402
STATEMENT ON AIDS INITIATIVES IN DRUG TREATMENT SERVICES IN NEW YORK CITY* COMMITTEE ON PUBLIC HEALTH The New York Academy of Medicine New York, New York
THE AIDS EPIDEMIC CONTINUES TO BE a most serious public health problem facing the nation, with more than 100,000 reported deaths from the disease and an estimated one million infected with the virus. 1,2 At least 40,000 new infections occur each year among adults and adolescents.2 New York State has been especially hard hit by the epidemic, leading the country in AIDS cases and projected prevalence of HIV infection. In New York City AIDS is the leading cause of death for males 25 44 years of age, and for females, 25-34 years.3 The relationship between HIV infection and IV drug use has been well established and the incidence of AIDS is increasing at an alarming rate in the intravenous (IV) drug-using population. Among all new cases of AIDS diagnosed in New York State in 1989, more than 44% were IV drug users.4 Furthermore, in the same year, approximately 82% of cases transmitted heterosexually in New York State involved transmission from a male IV drug user to a non IV drug using partner and 74% of pediatric AIDS cases in the State were children of an IV drug using parent.5 The high incidence of HIV infection among IV drug users in New York City (estimated anywhere from 30 to 60%) and the potential infection of their partners and offspring underscores the need to bring addicts into treatment and to provide adequate HIV counseling, testing and case management.6,7 Currently, 95 active funded treatment providers operate 132 active drug treatment programs (methadone maintenance, drug-free residential, and drug-free outpatient) at approximately 242 sites (program reporting units) throughout New York City.8 Unfortunately, only a small percentage of drug treatment sites provide the type of HIV related services mandated by the New York State Division of *Prepared by an Ad Hoc Working Group of the Subcommittee on Alcoholism and Drug Abuse comprised of D. Vincent Biase, Ph.D., Robert Maslansky, M.D. and Carol Weiss, M.D., Ex Officio: Jacqueline Messite, M.D., Ana Taras, M.P.H. Approved by the Committee on Public Health on February 4, 1991 and the Board of Trustees of the New York Academy of Medicine on May 22, 1991.
Bull. N.Y. Acad. Med.
STATEMENT ON AIDS INITIATIVES
403
Substance Abuse Services (DSAS) regulations number 1070 and 1072.9 These regulations state that providers of substance abuse services must develop a written plan, to be updated annually and approved by DSAS, that would "delineate ongoing programs, activities, and procedures to deal with HIV related issues in a comprehensive and consistent manner. " 10 Each plan must include strategies for staff and client education about HIV related conditions and risk reduction activities; a strategy for infection control; and designation of an individual to oversee development, implementation and evaluation of the program's plan. Drug treatment programs have the opportunity to promote both the prevention and detection of HIV infection in their patient populations and assure that those infected receive adequate HIV-related services, including quality medical care and AZT prophylaxis for those with critical T-cell levels. Since approximately 53,000 people in New York State, 36,000 of which are in New York City, are currently being served in drug treatment programs, a significant number of HIV infected individuals can be assisted and the possibility of further transmission of the virus can be diminished. Therefore, the New York Academy of Medicine urges that the New York State Division of Substance Abuse Services, with the support of the New York State and New York City Health Departments, and the New York State AIDS Institute, promptly: 1) assure that all drug treatment settings have, at the minimum, the capability of providing education on HIV-related conditions and risk reduction activities, as well as pre- and post-HIV test counseling conducted by capable staff; 2) develop and implement programs to increase HIV testing in drug treatment settings; 3) assure that drug treatment settings have either a program for diagnosis, prophylaxis and quality HIV/AIDS treatment or have in place firm working linkages with programs, hospitals, community health centers or other facilities that have the capability for such services; and, 4) assure that the provisions of DSAS regulations 1070 and 1072 pertinent to HIV initiatives in drug treatment settings are implemented. REFERENCES 1. Centers for Disease Control: Mortality attributable to HIV infection/AIDSUnited States, 1981-1990. MMWR 40:3, 1991. 2. Centers for Disease Control: HIV prevaVol. 67, No. 4, July-August 1991
lence estimates and AIDS case projections for the United States: report based upon a workshop. MMWR 39:RR-16, 1990. 3. New York City Department of Health,
404
4. 5.
6.
7.
COMMYITEE ON PUBLIC HEALTH
Division of Vital Statistics: ChiefCauses of Death-1989. Personal Communication. Sue Hyde, New York State AIDS Epidemiology Program, 1991. Personal Communication. Sue Hyde, New York State AIDS Epidemiology Program, 1991. Des Jarlais, D. et al.: HIV-l infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. J.A.M.A. 261:7, 1989. New York State Department of Health:
AIDS in New York State, 1989. 8. Information Management Services, New York State Division of Substance Abuse Services. March 15, 1991. 9. Office of Technology Assessment: The Effectiveness of Drug Abuse Treatment: Implications for Controlling AIDS/HIV Infection. September 1990. 10. New York State Division of Substance Abuse Services: Substance Abuse Services and the Law in New York State. 1990.
Bull. N.Y. Acad. Med.
STATEMENT ON AIDS INITIATIVES IN DRUG TREATMENT SERVICES IN NEW YORK CITY* COMMITTEE ON PUBLIC HEALTH The New York Academy of Medicine New York, New York
THE AIDS EPIDEMIC CONTINUES TO BE a most serious public health problem facing the nation, with more than 100,000 reported deaths from the disease and an estimated one million infected with the virus. 1,2 At least 40,000 new infections occur each year among adults and adolescents.2 New York State has been especially hard hit by the epidemic, leading the country in AIDS cases and projected prevalence of HIV infection. In New York City AIDS is the leading cause of death for males 25 44 years of age, and for females, 25-34 years.3 The relationship between HIV infection and IV drug use has been well established and the incidence of AIDS is increasing at an alarming rate in the intravenous (IV) drug-using population. Among all new cases of AIDS diagnosed in New York State in 1989, more than 44% were IV drug users.4 Furthermore, in the same year, approximately 82% of cases transmitted heterosexually in New York State involved transmission from a male IV drug user to a non IV drug using partner and 74% of pediatric AIDS cases in the State were children of an IV drug using parent.5 The high incidence of HIV infection among IV drug users in New York City (estimated anywhere from 30 to 60%) and the potential infection of their partners and offspring underscores the need to bring addicts into treatment and to provide adequate HIV counseling, testing and case management.6,7 Currently, 95 active funded treatment providers operate 132 active drug treatment programs (methadone maintenance, drug-free residential, and drug-free outpatient) at approximately 242 sites (program reporting units) throughout New York City.8 Unfortunately, only a small percentage of drug treatment sites provide the type of HIV related services mandated by the New York State Division of *Prepared by an Ad Hoc Working Group of the Subcommittee on Alcoholism and Drug Abuse comprised of D. Vincent Biase, Ph.D., Robert Maslansky, M.D. and Carol Weiss, M.D., Ex Officio: Jacqueline Messite, M.D., Ana Taras, M.P.H. Approved by the Committee on Public Health on February 4, 1991 and the Board of Trustees of the New York Academy of Medicine on May 22, 1991.
Bull. N.Y. Acad. Med.
STATEMENT ON AIDS INITIATIVES
403
Substance Abuse Services (DSAS) regulations number 1070 and 1072.9 These regulations state that providers of substance abuse services must develop a written plan, to be updated annually and approved by DSAS, that would "delineate ongoing programs, activities, and procedures to deal with HIV related issues in a comprehensive and consistent manner. " 10 Each plan must include strategies for staff and client education about HIV related conditions and risk reduction activities; a strategy for infection control; and designation of an individual to oversee development, implementation and evaluation of the program's plan. Drug treatment programs have the opportunity to promote both the prevention and detection of HIV infection in their patient populations and assure that those infected receive adequate HIV-related services, including quality medical care and AZT prophylaxis for those with critical T-cell levels. Since approximately 53,000 people in New York State, 36,000 of which are in New York City, are currently being served in drug treatment programs, a significant number of HIV infected individuals can be assisted and the possibility of further transmission of the virus can be diminished. Therefore, the New York Academy of Medicine urges that the New York State Division of Substance Abuse Services, with the support of the New York State and New York City Health Departments, and the New York State AIDS Institute, promptly: 1) assure that all drug treatment settings have, at the minimum, the capability of providing education on HIV-related conditions and risk reduction activities, as well as pre- and post-HIV test counseling conducted by capable staff; 2) develop and implement programs to increase HIV testing in drug treatment settings; 3) assure that drug treatment settings have either a program for diagnosis, prophylaxis and quality HIV/AIDS treatment or have in place firm working linkages with programs, hospitals, community health centers or other facilities that have the capability for such services; and, 4) assure that the provisions of DSAS regulations 1070 and 1072 pertinent to HIV initiatives in drug treatment settings are implemented. REFERENCES 1. Centers for Disease Control: Mortality attributable to HIV infection/AIDSUnited States, 1981-1990. MMWR 40:3, 1991. 2. Centers for Disease Control: HIV prevaVol. 67, No. 4, July-August 1991
lence estimates and AIDS case projections for the United States: report based upon a workshop. MMWR 39:RR-16, 1990. 3. New York City Department of Health,
404
4. 5.
6.
7.
COMMYITEE ON PUBLIC HEALTH
Division of Vital Statistics: ChiefCauses of Death-1989. Personal Communication. Sue Hyde, New York State AIDS Epidemiology Program, 1991. Personal Communication. Sue Hyde, New York State AIDS Epidemiology Program, 1991. Des Jarlais, D. et al.: HIV-l infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. J.A.M.A. 261:7, 1989. New York State Department of Health:
AIDS in New York State, 1989. 8. Information Management Services, New York State Division of Substance Abuse Services. March 15, 1991. 9. Office of Technology Assessment: The Effectiveness of Drug Abuse Treatment: Implications for Controlling AIDS/HIV Infection. September 1990. 10. New York State Division of Substance Abuse Services: Substance Abuse Services and the Law in New York State. 1990.
Bull. N.Y. Acad. Med.
