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HIV, Hepatitis, and Heroin

"I Would Like to Get Help but I Feel Lost in the System and Afraid"

June 2005

HIV, Hepatitis, and Heroin
I am a 37-year-old female, with a diagnosis of hepatitis C, HIV, and major depression. I was a heroin abuser, now I am enrolled in a clinic. I have recently begun using crack and I continue to use prescribed medications in combination with my methadone treatment to get high. Most days I lie in bed, just sleeping and watching TV.

I am unemployed but have worked as a prostitute to pay my rent. People on the street say I still "turn heads," and I do get car honks, but I feel worthless and have destroyed my health. I would like to get help for drug treatment but I feel lost in the system and afraid. My thoughts are often filled with my own death and where I will be laid to rest. I want to rejoin the living and develop a loving long-term relationship -- but where do I start when I feel inside that I don't belong?

A Response to This Composite Case Study

You have already started to seek help by reaching out. The conscious act of thinking about being sober and drug-free will hopefully encourage you to pursue drug treatment. For you and anyone else with a diagnosis of HIV coupled with hepatitis C, the first step is to know that you are not alone and you can receive the help and treatment you desperately need. However, don't put it off -- you need to follow up on your thoughts with actual behavior. Please remember that since HIV and hep C are both spread by contact with infected blood, it is common for people to be co-infected with both viruses. This co-infection can lead to challenging medical problems. For example, hep C can make HIV disease more difficult to stabilize, most likely due to the liver damage caused by hepatitis C. However, an important issue to remember is that hepatitis C doesn't interfere with anti-HIV medications. Thus finding an experienced HIV medical doctor is the first step in your road to living emotionally and physically well.

Seek out clinics that report they have a solid background working with HIV, hep C, and a substance abusing population -- they do exist. Ask for recommendations from your city's free health clinics or department of health and request information from community-based agencies. Make a commitment to find a drug treatment program. Talk to as many people as you can on this subject! Don't let your concerns be minimized. You must have the sense that you deserve help and regardless of their background, everyone should be receiving equal treatment. Good treatment does exist! You must take the pro-active steps to find it.


Battling Depression

Because you have HIV coupled with hepatitis C, you are more likely to suffer from depression. As a result, you must have access to HIV support groups and an individual psychologist or social worker who has a clinical background with an HIV population. Once again, seek out recommendations from other mental health clinics.

Your substance abuse history coupled with your abuse of prescription medications calls out for you to consider an in-patient program. By placing yourself in an in-patient hospital setting, you would hopefully give your body sometime to adjust to being substance free in addition to receiving ongoing medical and psychological interventions. Once truly sober, you would then be able to begin the long term process you wish for. Hopefully in time this would allow you to see the world around you clearly with gained insight and wisdom based on your life experiences thus far.

I can understand your sense of feeling that you do not belong in a world where you have probably been subjected to verbal, physical, and emotional harm. Discrimination does exist and the world is full of a long history of cruelties. However, please continue to seek out recommendations for in-patient programs and realize you may continue to be confronted with rejection and judgments while in treatment. The world is not a place where you can always have control over the population that surrounds you, but you can have much more control over how you relate to them.

One part of treatment is to adapt to the world as it is and with that to realize that you are a valuable member of that world. Fear can often be a ruling factor when taking the steps for in-patient treatment, but don't allow your fears to rule your judgments. Your goal is to gain control over your physical and emotional health. To that end, you should pursue emotional balance in your life while seeking reasonable employment solutions which are legal and help you lead a productive life.

Considering your hep C, HIV, substance abuse and experiences with prostitution, depression is a likely outcome. Self-medication with crack, combined with your methadone treatment and your abuse of prescription drugs, is only worsening your loneliness and low sense of self-value. Overmedication with these substances has given you a distorted view and led to poor judgment. You need to take the steps to become fully conscious by becoming drug-free and begining to undo the damage to your physical and emotional health.

Participating in an HIV support group may help you to face your everyday challenges provided that you feel a strong connection with the people in your group. Any support group should be a part of your weekly structure regardless if you are placed in-patient or out-patient for your substance use. A support group may in time provide you with the social network that you clearly need in your life. Likewise, you would have opportunities to discuss health concerns and social questions as well as the issues of shame, humiliation and resentment that you have encountered in your current and past life.

When anyone is faced with a life-threatening illness, they must place all other issues aside and battle that disease in any way they can. My recommendation is for you is to develop a core group of support connections that will help you continue to fight for your life in positive life enhancing ways. You can get started by:

  1. Developing and then staying connected to your hep C and HIV medical advisor.

  2. Taking your hep C and HIV medication consistently.

  3. Conducting yourself in a mature and educated manner on all new developments including how medication for HIV and hep C can produce depressive effects.

  4. Working with mental health professionals for your substance abuse and emotional stability who have a clinical background working with an HIV-positive population.

  5. Joining an HIV and hep C support group that understands your individual needs.

In conclusion, please consider taking the steps needed to seek out medical and psychological intervention for your HIV and hep C status. Consider entering an in-patient substance abuse program to gain the emotional and physical control you need to overcome your crack dependence. Once placed in an in-patient program work within your individual and group therapy to develop the coping skills you need to work within a world you have often felt alienates you. Ultimately as you have the power to do so, seek out vocational programs to help you find your place with this world as an employable productive and valued member of society. With all these steps allow yourself to be open to positive social relationships and the possibility for romantic connections. Good luck!

J. Buzz von OrnsteinerJ. Buzz von Ornsteiner, Ph.D. is a psychologist and behavioral consultant in New York City and writes the "Psychologically Speaking" column. He is also the host of "Ask Dr. Buzz," a Body Positive-sponsored weekly call-in radio show about HIV/AIDS issues on WWRL 1600 AM at 2:30 pm on Wednesdays.

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This article was provided by Body Positive. It is a part of the publication Body Positive.