If you're HIV+ and a substance user, it can be tough to talk to your doctor about your substance use. The concerns and solutions below are designed to help you and your doctor overcome any misconceptions so that an effective HIV treatment plan can be put in place.
- My doctor will not treat me if he or she knows I am abusing alcohol or other drugs.
Your doctor needs as much accurate information as you can provide about your current health status, including the use of substances that may produce dangerous results when mixed with your anti-HIV medications. If your doctor is not aware of your substance use, you may not get the full benefit that his or her services can provide.
- My doctor will not trust me if he or she knows I am abusing alcohol or other drugs.
A doctor that is well matched to you and your needs will not assume that you can't use your anti-HIV medications correctly while using alcohol or other drugs. That's why it's important to talk openly about your health status and available treatment options for both HIV and addiction.
- My doctor will expect me to go into substance abuse treatment if he or she knows I am using alcohol or other drugs.
Your doctor understands the harmful effects of substance abuse and may recommend treatment. If you are not ready for substance abuse treatment, you should communicate this with your doctor, continue your HIV treatment and tell your doctor about any changes in your drug use. Reducing your drug use is a good way to support the effects of the anti-HIV medications.
- My doctor doesn't understand my alcohol or drug problem.
All doctors have knowledge of the harmful effects of substance abuse on your overall health and the progression of your HIV infection, although not all doctors have training in addiction management. Talking honestly about your use is crucial. It is helpful for you to educate your doctor on your drug use patterns. Be sure to ask your doctor about his or her background in treating HIV+ substance users.
Many active substance users have strong feelings of fear, shame and guilt for using drugs and having HIV. This coupled with a lack of trust and fear of being judged make it difficult for them to speak openly and honestly about drug use with their providers. In addition, substance abusers often deny that they are using, but it is important to be honest with your doctor. Remember that everything you say is confidential.
Your doctor needs to have all the facts in order to provide you with the best possible care. Working openly with your doctor is the key to building a trusting relationship and protecting your health. Try bringing this article to your doctor and using it as a tool to begin discussions about your situation.
Larry Siegel, M.D. serves as the Senior Deputy Director for Substance Abuse Services at the District of Columbia Department of Health. Kevin Shipman, M.H.S., L.P.C., is the Assistant Deputy Administrator for Special Populations, APRA.