Substance abuse, medications, HIV, and the community

This article describes the experience of a medical internist caring for thousands of persons living with HIV/AIDS (PLWA) for more than 23 years, many of whom have abused illicit substances and ethanol. Divided in three major sections, the article looks at the effects of substance abuse on HIV treatment and how a community physician rallies the health team, patients, and the community to address the issues that pose barriers to quality HIV care. Many studies have documented that HIV-infected patients need to obtain 95% medication adherence to maintain optimal, sustained HIV viral suppression. Several publications state that. some of the determinants of poor adherence include active illicit substance or ethanol abuse, depression, and older age. As a physician practicing medicine within an urban environment in New Jersey (which has been among the states with the highest prevalence of HIV-positive patients, the majority of them being African American or Hispanic), it has been noted that lifestyle issues weigh in on improving a community's health. This paper also describes how the author developed a program that provides comprehensive health services within several public health settings, both in ambulatory and inpatient services facilities.