education, treatment plans, and project evaluations for those impacted by these infections. SAMHSA urges practitioners to consider culture at every step as they use SAMHSA’s Strategic Prevention Framework (SPF). The SAMHSA Center for the Application of Prevention Technologies (CAPT) is a national substance abuse prevention training and technical assistance system that helps SAMHSA-funded grantees successfully implement all five steps of the SPF. The CAPT lists the elements of a culturally competent prevention system.
The SAMHSA Office of Behavioral Health Equity (OBHE) is devoted to offering support to populations that are most vulnerable to behavioral health disparities, including those at risk for or with HIV, AIDS, and viral hepatitis.
For additional guidelines on how providers can offer culturally relevant services, refer to the SAMHSA-Health Resources and Services Administration (HRSA) Center for Integrated Health Solutions. The following resources are also available:
- HRSA’s Cultural Competency and HIV/AIDS Care: The Legacy of the Ryan White HIV/AIDS Program
- AIDSinfo’s list of resources for health care providers on cultural competency
- The National Prevention Information Network’s webpage on Cultural Competence
- AIDS.gov’s webpage on the Affordable Care Act and HIV/AIDS
- The Presidential Advisory Council on HIV/AIDS (PACHA) Resolution on Effectively Addressing the HIV/AIDS Epidemic in Transgender Populations – 2013 (PDF | 65 KB)
- A Model for Cultural Competency in the HIV Management of African American Patients – 2003
- HIV/AIDS Education: A Culturally Competent Approach for Hispanic/Latino – 2003 (PDF | 662 KB)
- Target Center’s BESAFE: A Cultural Competency Model for Asians and Pacific Islanders – 2009
- Target Center’s BESAFE: A Cultural Competency Model for American Indians, Alaska Natives, and Native Hawaiians – 2006
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