• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

E-Module

An HIV and Rehab Resource

  • Français
  • About
    • 1 – What is this resource about and who is it for?
    • 2 – Why was this resource created?
    • 3 – How can this resource be used?
    • 4 – Can this resource be used for teaching?
    • 5 – How was this resource developed?
    • 6 – Who contributed to developing this adapted resource?
    • 7 – Who funded the development of this resource?
    • 8 – Disclaimer
  • Section 1
    • 1.1 How is “rehabilitation” defined in this resource?
    • 1.2 How can rehabilitation help people living with HIV?
    • 1.3 How can the World Health Organization’s “ICF” help us think about rehabilitation for people living with HIV?
    • 1.4 How can the Episodic Disability Model help us think about rehabilitation for people living with HIV?
    • 1.5 Who provides rehabilitation for people living with HIV?
    • 1.6 Do rehabilitation providers need special skills or training to care for people living with HIV? If so, what?
    • 1.7 What roles do rehabilitation providers have related to HIV?
    • 1.8 When is rehabilitation clinical intervention useful along the HIV care continuum?
  • Section 2
    • 2.1 What do rehabilitation professionals need to know about the stages of HIV infection?
    • 2.2 What do rehabilitation providers need to know about CD4 count and viral load?
    • 2.3 What is the impact of HIV on body systems and why does this matter for rehabilitation providers?
    • 2.4 Who might rehabilitation providers treat?
    • 2.5 What do rehabilitation providers need to know about antiretroviral therapies?
  • Section 3
    • 3.1 What are the rehabilitation interventions that address impairments common among people living with HIV?
    • 3.2 What are the rehabilitation interventions that can address the activity limitations and participation restrictions common among people living with HIV?
    • 3.3 More information on the rehabilitation interventions available for people living with HIV
    • 3.4 – What do rehabilitation providers need to know about their patients’ beliefs and use of traditional healers, spiritual leaders and alternative therapies outside the formal medical system?
  • Section 4
    • 4.1: Intersectionality Theory in the Context of Rehabilitation
    • 4.2: Children and Youth
    • 4.3: HIV and Aging
    • 4.4: Substance Use
    • 4.5: Trauma
    • 4.6: Racialized Populations
    • 4.7: Indigenous Populations
    • 4.8: HIV, Sex and Gender
    • 4.9: HIV and COVID-19
    • 4.10: Is HIV itself a disability?
  • Section 5
    • 5.1 What are outcome measures?
    • 5.2 Why is it important to use outcome measures during rehabilitation with people living with HIV?
    • 5.3 How do rehabilitation providers know if an outcome measure will be useful in practice?
    • 5.4 What are floor and ceiling effects in outcome measurement?
    • 5.5 What is the difference between generic and HIV-specific outcome measures?
    • 5.6 How should you decide which outcome measures to use?
    • 5.7 How do you access a copy of an outcome measure?
    • 5.8 What are rehabilitation-related outcome measures that can be useful for people living with HIV?
  • Case Studies
    • Case #1 – Acute Care, Cardiorespiratory and Neurological
    • Case #2 – Musculoskeletal – Knee Pain
    • Case #3 – Aging, Cognition, Community, Stroke
    • Case #4 – Complex Case – Musculoskeletal, Episodic, Cardiorespiratory
    • Case #5 – Diabetes, Neuropathy, Substance Use
    • Case #6 – Transition from Paediatric to Adult Care
    • Supplemental Case Studies without Leading Questions
Hide Search
Show Search

4.4: Substance Use

Intravenous drug use is an important risk factor for transmission of HIV, accounting for 30% of new infections in Canada.1 In addition, approximately 20% of people living with HIV in Canada use drugs.1 Drug use and addiction can hasten the progression of HIV and its consequences, especially in the brain. Clinical research indicates that drug use and addiction may increase viral load, accelerate disease progression, and worsen AIDS-related mortality even among patients who follow ART regimens. In addition, people with substance use disorders are less likely adhere to ART, which worsens the course of their illness.2

There is an ongoing debate concerning the care of people who use drugs and whether harm reduction or abstinence is the best approach to handling the needs of these individuals. While abstinence requires the complete cessation of substance use, harm reduction advocates for the improvement of the health and safety of the person that is using substances by aiming to reduce the harms associated with it. Those in favour of the harm reduction model argue that abstinence is not a realistic goal for some people who use drugs and therefore should be not be used as a barrier to providing services. Community organizations working in HIV generally favour the harm reduction model. A full discussion of this topic and approaches to treatment can be found in Section 3_10 of the E-Module for Evidence-Informed HIV Rehabilitation (PDF) .

A substantial number of individuals who inject drugs and are living with HIV also have hepatitis C virus (HCV) coinfection.3 These individuals are at a significant higher risk for not receiving care or falling out of care.4 Impacts of the social determinants of health, specifically meeting basic needs for food, shelter and safety, undermine many individual’s in their attempt to adhere to HIV and HCV treatments, resulting in increased mortality and morbidity.3 For those receiving care, hepatotoxicity associated with ART can worsen the liver diseases associated with HCV.4 While HCV is now treatable/curable, successful treatment interventions for this population require an interdisciplinary approach, where available.5

1 Canadian AIDS Society. Injection Drug Users.

2 National Institute on Drug Abuse. Part 3: The connection between substance use disorders and HIV.

3 Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017 Dec;5(12):e1192-e1207. doi: 10.1016/S2214-109X(17)30375-3. Epub 2017 Oct 23. Erratum in: Lancet Glob Health. 2017 Nov 15;: PMID: 29074409

4 Hu J, Liu K, Luo J. HIV-HBV and HIV-HCV Coinfection and Liver Cancer Development. Cancer Treat Res. 2019;177:231-250. doi: 10.1007/978-3-030-03502-0_9. PMID: 30523627.

5 Reece R, Dugdale C, Touzard-Romo F, Noska A, Flanigan T, Rich JD. Care at the Crossroads: Navigating the HIV, HCV, and Substance Abuse Syndemic. Fed Pract. 2014 Feb;31:37S-40S. PMID: 25520548.

Primary Sidebar

Copyright © 2025 · Realize Canada