When is an active substance abuser ready for HIV treatment?
The most important clinical decision for successful treatment of drug-abusing patients with HIV is deciding when they are ready — both substance abuse treatment and antiretroviral therapy (ART). Patients fall into 3 categories: those who do not want treatment, those who are ambivalent, and those who want treatment. For patients who do not want treatment, the provider should continue to be available with information on HIV and drug abuse treatment until they are ready to consider treatment. For those who are ambivalent about treatment, time is well spent during several clinical visits discussing the health issues of AIDS and drug abuse until they are ready for treatment. For patients who are ready for treatment the next step is to assess what factors will affect their adherence (see Chapter 7: Adherence to HIV Therapies). History of injection drug use, race, gender, age, socioeconomic status, level of education, and occupation are poor predictors of medication adherence. Accurate predi
