Clien

t Workbook

Holistic H

ealth R

ecovery Program

Yale Un

iversity Sch

ool of Med

icine

Division

of Su

bstan

ce Ab

use

http://in

fo.med.yale.edu

/psych/h

hrp

© 2001

33

Gro

up Six

HEA

LTH C

ARE PA

RTICIPA

TION

Skills to Be

Lea

rned

■Le

arning

to Be

a Po

sitive Pa

rticipa

ntin H

ea

lth Ca

re

■Incre

asing

Patie

nt “IQ”

■Im

pro

ving Skills fo

r Estab

lishing a

ndM

ainta

ining a

Partne

rship w

ith He

alth

Ca

re Pro

vide

rs

■K

now

ing the

Co

nseq

uence

s of

No

n-ad

here

nce to

Me

dica

tion Re

gim

ens

■Im

pro

ving Stra

teg

ies fo

r Ide

ntifyinga

nd O

verco

ming

Ob

stacle

s to A

dhe

rence

■Le

arning

Me

mo

ry Aid

s for Im

pro

ving

Ad

here

nce

■Be

com

ing K

now

led

ge

ab

le a

bo

ut HIV

and

He

pa

titis B and

C

HH

RP

+W

orkb

ook

Tab

le o

f Co

ntents

Preface

HH

RP

+ Mem

bersh

ip C

ontract

Person

al Inform

ation:

Nam

e and E

mergen

cy Con

tactsF

amily In

formation

Edu

cational/E

mploym

ent H

istoryS

ocial Su

pport Netw

orkA

ddresses and Teleph

one N

um

bersP

roject Tim

e Man

agemen

t Sh

eetP

roject Plan

Cu

rrent M

edical Inform

ationP

ast Medical H

istoryM

edications L

istM

onth

ly Expen

ditures

Bills

Safety C

hecklist

Oth

er

Calen

dars:

Week-at-a-glan

ceM

onth

ly Calen

darsTo D

o Today

HH

RP

+ Grou

ps:

Reach

ing you

r goals ..............................................................................................................1R

educin

g the h

arm of in

jection dru

g use .............................................................................7

Harm

reduction

with

latex ..................................................................................................12N

egotiating h

arm redu

ction w

ith partn

ers .......................................................................22P

reventin

g relapse to risky behavior .................................................................................27

Health

care participation ....................................................................................................33

Health

y lifestyle choices .....................................................................................................61

Introdu

ction to th

e 12-Step P

rogram .................................................................................76

Overcom

ing stigm

a ..............................................................................................................80M

otivation for ch

ange: overcom

ing h

elplessness .............................................................84

Movin

g beyond grief ............................................................................................................88

Health

y social relationsh

ips and activities ........................................................................93

Sch

edu

les:N

AS

chedu

lesN

eedle Exch

ange L

ocations

Tran

sportation S

chedu

les

Com

mu

nity R

esources: U

seful telep

hon

e nu

mb

ersM

anagin

g Un

health

y Em

otions

Learn

ing H

ow to H

ave Fu

n w

ithou

t Dru

gsV

ocational S

ervicesS

ocial Su

pportA

nger M

anagem

ent

34

He

alth C

are

Particip

atio

n

•A

sense of person

al responsibility for th

eir health

•A

sense th

at they can

influ

ence th

eir own

health

outcom

e

•A

comm

itmen

t to life in term

s of “un

finish

ed busin

ess,” un

met

goals, or as yet un

fulfilled experien

ces and w

ishes

•A

sense of m

eanin

gfuln

ess and pu

rpose in life

•F

oun

d new

mean

ing in

life as a result of th

e illness itself

•E

ngaged in

physical fitn

ess—exercise, dietary w

ork

•D

erived usefu

l inform

ation from

, and su

pportive contact w

ith,

a person w

ith th

e same diagn

osis shortly after th

e diagnosis

•B

ecame altru

istically involved w

ith oth

er affected persons

•A

ccepted the reality of th

e diagnosis in

conju

nction

with

arefu

sal to perceive the con

dition of a death

senten

ce

•D

eveloped a personalized m

eans of active copin

g that th

eybelieve h

as beneficial h

ealth effects

•A

ssertive, able to say “no”

•T

he ability to w

ithdraw

from taxin

g involvem

ents an

d ton

urtu

re them

selves

•S

ensitivity to oth

er bodies, inclu

ding psych

ological and ph

ysicaln

eeds

•A

bility to comm

un

icate openly abou

t their con

cerns

Ch

aracteristics of Lon

g-term S

urvivors of H

IV

Sou

rce: S

olomon

, Temosh

ok, O’L

eary, &Z

ich (1987). A

n in

tensive psych

oimm

un

ologic study of lon

g-survivin

gperson

s with

AID

S.

An

nals of th

e New

York Acad

emy of S

cience,496, 647–655.

Th

e goal of HH

RP

+is to h

elp you m

ake certain decision

s about you

r life, especially deci-sion

s that can

affect your h

ealth. S

ome people w

ho are stru

ggling w

ith addiction

and are

infected w

ith H

IV feel pow

erless; they th

ink th

ere is noth

ing th

ey can do to stay h

ealthy,

and so con

tinu

e to use dru

gs. In fact, th

ere are man

y thin

gs you can

do to lead a health

y,fu

lfilling life. E

ach ch

apter in th

is workbook provides relevan

t han

d-outs an

d practice exer-cises. M

aterial is provided in detail to h

elp you to rem

ember th

e material an

d to use it in

your daily life.

Th

e HH

RP

+w

orkbook is for individu

als wh

o have en

tered a treatmen

t facility and h

avebeen

accepted for mem

bership in

HH

RP

+. H

HR

P+

mem

bership requ

ires a comm

itmen

t toredu

cing h

arm, prom

oting h

ealth, an

d improvin

g the qu

ality of life. If you are ready to

make th

is comm

itmen

t, sign th

e mem

bership con

tract on th

e followin

g page and begin

your

journ

ey.We

lcom

e to

HH

RP +

PREFAC

E

35

He

alth C

are

Particip

atio

n

PerceivedC

osts

TO

TA

Lcosts

TO

TA

Lb

enefits

Importan

ceR

ating (0–10)

Importan

ceR

ating (0–10)

Perceived

Ben

efits

Cost:B

enefit R

atio =

Th

e Decision

al Balan

ce Sh

eet(a cost–b

enefit an

alysis for followin

g med

ical recomm

end

ations)

HH

RP +M

EMBERSH

IP CO

NTRA

CT

1.I u

nderstan

d that th

is phase of m

y treatmen

t program w

ill last _____ weeks, an

d Iagree to participate for th

at length

of time. A

lthou

gh I am

free to with

draw from

the

program at an

y time, I agree to discu

ss this decision

with

my cou

nselor prior to takin

gth

is action.

2.I agree to atten

d all group an

d individu

al sessions (if th

ey are offered in m

y facility), tobe on

time, an

d to bring m

y Clien

t Workbook w

ith m

e to each session

. I will also call if

I am goin

g to be late.

3.I agree n

ot to disclose the iden

tity of any oth

er HH

RP

+m

ember, n

or will I disclose th

edetails of an

y personal in

formation

revealed by other H

HR

P+

mem

bers durin

g groups.

4.I u

nderstan

d that th

is treatmen

t is inten

ded for people wh

o are comm

itted to being

abstinen

t from all illicit dru

gs, and w

ho w

ant learn

how

to make h

ealthy lifestyle

choices. I u

nderstan

d that I m

ust w

ork hard on

my recovery in

order for this program

to be helpfu

l to me.

5.I u

nderstan

d that I w

ill be expected to openly discu

ss with

my cou

nselor an

y other

behavior th

at may risk m

y health

or the h

ealth of oth

ers, inclu

ding u

nsafe sexu

albeh

avior and sh

aring of dru

g paraphern

alia (“works”).

6.I u

nderstan

d that H

HR

P+

recomm

ends a team

approach to m

y treatmen

t. If possible, Iw

ill involve m

y “significan

t other,” frien

d, or family m

ember in

my recovery—

someon

ew

ho is w

illing to h

elp me w

ith m

y recovery plan ou

tside of this treatm

ent program

, and

I agree to permit m

y coun

selor to comm

un

icate with

this person

and w

ith m

y other

health

care providers for the pu

rpose of coordinatin

g my treatm

ent.

**************************************************************************************

I have review

ed the above statem

ents w

ith m

y coun

selor and I requ

est to be enrolled as a

mem

ber of the H

olistic Health

Recovery P

rogram (H

HR

P+

).

Clien

t signatu

reD

ate

Cou

nselor sign

ature

Date

Con

gra

tula

tions, you

ha

ve been

accep

ted for m

emb

ership

in H

HR

P+

.

Your grou

p sessions begin

at (tim

e) and en

d at(tim

e) on(day)

and m

eet at(location

). Your n

ext individu

al session w

ith you

r coun

seloris at

(time) on

(date)

Cou

nselor’s n

ame

(print) Teleph

one N

o.

36

He

alth C

are

Particip

atio

n

Instru

ctions:

Patien

t Pat h

as been prescribed th

e followin

g medication

s.

Medication

Instru

ctions for U

seS

pecial Instru

ctions

(A)

DD

I2 tablets tw

ice a dayT

ake a half-h

our before

(Didan

osine)

a full m

eal

(B)

Viram

un

e1 tablet tw

ice a day(N

ivirapine)

(C)

Viracept

3 tablets 3 times a day

Take w

ith a m

eal(N

elfinavir M

esylate)

(D)

Eryth

romycin

1 pill 4 times a day

Do n

ot eat 2 hou

rs beforeor 2 h

ours after takin

g

Facts to k

now

abou

t Patien

t Pat:

Pat u

sually gets u

p at aroun

d 6:00 in th

e morn

ing an

d goes to the clin

ic form

ethadon

e at 6:30. Pat u

sually eats 2 m

eals a day—breakfast at arou

nd 7:30 am

,after retu

rnin

g from th

e meth

adone clin

ic, and din

ner at arou

nd 6:30 pm

. Pat

works as a retail clerk from

9:00 am to 5:00 pm

, sometim

es goes out in

the even

ing

with

friends, an

d goes to bed at aroun

d midn

ight. Tw

o nigh

ts a week P

at bowls on

a bowlin

g league from

8:00 pm to 10 pm

.

Poten

tial Ob

stacles to Ad

heren

ceP

ossible S

olution

s

1)2)3)4)5)6)Mem

ory Aid

s to Recom

men

d to P

at:

1)2)3)4)5)6)

Med

ication A

dh

erence G

ame W

orksh

eet

Othe

r:

Spo

nsor:

This Wo

rkbo

ok b

elo

ngs to

Eme

rge

ncy Phone

Num

be

rs

Na

me

:

Ad

dre

ss:

Phone

:

Eme

rge

ncy:

Do

ctor:

Ne

xt-of-kin:

Pharm

acy:

Co

unselo

r:

37

He

alth C

are

Particip

atio

n

Usin

g the letters A

,B, C

, D to rep

resent th

e prescrib

ed m

edication

s, createP

at’s daily m

edication

sched

ule b

elow (N

o. = n

um

ber of pills).

Tim

eA

, B, C

, DN

o.T

ime

A, B

, C, D

No.

6:00 AM

3:00 PM

6:303:30

7:004:00

7:304:30

8:005:00

8:305:30

9:006:00

9:306:30

10:007:00

10:307:30

11:008:00

11:308:30

Noon

9:00

12:30 PM

9:30

1:0010:00

1:3010:30

2:0011:00

2:3011:30

Midn

ight

Med

ication A

dh

erence G

ame W

orksh

eet(p

age two)

Fam

ily Inform

ation S

heet

Ch

ildren

’s Nam

esA

geD

ate of Birth

Gran

dch

ildren

’s Nam

esA

geD

ate of Birth

Broth

ers’Nam

esA

geD

ate of Birth

Sisters’N

ames

Age

Date of B

irth

38

He

alth C

are

Particip

atio

n

Patien

t Nam

eTeleph

one N

o.

Address

Prim

ary Health

Care P

rovider.

Nam

eTeleph

one N

o.

Address

“Med

ication B

ud

dy”.

Nam

eTeleph

one N

o.

Address

Health

Insu

rance In

formation

.

ID N

o.C

arrier

Allergies

Med

ications P

rescribed

.

Medication

Nam

eD

oseS

pecial Instru

ctions

Date D

iscontin

ued

Med

ical Inform

ation S

heet

(keep

up

dated

)

Ed

ucation

/Em

ploym

ent H

istory

Sch

ool Nam

eD

ates Atten

ded

Dip

loma/D

egree

Most recen

t place of em

ploym

ent.

Com

pan

y:

Nam

e and

ph

one n

o. of sup

erior:

Dates em

ployed

:

Job

respon

sibilities:

Sp

ecial skills:

Hob

bies:

39

He

alth C

are

Particip

atio

n

Med

ical Inform

ation S

heet

(page tw

o)

Oth

er Dru

gs Used

Dru

g nam

eA

mou

nt/F

requen

cyD

ate Discon

tinu

ed

Alcoh

ol

Nicotin

e

Opiates

Cocain

e

Ben

zodiazepines

Mariju

ana

Oth

er:

“Altern

ative” or “Com

plem

entary” T

herap

ies Used

Dru

g nam

eA

mou

nt/F

requen

cyD

ate Discon

tinu

ed

Acu

pun

cture

Herbal rem

edies

Nu

tritional su

pplemen

ts

Oth

er

Poten

tial Ob

stacles to Ad

heren

ce1)2)3)4)5)6)

Possib

le Solu

tions

1)2)3)4)5)6)

Mem

ory Aid

s1)2)3)4)5)6)

My S

ocial Su

pp

ort Netw

ork

Nam

e:P

hon

e:

Typ

e of sup

port:

Nam

e:P

hon

e:

Typ

e of sup

port:

Nam

e:P

hon

e:

Typ

e of sup

port:

Nam

e:P

hon

e:

Typ

e of sup

port:

Nam

e:P

hon

e:

Typ

e of sup

port:

Nam

e:P

hon

e:

Typ

e of sup

port:

Nam

e:P

hon

e:

Typ

e of sup

port:

40

Bein

g a positive p

articipan

tin

volves taking respon

sibility for your h

ealth. In

order to main

tain or im

prove your ph

ysical health

, you n

eed to be well-in

formed

about th

e effects of drug u

se and u

nsafe sexu

al practices on you

r health

, so that

you can

make ch

oices that w

ill protect your h

ealth.

Th

e materials in

this section

contain

importan

t inform

ation abou

t HIV, H

epatitisB

(HB

V), an

d Hepatitis C

(HC

V), as w

ell as other diseases th

at occur at h

ighrates am

ong dru

g users, th

eir sex partners, an

d their ch

ildren.

In order for th

is section to be as h

elpful as possible, it con

tains a n

um

ber of med-

ical terms th

at doctors and oth

er health

care professionals m

ay use w

ith th

eirpatien

ts and w

hen

talking am

ong th

emselves abou

t these disorders. S

ome of

these term

s may be u

nfam

iliar to you, an

d you m

ay also find som

e difficult to

read and pron

oun

ce. If this is th

e case, we en

courage you

to speak with

your

health

care provider, coun

selor, or someon

e wh

o is know

ledgeable about th

e sub-

ject, and to becom

e inform

ed regarding th

e mean

ing an

d use of th

ese terms. T

his

could m

ake your discu

ssion w

ith you

r health

care providers mu

ch m

ore produc-

tive and m

eanin

gful for you

.

Rem

ember th

at taking respon

sibility for your h

ealth m

eans developin

g a high

Patien

t IQ. “IQ

” stands for In

form an

d Qu

estion: you

need to In

formyou

rselfabou

t issues th

at trouble you

; Inform

your h

ealth care provider of you

r problems

and con

cerns; an

d ask Qu

estions

of those w

ho provide m

edical services to you.

Med

ical Lan

guage S

tatemen

t

He

alth C

are

Particip

atio

n

Ad

dresses an

d T

eleph

one N

um

bers

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

41

Th

e hu

man

imm

un

odeficiency viru

s (HIV

) is the viru

s that cau

ses AID

S. It is esti-

mated th

at between

650,000 to 900,000 people in th

is coun

try are now

infected

with

HIV

and approxim

ately 40,000 new

infection

s occur every year.

More th

an on

e third

of all AID

S cases

reported in th

e Un

ited States are direct-

ly or indirectly associated w

ith d

rug u

se.

HIV

is passed from on

e person to an

other th

rough

blood-to-blood and sexu

al con-

tact. In addition

, infected pregn

ant w

omen

can pass H

IV to th

eir babies durin

gpregn

ancy or delivery, as w

ell as throu

gh breast feedin

g. HIV

causes A

IDS

and

most people w

ith H

IV in

fection w

ill develop AID

S as a resu

lt of their H

IV in

fection.

AID

S is life-th

reatenin

g because th

e imm

un

e system of som

eone w

ith A

IDS

has lost

the ability to defen

d itself against life-th

reatenin

g cancers an

d other in

fections.

HIV

is not spread by casu

al contact or in

sect bites. On

ly the follow

ing body flu

idsh

ave been proven

to spread HIV

:Blood

Sem

enV

aginal flu

idB

reast milk

Gettin

g tested

Th

e blood tests comm

only u

sed to detect HIV

infection

actually determ

ine w

heth

eran

tibodies have been

produced by you

r body to fight H

IV. An

tibodies are produced

by your im

mu

ne system

in respon

se to infection

, so you w

ould on

ly have th

ese par-ticu

lar HIV

antibodies if in

fact you h

ad been in

fected.

Th

e win

dow

period

Th

e period of time betw

een w

hen

you w

ere infected w

ith H

IV an

d wh

en an

tibodiescan

be detected is called the “w

indow

period.” Du

ring th

is win

dow period, you

rH

IV test resu

lt may be n

egative wh

en in

fact you are actu

ally HIV

-positive. Most

peop

le will d

evelop d

etectable an

tibod

ies with

in 3 m

onth

s after infection

.T

he average w

indow

period is about th

ree weeks. In

rare cases, it can take u

p to 6m

onth

s.

It is therefore recom

men

ded

that you

get tested 6 m

onth

s after the last

possib

le exposu

re (un

protected

vaginal, an

al, or oral sex or sharin

g nee-

dles).

He

alth C

are

Particip

atio

n

HIV

/ AID

S

Ad

dresses an

d T

eleph

one N

um

bers

(page tw

o)

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

Nam

e:A

dd

ress:

Ph

one:

42

He

alth C

are

Particip

atio

n

HIV

/ AID

S(p

age two)

It is very importan

t to get tested regu

larlyan

d to learn you

r test results becau

sem

edications are n

ow available th

at may keep you

health

ier longer. T

he less tim

eth

at HIV

has to m

ultiply in

your body, th

e better your ch

ances for m

anagin

g the

disease and th

e more likely you

can preven

t transm

ission of H

IV to you

r drug an

dsexu

al partners an

d to your partn

er’s children

.

Do n

ot confu

se HIV

testing w

ith preven

tion. S

ome people w

ho are n

ot well-

inform

ed thin

k that th

ey do not n

eed to chan

ge their beh

avior if they con

tinu

e totest n

egative for HIV. T

his is n

ot true.

If you en

gage in an

y of the beh

aviors we ju

st discussed w

ith som

eone w

ho h

as beenin

fected, you are at risk for in

fection. T

here is n

o way to preven

t transm

issionexcept th

rough

your ow

n beh

avior. You are in

control.

Interp

reting you

r test results

If you test n

egative:If you

test negative, don

’t forget the “w

indow

period.” You m

ay in fact b

e HIV

-p

ositive,but you

r imm

un

e system h

as not yet developed detectible an

tibodies.H

owever, if you

still test negative six m

onth

s after the last tim

e you en

gaged in an

yh

igh risk beh

avior, then

you can

feel assured th

at you h

ave not been

infected. D

on

ot assum

e that b

ecause you

tested n

egative, that you

r partn

er mu

st alsob

e negative.

HIV

is not n

ecessarily transm

itted every time th

ere is exposure. S

o,for exam

ple, you cou

ld have h

ad un

protected sex or shared dru

g paraphern

aliaw

ith an

HIV

-positive partner w

ithou

t havin

g become in

fected on th

at particular

occasion. H

owever, if you

engage in

high

risk behavior again

with

this person

youcou

ld still be at risk un

less your partn

er also tested negative 6 m

onth

s after his or

her m

ost recent h

igh risk beh

avior.

If you test positive:

Depen

ding on

how

mu

ch of th

e virus you

have an

d the stren

gth of you

r imm

un

esystem

, your doctor m

ay prescribe some m

edications th

at will h

elp you to stay

health

y longer. T

here is n

o cure.

If you en

gaged in h

igh risk beh

avior any tim

eafter you

were in

fected, you cou

ld have in

fected your partn

ers or have becom

e re-in

fected with

a strain of th

e virus th

at does not respon

d well to m

edications. T

hat’s

wh

y it is so importan

t for everyone to get tested. T

he soon

er you kn

ow th

at youh

ave been in

fected, the soon

er you can

begin treatm

ent, an

d the soon

er you can

stop the spread of H

IV to oth

ers.

Som

e peop

le believe th

at they d

on’t h

ave to worry ab

out gettin

g HIV

any

more b

ecause th

ey thin

k th

at it can b

e cured

with

med

ication. T

HIS

ISN

OT

TR

UE

. T

he tru

th is th

at despite medical advan

ces, HIV

remain

s a very seri-ou

s disease that requ

ires costly, and often

complicated, treatm

ent regim

ens th

atm

ayslow

the disease, bu

t do not cu

re it.

43

Project T

ime M

anagem

ent S

heet

Projects to b

e comp

leted:

Date D

ue:

1)________________________________________________

_____________2)

_____________________________________________________________

3)________________________________________________

_____________ 4)

_____________________________________________________________

5)________________________________________________

_____________ 6)

_____________________________________________________________

Ord

er in w

hich

to work

on p

rojects:1)

________________________________________________2)

________________________________________________ 3)

________________________________________________ 4)

________________________________________________ 5)

________________________________________________ 6)

________________________________________________

Work

Sch

edu

le:W

ork on: ______________________________ from

____:____ to ____:____W

ork on: ______________________________ from

____:____ to ____:____W

ork on: ______________________________ from

____:____ to ____:____W

ork on: ______________________________ from

____:____ to ____:____W

ork on: ______________________________ from

____:____ to ____:____W

ork on: ______________________________ from

____:____ to ____:____W

ork on: ______________________________ from

____:____ to ____:____

He

alth C

are

Particip

atio

n

Preven

t Hep

atitis B: G

et Vaccin

ated

Hep

atitis B is a seriou

s disease cau

sed b

y the h

epatitis B

virus (H

BV

) that attack

sth

e liver and

can b

e spread

to others.

Is hep

atitis B a seriou

s prob

lem?

Yes. Each

year, thou

sands of people of all ages get h

epatitis B an

d about 5,000 die of ch

ron-

ic (life-long) liver problem

s caused by H

BV

infection

. If you h

ave had oth

er types of hepati-

tis, such

as hepatitis A

or hepatitis C

, you can

still get hepatitis B

.

How

is hep

atitis B sp

read?

•H

BV

is spread by contact w

ith th

e blood of an in

fected person or by h

aving sex w

ith an

infected person

•A

wom

an w

ho h

as hepatitis B

can spread th

e virus to h

er baby durin

g birth.

•H

BV

is spread by contact w

ith th

e blood of an in

fected person or by h

aving sex w

ith an

infected person

You can

not get H

BV

from:

•sn

eezing or cou

ghin

g

•kissin

g or hu

gging

•sh

aring eatin

g uten

sils of drinkin

g glasses

•breast feedin

g

•food or w

ater

•casu

al contact (su

ch as an

office setting)

How

do you

kn

ow if you

have h

epatitis B

?

On

ly a blood test can tell for su

re. See you

r doctor if you h

ave symptom

s of hepatitis (e.g.,

tiredness, stom

ach ach

e, joint pain

, yellow skin

or eyes), or if you th

ink you

have h

ad directcon

tact with

someon

e wh

o has h

epatitis B.

It is very imp

ortan

t tha

t all p

regn

an

t wom

en g

et a b

lood test for h

epa

titis B ea

rlyin

their p

regn

an

cy, since a

wom

an

wh

o ha

s hep

atitis B

can

sprea

d th

e virus to h

erb

ab

y du

ring

birth

.

How

can you

protect you

rself from gettin

g infected

with

HB

V?

•G

et vaccinated

!H

epatitis B vaccin

e is safe, effective, and you

r best protection.

44

Project P

lan #____

Project:

_________________________________________________________

Com

pletion

date:

_______________________________________________

Th

ings to P

urch

ase:_______________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

_________________________________

Th

ings to G

ather:

________________________________________________________________

________________________________________________________________

________________________________________________________________

Step

s to Com

plete th

e Task

:1)

______________________________________________________________2)

______________________________________________________________3)

______________________________________________________________4)

______________________________________________________________5)

______________________________________________________________6)

______________________________________________________________7)

______________________________________________________________8)

______________________________________________________________9)

______________________________________________________________10)

______________________________________________________________

He

alth C

are

Particip

atio

n

Preven

t Hep

atitis B: G

et Vaccin

ated(p

age two)

•P

ractice “safer” sex.If you

are havin

g sex, but n

ot with

one steady partn

er, use latex con

doms correctly every

time you

have sex an

d get vaccinated again

st hepatitis B

. Men

wh

o have sex w

ith m

ensh

ould be vaccin

ated against both

hepatitis A

and h

epatitis B.

•D

on’t sh

are anyth

ing th

at migh

t have b

lood on

it.N

ever share an

ythin

g that m

ight h

ave blood on it, su

ch as a razor or tooth

brush

.

If you sh

oot drugs, get h

elp to stop or get into a treatm

ent program

. Don

’t share n

eedles,syrin

ges, cookers, cottons, w

ater, or rinse cu

ps. Get vaccin

ated against h

epatitis Aan

dh

epatitis B.

•T

hin

k ab

out th

e health

risks if you

are plan

nin

g to get a tattoo or bod

y piercin

g.You

can get in

fected if the artist or piercer doesn

’t sterilize needles an

d equipm

ent, u

sedisposable gloves, an

d wash

han

ds properly.

•F

ollow stan

dard

precau

tions.

If you are a h

ealth-care w

orker, follow stan

dard precaution

s and h

andle n

eedles and

sharps safely. G

et vaccinated again

st hepatitis B

.

Get h

epatitis B

vaccine if:

•you

r sex partner h

as hepatitis B

•you

are a man

wh

o has sex w

ith m

en•

you h

ave had a sexu

ally transm

itted disease (e.g. gonorrh

ea, syphilis)

•you

have sex w

ith m

ore than

one partn

er•

you sh

oot drugs

•you

live with

someon

e wh

o has life-lon

g hepatitis B

•you

have a job th

at exposes you to h

um

an blood

•you

are a kidney dialysis patien

t•

you live or travel for m

ore than

six mon

ths in

coun

tries wh

ere hepatitis B

is comm

on

Everyon

e un

der 19 yea

rs old sh

ould

get va

ccina

ted a

ga

inst h

epa

titis B!

Is the vaccin

e safe?Yes. H

epatitis B vaccin

e is safe and effective. M

illions of people h

ave received the vaccin

ew

orldwide sin

ce 1982. You d

o not n

eed b

ooster shots

after you com

plete the th

ree-shot

vaccine series.

Sh

ould

you get a b

lood test after th

e three sh

ot vaccine series to b

esu

re that you

are protected

?M

ost people don’t n

eed to get their blood tested after gettin

g the vaccin

e.

You sh

ould get a blood test 1 to 2 m

onth

s after you com

plete the series if:

•you

r sex partner h

as chron

ic hepatitis B

•you

r imm

un

e system is n

ot workin

g well(i.e., you

are on dialysis or you

have A

IDS

)•

you h

ave a job that exposes you

to hu

man

blood

Ba

bies b

orn to in

fected m

others sh

ould

get th

eir blood

tested a

t 9 to 15 mon

ths old

to be su

re tha

t they a

re protected

.

Sou

rce: C

enters for D

isease Con

trol and P

revention

(CD

C) an

d Nation

al Institu

te on D

rug A

buse (N

IDA

), NIH

Pu

blication N

um

ber 00-4812, printed S

eptember 2000.

45

Cu

rrent M

edical In

formation

Typ

e of illness:

___________________________________________________________________________________________________________________

Date of illn

ess:_________________________________________________

Dates of h

ospitalization

s:_______________________________________

Nam

e of hosp

ital:_______________________________________________

Prim

ary ph

ysician:

_____________________________________________M

edication

s prescrib

ed:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Treatm

ents received

:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Su

rgery:________________________________________________________

____________________________________________________________________________________________________________________________________

Su

rgeon:

____________________________________________________________________________________________________________________________________________________________________________________________

Alm

ost 4 million

Am

ericans are in

fected w

ith h

epatitis C

virus.

Wh

at is hep

atitis C?

Hepatitis C

is a liver disease caused by th

e hepatitis C

virus (H

CV

), wh

ich is fou

nd in

the

blood of persons w

ho h

ave this disease. T

he in

fection is spread by con

tact with

the blood of

an in

fected person.

How

serious is h

epatitis C

?

Hepatitis C

is serious for som

e persons, bu

t not for oth

ers. Most person

s wh

o get hepatitis

C carry th

e virus for th

e rest of their lives. M

ost of these person

s have som

e liver damage

but m

any do n

ot feel sick from th

e disease. Som

e persons w

ith liver dam

age due to h

epati-tis C

may develop cirrh

osis (scarring) of th

e liver and liver failu

re wh

ich m

ay take man

yyears to develop.

How

can I p

rotect myself from

getting h

epatitis C

?

HC

V is spread prim

arily by exposure to h

um

an blood.

•D

on’t ever sh

oot drugs! If you

shoot dru

gs, stop and get in

to a treatmen

t program. If you

can’t stop, u

se a clean n

eedle and w

orks every time an

d don’t sh

are them

.

•P

ractice safer sex. If you h

ave sex with

mu

ltiple partners, low

er your n

um

ber of partners

and alw

ays use barrier precau

tions, su

ch as latex con

doms.

•If you

are a health

care worker, alw

ays follow rou

tine barrier precau

tions an

d safely han

-dle n

eedles and oth

er sharps.

•D

o not sh

are toothbru

shes, razors, or oth

er personal care articles. T

hey m

ight h

ave bloodon

them

.

Hep

atitis C is n

ot spread

by:

•sn

eezing

•h

uggin

g

•cou

ghin

g

•sh

aring eatin

g uten

sils or drinkin

g glasses

•food or w

ater

•casu

al contact

He

alth C

are

Particip

atio

n

Hep

atitis C P

revention

46

Past M

edical H

istory

Lifetim

e illnesses/in

juries:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dru

g allergies:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Fam

ily history:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Treatm

ents:

Provid

er:___________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

_____________________________

He

alth C

are

Particip

atio

n

Hep

atitis C P

revention

(page tw

o)

Cou

ld I alread

y have h

epatitis C

?

Ask you

r doctor for a blood test for hepatitis C

if:

•you

received a blood transfu

sion or solid organ

transplan

t (e.g., kidney, liver, h

eart)before 1992.

•you

were treated w

ith a blood produ

ct for clotting problem

s before 1987.

•you

ever injected street dru

gs,even on

ce.

•you

were ever on

long-term

kidney dialysis.

Wh

y shou

ld I b

e tested for h

epatitis C

?

Early diagn

osis is importan

t so you can

be:

•cou

nseled abou

t how

to prevent tran

smission

of HC

V to oth

ers.

•ch

ecked for liver disease and get treatm

ent, if in

dicated.

Man

y people wh

o are at risk for hepatitis C

are at risk for hepatitis A

and h

epatitis B.

Ch

eck with

your doctor to see if you

shou

ld get hepatitis A

and h

epatitis B vaccin

es.

Th

ere is no vaccin

e to preven

t hep

atitis C.

Sou

rce: C

enters for D

isease Con

trol and P

revention

(CD

C) an

d Nation

al Institu

te on D

rug A

buse (N

IDA

), NIH

Pu

blication N

um

ber 00-4812, printed S

eptember 2000.

47

Med

ications L

ist

Reason

Dosage /

Date

Med

ications

to take

Instru

ctions

times p

er day

Th

ere is now

strong eviden

ce that oth

er ST

Ds in

crease the risk of H

IVtran

smission

and, con

versely, that S

TD

treatmen

t reduces th

e spread ofH

IV. People are 2–5 tim

es more likely to becom

e infected w

ith H

IV w

hen

other S

TD

s are present. F

urth

ermore, people in

fected with

HIV

are more

likely to infect th

eir partners if eith

er one of th

em also h

as an S

TD

. Th

is isbecau

se ST

Ds th

at cause gen

ital lesions m

ake it easier for HIV

to gainen

try. Even

if the S

TD

does not cau

se lesions, th

ey increase th

e nu

mber of

HIV

-target cells in gen

ital secretions an

d therefore provide H

IV w

ith an

easy target. If you are already in

fected with

HIV, h

aving an

other S

TD

makes you

even m

ore infectiou

s—you

are more likely to spread H

IV to

someon

e else—an

d in addition

, havin

g an S

TD

can redu

ce the effectiven

essof H

IV-treatm

ent an

d contribu

te to HIV

disease progression. S

o, there are

very good reasons for everyon

e to be tested regularly for S

TD

s. ST

Ds can

bepreven

ted and treated. D

etection an

d treatmen

t of ST

Ds can

substan

tiallyredu

ce HIV

transm

ission. S

o, be inform

ed. Be a positive participan

t in you

row

n h

ealth care. S

TD

s and

Infectiou

s Disease

He

alth C

are

Particip

atio

n

48

Mon

thly E

xpen

ditu

res

Am

oun

tD

ateD

escription

of Pu

rchase

of Pu

rchase

Balan

ce

Mon

th____________________

ST

Ds an

d In

fectious D

isease(p

age two)

He

alth C

are

Particip

atio

n

• P

eople often h

ave more sex w

hen

they u

se cocaine, an

d they often

forget tow

ear latex condom

s or to ask their partn

er to wear a con

dom.

• S

ome people sell sex to get cocain

e or to get mon

ey for cocaine. T

his m

aym

ean th

ey have m

ore sex or un

protected sex.•

Crack an

d cocaine m

ay weaken

the im

mu

ne system

, makin

g it easier toget H

IV, HB

V, HC

V, and oth

er ST

Ds.

• C

rack and cocain

e often m

ake it difficult to reach

sexual clim

ax. Th

is may

lead to prolonged in

tercourse an

d increased ch

ances for gettin

g cuts an

dabrasion

s, wh

ich cou

ld result in

blood-to-blood contact an

d the tran

smis-

sion of H

IV, HB

V, HC

V, and oth

er ST

Ds.

• If you

are a crack or cocaine u

ser, you can

decrease your ch

ances of gettin

gH

IV, HB

V, HC

V, or other S

TD

s by getting off dru

gs. If you can

’t get offdru

gs, don’t sh

are needles or “w

orks.” In addition

, wh

en h

aving sex be

sure to u

se latex condom

s.

People w

ho in

ject drugs are at risk for oth

er serious in

fections, besides H

IVan

d hepatitis B

and C

. Use of alcoh

ol swabs to clean

the in

jection site prior

to injection

has been

show

n to redu

ce the occu

rrence of cellu

litis, injection

site abscesses, and, possibly, en

docarditis amon

g persons w

ho in

ject drugs.

49

Bills

Date

Am

oun

tC

omp

any

Received

Date D

ue

Paid

Mon

th____________________

En

docard

itis(B

acterial En

docard

itis; Infective E

nd

ocarditis)

He

alth C

are

Particip

atio

n

Basic in

formation

Descrip

tionA

non

contagiou

s infection

involvin

g the h

eart mu

scle, heart valves, en

docardium

(linin

g of the h

eart cham

bers or valves).

Freq

uen

t signs an

d sym

ptom

sE

arly symp

toms:

•F

atigue an

d weakn

ess.•

Interm

ittent fever, ch

ills and excessive sw

eating, especially at n

ight.

•W

eight loss.

•V

ague ach

es and pain

s.•

Heart m

urm

ur.

Late sym

ptom

s:•

Severe ch

ills and h

igh fever.

•S

hortn

ess of breath on

exertion.

•S

wellin

g of the feet, legs an

d abdomen

.•

Rapid or irregu

lar heartbeat.

Cau

sesB

acteria or fun

gi that en

ter the blood an

d infect th

e valves and h

eart linin

g ofperson

s with

damaged skin

(See risks below

). Bacteria or fu

ngi fu

rther dam

age the

heart valves, m

uscles an

d linin

gs.

Risk

increases w

ithR

isk of heart-valve dam

age increases w

ith:

•R

heu

matic fever.

•C

ongen

ital heart disease.

Risk

of end

ocarditis follow

ing h

eart valve dam

age increases w

ith:

•P

regnan

cy.•

Injection

s of contam

inated m

aterials into th

e bloodstream, su

ch as w

ithself-adm

inistered in

travenou

s drugs.

•E

xcess alcohol con

sum

ption.

•U

se of Imm

un

osuppressive dru

gs.•

Artificial h

eart valves.

Safety C

heck

list

50

Turn

down

heat

Turn

off stove/oven

Turn

off lights

Turn

off television

Turn

off stereo

Turn

off iron/h

air dryeran

d other sm

all appliances

Close w

indow

s

Take you

r watch

Take you

r wallet/pu

rse

Take you

r hou

se keys

Take a con

dom/bleach

kit

Lock th

e door

Oth

er ______________________________

Oth

er ______________________________

Oth

er ______________________________

En

docard

itis(B

acterial En

docard

itis; Infective E

nd

ocarditis)

(page tw

o)

He

alth C

are

Particip

atio

n

Preven

tive measu

resIf you

have h

eart-valve damage or a h

eart mu

rmu

r•

Requ

est antibiotics before m

edical procedures th

at may in

troduce bacteria in

toth

e blood. Th

ese inclu

de dental w

ork, childbirth

and su

rgery of the u

rinary or

gastrointestin

al tract.•

Don

’t drink m

ore than

1-2 if any alcoh

olic drinks in

1 day.•

Con

sult m

edical professional before becom

ing pregn

ant.

•D

on’t u

se illicit drugs like h

eroin or cocain

e.

Exp

ected ou

tcome

Usu

ally curable w

ith early diagn

osis and treatm

ent, bu

t recovery may take w

eeks.If treatm

ent is delayed, h

eart fun

ction deteriorates, resu

lting in

congestive h

eartfailu

re and death

.

Possib

le comp

lications

•B

lood clots that m

ay travel to the brain

, kidneys or abdom

inal organ

s, causin

gin

fections, abscesses or stroke.

•H

eart-rhyth

m distu

rbances (atrial fibrillation

is most com

mon

).

Treatm

ent

Gen

eral measu

resD

iagnostic tests m

ay inclu

de laboratory blood coun

ts and blood cu

ltures,

electrocardiogram (m

ethod of diagn

osing h

eart diseases by measu

ring electrical

activity of the h

eart), X-rays of th

e heart an

d lun

gs, inclu

ding ech

ocardiogram(stu

dying th

e heart by exam

inin

g soun

d waves created by an

instru

men

t placed onth

e chest).

•T

he goal of treatm

ent is to eradicate th

e infectin

g organism

with

medication

s,an

d supportive care for relievin

g symptom

s.•

Hospital care du

ring acu

te phase. O

nce stable, som

e patients can

contin

ue w

ithtreatm

ent at h

ome.

•S

urgery to replace in

fected valve in som

e patients.

•If you

have dam

aged heart valves, tell an

y doctor or dentist before an

ytreatm

ent or procedu

re. Preven

tive antibiotics w

ill be needed in

some

situation

s.•

On

going den

tal hygien

e is importan

t to prevent in

fection.

•O

nce you

have h

ad endocarditis, stay u

nder a doctor’s care to preven

t a relapse.•

Wear a m

edical alert type bracelet or neck tag th

at indicates you

r medical

problem. C

arry a wallet card listin

g the an

tibiotic regimen

s needed for m

edicalan

d dental procedu

re.

Oth

er Person

al Inform

ation

51

En

docard

itis(B

acterial En

docard

itis; Infective E

nd

ocarditis)

(page th

ree)

He

alth C

are

Particip

atio

n

Med

icationA

ntibiotics for m

any w

eeks to fight in

fection. A

ntibiotic treatm

ent is often

intraven

ous.

Activity

•R

est in bed u

ntil you

are fully recovered. W

hile in

bed, flex your legs often

topreven

t clots from form

ing.

•R

esum

e your n

ormal activities, in

cludin

g sexual relation

s, wh

en stren

gthallow

s.

Diet

No special diet.

Notify ou

r office ifYou

or a family m

ember h

as symptom

s of endocarditis.

Th

e followin

g occur du

ring or after treatm

ent:

•W

eight gain

with

out diet ch

anges.

•B

lood in th

e urin

e.•

Ch

est pain or sh

ortness of breath

.•

Su

dden w

eakness or n

um

bness in

the m

uscles of th

e face, trun

k, or limbs.

© C

opyright 1994 by W

B S

aun

ders Com

pany. A

ll rights reserved.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

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1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

52

He

alth C

are

Particip

atio

n

Cirrh

osis of the L

iver

Basic in

formation

Descrip

tionC

hron

ic scarring of th

e liver, leading to loss of n

ormal liver fu

nction

. It is twice as

comm

on in

men

as in w

omen

. Con

genital cirrh

osis can affect in

fants or you

ng

children

.

Freq

uen

t signs an

d sym

ptom

sE

arly stages:•

Fatigu

e, weakn

ess.•

Poor appetite: n

ausea; w

eight loss.

•E

nlarged liver.

•R

ed palms.

Late stages:

•Jau

ndice (yellow

skin an

d eyes).•

Dark yellow

or brown

urin

e.•

Spider blood vessels of th

e skin (fin

e vessels that spread ou

t from a cen

tralpoin

t).•

Hair loss.

•B

reast enlargem

ent in

men

.•

Flu

id accum

ulation

in th

e abdomen

and legs.

•E

nlarged spleen

.•

Diarrh

ea; stool may be black or bloody.

•B

leeding an

d bruisin

g.•

Men

tal confu

sion, com

a.

Cau

sesIn

flamm

ation of th

e liver, accompan

ied by destruction

of liver cells, cellregen

eration an

d scarring. T

hese m

ay be preceded by:•

Prolon

ged, excess alcohol con

sum

ption.

•H

epatitis.•

Exposu

re to toxic chem

ical.•

Inh

erited causes.

Risk

increases w

ith•

Poor n

utrition

.•

Hepatitis.

•E

xcess alcohol con

sum

ption. In

dividuals vary w

idely in th

e amou

nt an

ddu

ration of alcoh

ol consu

mption

necessary to cau

se cirrhosis.

•O

ccupation

al exposure to ch

emicals toxic to th

e liver.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

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1:00

2:00

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4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

53

He

alth C

are

Particip

atio

n

Cirrh

osis of the L

iver(p

age two)

Preven

tive measu

res•

Obtain

treatmen

t for alcoholism

.•

Obtain

prompt m

edical treatmen

t for hepatitis.

•S

urvey you

r work en

vironm

ent for possible exposu

re to toxic chem

icals.

Possib

le comp

lications

•C

irrhosis can

be arrested if the u

nderlyin

g cause can

be removed. L

iver damage

is irreversible, but sym

ptoms can

be relieved or controlled. A

near-n

ormal life

is possible if treated early and treatm

ent su

cceeds.•

If the u

nderlyin

g cause is n

ot removed, liver scarrin

g will con

tinu

e, resultin

g indeath

from liver failu

re.

Gen

eral measu

res•

Life-th

reatenin

g hem

orrhage, especially from

the esoph

agus an

d stomach

.•

Liver can

cer.•

Body poison

ing an

d coma from

a buildu

p of amm

onia an

d other body w

aste.•

Sexu

al impoten

ce.

Treatm

ent

Gen

eral measu

res•

Diagn

ostic tests may in

clude laboratory stu

dies, such

as blood and u

rine tests

of liver fun

ction, X

-ray and/or biopsy of liver.

•T

reatmen

t meth

ods may in

clude dru

g treatmen

t, dietary restrictions, rest an

doth

er supportive m

easures.

•If cirrh

osis is caused by alcoh

olism, stop drin

king. A

sk for help from

family,

friends an

d comm

un

ity agencies. C

ontact an

Alcoh

olics An

onym

ous grou

p inyou

r comm

un

ity.•

Addition

al Inform

ation available from

the A

merican

Liver F

oun

dation75 M

aiden L

ane

Su

ite 603N

ew York, N

Y 10038

(800) GO

-Liver (465-4837) toll-free

(888) 4HE

P-U

SA

(443-7872) toll-free(212) 668-1000(212) 483-8179 faxin

fo@liverfou

ndation

.org

Med

ication•

Iron su

pplemen

ts for anem

ia resultin

g from or poor n

utrition

.•

Diu

retics to reduce flu

id retention

.•

An

tibiotics, such

as neom

ycin, to redu

ce amm

onia bu

ildup.

•S

tool softeners.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

54

He

alth C

are

Particip

atio

n

Cirrh

osis of the L

iver(p

age three)

Activity

•M

aintain

as active a life as possible.•

Elevate sw

ollen feet an

d legs wh

en restin

g.

Diet

•In

the early stages, eat a w

ell-balanced diet th

at is high

in carboh

ydrates, high

in protein

and low

in salt.

•L

ate stages may requ

ire protein redu

ction.

•V

itamin

and m

ineral su

pplemen

ts may be n

ecessary.•

Don

’t drink alcoh

ol.

Notify ou

r office if•

You or a fam

ily mem

ber has sym

ptoms of cirrh

osis.•

Th

e followin

g occur du

ring treatm

ent:

•V

omitin

g blood or passing black stool.

•M

ental con

fusion

or coma.

•F

ever or other sign

s of infection

(redness, sw

elling, ten

derness or pain

).

© C

opyright 1994 by W

B S

aun

ders Com

pany. A

ll rights reserved.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

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1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

55

He

alth C

are

Particip

atio

n

Cellu

litis

Basic in

formation

Descrip

tionA

non

contagiou

s infection

of conn

ective tissue ben

eath th

e skin. It can

affect skinan

ywh

ere on th

e body, but m

ost likely on th

e face or lower legs. E

rysipelas is the

nam

e of a severe cellulitis of th

e face.

Freq

uen

t signs an

d sym

ptom

s•

Su

dden ten

derness, sw

elling, an

d redness in

an area of th

e skin. T

he area of

cellulitis is in

itially 5cm to 20cm

in diam

eter, and grow

s rapidly in th

e first 24h

ours. A

thin

, red line often

extends from

the m

iddle of the cellu

litis toward th

eh

eart. Cellu

litis does not develop in

to a boil.•

Fever, som

etimes accom

panied by ch

ills and sw

eats.•

Gen

eral ill feeling.

•S

wollen

lymph

glands n

ear the cellu

litis (sometim

es).

Cau

sesIn

fection from

Staph

ylococcus

or Streptococcu

sbacteria.

Risk

increases w

ith•

Use of im

mu

nosu

ppressive or cortisone dru

gs.•

Ch

ronic illn

ess, such

as diabetes mellitu

s, or a recent in

fection th

at has low

eredresistan

ce.•

An

y inju

ry that breaks th

e skin, or u

nderlyin

g skin lesion

.•

Intraven

ous dru

g use.

•B

urn

s.•

Su

rgical wou

nd.

•D

iabetes mellitu

s.•

Imm

un

osuppression

due to illn

ess or medication

s.

Preven

tive measu

res•

Avoid skin

damage. U

se protective clothin

g or gear if you participate in

strenu

ous w

ork or sports.•

Keep th

e skin clean

.•

Avoid sw

imm

ing if you

have skin

lesion.

Exp

ected ou

tcome

Usu

ally curable in

7 to 10 days with

treatmen

t, un

less the patien

t has a ch

ronic

disease or is receiving im

mu

nosu

ppressant treatm

ent; in

that case, cellu

litis may

lead to blood poisonin

g and becom

e life threaten

ing.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

56

He

alth C

are

Particip

atio

n

Cellu

litis(p

age two)

Possib

le comp

lications

Blood poison

ing, if bacteria en

ter the bloodstream

.B

rain in

fection or m

enin

gitis, if cellulitis occu

rs on th

e central part of th

e face.

Treatm

ent

Gen

eral measu

res•

For diagn

osis, laboratory studies or a skin

biopsy may be recom

men

ded.•

Th

e usu

al treatmen

t is with

an an

tibiotic.•

Use w

arm-w

ater soaks to hasten

healin

g and relieve pain

and in

flamm

ation.

•If excess flu

id is lost from th

e skin, h

ospitalization m

ay be necessary to provide

adequate h

ydration.

•E

levation an

d restricted movem

ent of th

e affected area can h

elp reduce

swellin

g.

Med

icationA

ntibiotics to figh

t infection

. Fin

ish th

e prescribed dose, even if sym

ptoms

disappear quickly.

Activity

Rest in

bed un

til fever disappears and oth

er symptom

s improve. R

esum

e your

norm

al activities as soon as sym

ptoms im

prove.

Diet

No special diet.

Notify ou

r office ifYou

or a family m

ember h

as symptom

s of cellulitis, especially on

the face.

Th

e followin

g occur du

ring treatm

ent:

•F

ever.•

Headach

e or vomitin

g.•

Drow

siness an

d lethargy.

•B

lister over the area of cellu

litis.•

Red streaks th

at contin

ue to exten

d, despite treatmen

t.•

New

, un

explained sym

ptoms develop. D

rugs u

sed in th

e treatmen

t may

produce side effects.

© C

opyright 1994 by W

B S

aun

ders Com

pany. A

ll rights reserved.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

57

He

alth C

are

Particip

atio

n

Osteom

yelitis

Basic in

formation

Descrip

tionIn

fection of th

e bone an

d bone m

arrow. It can

involve an

y bone in

the body. In

ach

ild, the fem

ur (u

pper-leg bone), tibia (low

er-leg bone) or h

um

erus or radiu

s(bon

es in th

e arm) is u

sually affected. In

an adu

lt, the pelvis or spin

e is usu

allyaffected. It can

affect both sexes an

d all ages, but is m

ore comm

on in

rapidlygrow

ing ch

ildren (5 to 14 years), especially m

ales.

Freq

uen

t signs an

d sym

ptom

s•

Fever. S

ometim

es this is th

e only sym

ptom.

•P

ain, sw

elling, redn

ess, warm

th an

d tendern

ess in th

e area over the in

fectedbon

e, especially wh

en m

oving a n

ear by joint. N

earby joints, especially th

ekn

ee, may also be red, w

arm an

d swollen

.•

If a child is too you

ng to talk, sign

s of pain are relu

ctance to m

ove an arm

orleg or refu

sal to walk; lim

ping; or scream

ing w

hen

the lim

b is touch

ed orm

oved.•

Pu

s drainage th

rough

a skin abscess, w

ithou

t fever or severe pain (ch

ronic

osteomyelitis on

ly).•

Gen

eral ill feeling.

Cau

sesU

sually staph

ylococcal infection

, but m

any oth

er bacteria may be respon

sible. Th

ebacteria m

ay spread to the bon

e throu

gh th

e bloodstream from

the follow

ing

sources.

•C

ompou

nd fractu

re or other in

jury.

•B

oil, carbun

cle or any break in

the skin

.•

Middle-ear in

fection.

•P

neu

mon

ia.

Risk

increases w

ith•

Illness th

at has low

ered resistance.

•R

apid growth

durin

g childh

ood.•

Diabetes m

ellitus.

•Im

planted orth

opedic device (artificial knee).

•In

travenou

s drug u

se.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

58

He

alth C

are

Particip

atio

n

Osteom

yelitis(p

age two)

Preven

tive measu

resO

btain prom

pt medical treatm

ent of an

y bacterial infection

to prevent its spread to

bone or oth

er body parts.

Exp

ected ou

tcome

Usu

ally curable w

ith prom

pt and aggressive treatm

ent.

Possib

le comp

lications

•A

bscess that breaks th

rough

the skin

and w

on’t h

eal un

til the u

nderlyin

g bone

heals.

•P

erman

ent stiffn

ess in a n

earby joint (rare).

•F

racture.

•L

oosenin

g of implan

ted orthopedic device.

•M

ay require am

putation

if circulation

is blocked or severe gangren

e infection

occurs (rare).

Treatm

ent

Gen

eral measu

res•

Diagn

ostic tests may in

clude laboratory blood stu

dies and blood cu

ltures to

identify th

e bacteria, radionu

clide bone scan

, CT

or MR

I scans. X

-rays oftendon

’t show

chan

ges un

til 2 to 3 weeks after th

e infection

begins.

•T

reatmen

t involves m

edications, rest an

d other su

pportive measu

res.•

Keep th

e involved lim

b level or slightly elevated an

d imm

obilized with

pillows. D

on’t let it dan

gle.•

Keep u

naffected parts of th

e body as active as possible to prevent pressu

resores du

ring requ

ired, prolonged bed rest.

•H

ospitalization m

ay be necessary for su

rgery to remove pockets of in

fectedbon

e, and/or to adm

inister h

igh doses of an

tibiotics sometim

es intraven

ously.

•A

previously im

planted orth

opedic device (artificial, knee) m

ay need to be

removed (som

etimes a replacem

ent can

be implan

ted at the sam

e time).

Med

ication•

Large doses of an

tibiotics. With

powerfu

l new

antibiotics, in

travenou

sadm

inistration

, once a n

ecessity, may n

o longer be n

eeded. An

tibiotics may be

necessary, eith

er orally or by injection

for 8 to 10 weeks.

•P

ain relievers.

•L

axatives, if constipation

develops durin

g prolonged bed rest.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

59

He

alth C

are

Particip

atio

n

Osteom

yelitis(p

age three)

Activity

Rest in

bed un

til 2 to 3 weeks after sym

ptoms disappear. R

esum

e your n

ormal

activities gradually.

Diet

No special diet. E

at a nu

tritionally balan

ced diet. Take vitam

in an

d min

eralsu

pplemen

ts if needed.

Notify ou

r office ifYou

or your ch

ild has sym

ptoms of osteom

yelitis.T

he follow

ing occu

r durin

g treatmen

t:•

An

abscess forms over th

e infected bon

e, or drainage from

an existin

g abscessin

creases.•

Fever.

•P

ain becom

es intolerable.

•N

ew u

nexplain

ed symptom

s develop. Dru

gs used in

treatmen

t may produ

ceside effects.

© C

opyright 1994 by W

B S

aun

ders Com

pany. A

ll rights reserved.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

60

Notes

He

alth C

are

Particip

atio

n

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

61

Gro

up Se

ven

HEA

LTHY

LIFESTYLE C

HO

ICES

Skills to Be

Lea

rned

■Stre

ss Ma

nag

em

ent

■C

op

ing Skills

■N

utritiona

l Guid

eline

s and

Foo

d H

ygie

ne

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

To do today:

Weekly Schedule(duplicate this page as needed)

62

He

althy Life

style C

hoice

s

Relaxation

techn

iques decrease th

e negative h

ealth con

sequen

ces of stress.

Men

u of relaxation

techn

iqu

es to try:

Visu

alization/gu

ided

imagery

Progressive M

uscle R

elaxation (P

MR

)

Deep

breath

ing

Th

e Relaxin

g Sigh

Positive affirm

ations

Au

togenic train

ing

Med

itation

Relaxation

techn

iques are available com

mercially on

audio an

d video tape,or you

can create you

r own

. Books are available at you

r library and book

stores.

Relaxation

takes practice. Devote at least 15 m

inu

tes twice daily to you

rrelaxation

techn

ique. You

shou

ld notice resu

lts with

in tw

o weeks.

Th

is week I com

mit to do th

e followin

g stress man

agemen

t techn

ique tw

icedaily at

(time) an

d(tim

e) for at least 15 min

utes:

(techn

ique)

Stress M

anagem

ent

I am calm

and

relaxed.

7:00 AM

8:00

Monday Tuesday Wednesday SundayThursday Friday Saturday

9:00

10:00

11:00

12:00 PM

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

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To do today:

Weekly Schedule(duplicate this page as needed)

63

He

althy Life

style C

hoice

s

Moderate exercise m

ay strength

en you

r imm

un

e system, in

crease your

energy level an

d self-esteem, an

d decrease stress and an

xiety.

Men

u of exercises to try (in

moderation

):

Gen

tle stretchin

g

Brisk

walk

ing

Sw

imm

ing

Weigh

t trainin

g

Yoga

Tai C

hi

Cyclin

g

Sk

ipp

ing rop

e

Dan

cing

Exercise

Never exercise to th

e point of exh

austion

.

Ch

eck with

your h

ealth care provid

er before beginn

ing an

y exercise program.

Th

is week I com

mit to do th

e followin

g exercise daily at(tim

e)

for at least 15 min

utes:

(exercise)

January 2005

Sun Mon Tues Wed Thurs Fri Sat

1

9 151413121110

30 31

23 292827262524

16 222120191817

2 876543

64

He

althy Life

style C

hoice

s

1.E

stablish a sleep sch

edule. G

o to bed and get u

p at aroun

dth

e same tim

e each day.

2.G

et sufficien

t sleep. Health

y adults requ

ire eight to eigh

t-an

d-a-half h

ours of sleep per n

ight.

3.U

se your bedroom

only for sleepin

g or sleep-related activities.

4.C

reate a sleep-promotin

g environ

men

t. Your bedroom

shou

ldbe cool, qu

iet, and w

ithou

t any brigh

t light sh

inin

g in th

ew

indow

s.

5.D

on’t drin

k alcohol or caffein

ated beverages with

in six h

ours

of bedtime an

d don’t sm

oke imm

ediately before going to bed.

6.H

ave a glass of milk or ligh

t carbohydrate sn

ack before bed-tim

e.

7.R

elax for at least 30 min

utes before bedtim

e.

8.If you

are not asleep w

ithin

30 min

utes, get u

p and en

gage ina qu

iet activity un

til you feel sleepy.

9.E

xercise regularly, bu

t not righ

t before bedtime.

10.If you

take a nap du

ring th

e day, do not sleep for m

ore than

30 min

utes, an

d don’t n

ap after 3 p.m.

Sleep

Th

is week I com

mit to tryin

g the follow

ing strategy in

order toim

prove my sleep:

Con

sult you

r health

care provid

er if your sleep

prob

lems p

ersist.

February 2005

Sun Mon Tues Wed Thurs Fri Sat

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27 28

20 262524232221

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65

He

althy Life

style C

hoice

s

FDA Food Pyramid

March 2005

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54321

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27 31302928

20 262524232221

6 121110987

66

He

althy Life

style C

hoice

s

Gettin

g the B

enefits of G

ood N

utrition

Good n

utrition

is importan

t for everyone. B

ut it’s essen

tial for people infected w

ith h

um

anim

mu

nodeficien

cy virus (H

IV). T

his viru

s affects the body’s ability to figh

t infection

and

causes A

IDS

(acquired im

mu

nodeficien

cy syndrom

e).

On

e of the key com

ponen

ts of treatmen

t for HIV

infection

is a nu

tritious diet. T

imin

g isim

portant—

the soon

er good nu

trition starts, th

e more su

ccessful you

can be at stayin

gh

ealthier. E

ating en

ough

of the righ

t balance of foods m

ay help preven

t weigh

t loss and

fatigue, im

prove comfort an

d sense of w

ell-being, an

d contribu

te to quality of life.

Th

is booklet presents in

formation

you can

use to plan

a health

y diet. It also suggests w

aysto h

elp you overcom

e eating problem

s resultin

g from you

r illness or m

edical treatmen

t.

Bu

ildin

g a Nu

tritious D

iet

Protein

, carbohydrate, fat, vitam

ins, m

inerals, an

d water are th

e nu

trients n

eeded to main

-tain

body fun

ctions. A

diet contain

ing th

e right balan

ce of these n

utrien

ts promotes h

ealthan

d well-bein

g. Use th

e followin

g general gu

idelines to plan

a diet that gives you

r bodyen

ough

of these n

utrien

ts.F

at and lactose (m

ilk sugar) can

be hard to digest. If you

begin experien

cing n

ausea or

diarrhea, cu

t back on fat an

d/or lactose un

til symptom

s improve. A

nd rem

ember, try differ-

ent foods to fin

d out w

hich

ones agree w

ith you

; everyone respon

ds differently to variou

sfoods an

d to the sam

e food from on

e time it’s eaten

to the n

ext.

Every d

ay…

•D

rink tw

o cups or m

ore of lowfat m

ilk or butterm

ilk, or substitu

te two or th

ree servings of

lowfat ch

eese, cottage cheese, yogu

rt, ice cream, cu

stard, or puddin

g made w

ith m

ilk.

•E

at two or m

ore 2- to 3-oun

ce servings of lean

meat or oth

er foods contain

ing protein

,su

ch as eggs, fish

, poultry, dried bean

s and peas, pean

ut bu

tter, and n

uts an

d seeds.

•E

at or drink tw

o or more h

alf-cup servin

gs of fresh, frozen

, or cann

ed fruit or fru

it juice.

At least on

e of the servin

gs shou

ld be a citrus fru

it or juice. W

ash fresh

fruit th

orough

lybefore cookin

g or eating.

•E

at three or m

ore half-cu

p servings of vegetables. A

t least one servin

g shou

ld be a dark-green

, leafy vegetable or a yellow vegetable. W

ash fresh

vegetables thorou

ghly before

cooking or eatin

g.

•E

at six or more servin

gs of bread or other baked goods, cereal, rice, pasta, or grain

products.

•E

at other foods su

ch as desserts, m

argarine, con

dimen

ts, and beverages w

hen

you w

ant

them

. Th

ese foods add flavor, variety, and calories to you

r diet.

Pow

er-Pack

ing You

r Diet

Increasin

g the calorie an

d protein con

tent of you

r diet is a good habit to start righ

t now

.F

or other w

ays to boost calories and protein

with

out in

creasing servin

g sizes, try the follow

-

Nu

trition an

d H

IV

April 2005

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21

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67

He

althy Life

style C

hoice

s

ing su

ggestions. You

may n

eed to modify th

em if you

’re havin

g a problem w

ith diarrh

ea,fat, or lactose in

tolerance (see “S

olving P

roblems”).

To ad

d calories…

•In

cooking, u

se heavy cream

, wh

ole milk, or evaporated w

hole m

ilk instead of w

aterw

hen

ever possible.

•Top baked potatoes, vegetables, an

d fruits w

ith sou

r cream. O

ne tablespoon

adds about

30 Calories.

•U

se butter or m

argarine on

hot foods su

ch as toast, vegetables, cooked cereals, an

d rice.O

ne teaspoon

adds about 35 C

alories.

•S

pread bagels and toast w

ith cream

cheese. O

ne tablespoon

adds about 50 C

alories.

•E

at fruits can

ned in

heavy syru

p. Stir can

ned fru

it into yogu

rt or use it to top cereal an

dice cream

and oth

er desserts.

•S

weeten

toast, cereals, and fru

its with

sugar, jelly, an

d hon

ey.

To ad

d p

rotein…

•M

ake “double-stren

gth m

ilk” by adding n

onfat dry m

ilk powder to regu

lar wh

ole milk.

Ch

ill well before drin

king to en

han

ce the flavor. U

se double-stren

gth m

ilk in cookin

g and

for milksh

akes.

•A

dd grated cheese to cream

sauces, casseroles, an

d vegetables. On

e oun

ce of Am

ericanch

eese contain

s approximately seven

grams (g) of protein

.

•S

erve cottage cheese w

ith can

ned fru

it. On

e-half cu

p of cottage cheese provides abou

t15 g of protein

.

•H

ave peanu

t butter w

ith an

apple, banan

a, or pear; spread it on crackers; or u

se it as asan

dwich

spread with

jelly, jam, or preserves. O

ne tablespoon

of peanu

t butter provides

about 95 C

alories and fou

r g of protein.

•B

lend fin

ely chopped h

ard-cooked eggs into sau

ces, soups, an

d casseroles. On

e large eggprovides abou

t seven 7 g of protein

. Don

’t eat raw or soft-cooked (“su

nn

y-side up”) eggs or

foods contain

ing raw

eggs.

To ad

d com

plete n

utrition

…

Th

ere’s an altern

ative strategy for adding calories an

d protein, as w

ell as carbohydrates,

fat, vitamin

s, and m

inerals, w

hen

your n

utrition

al intake is less th

an ideal. A

dvera®S

pecialized, Com

plete Nu

trition is a n

utrition

al product specifically design

ed for peoplew

ith H

1V in

fection or A

IDS

. Advera is h

igh in

calories to meet th

e body’s increased n

eedfor th

em. It’s also h

igh in

protein an

d low in

fat, and h

as fiber to main

tain n

ormal bow

elfu

nction

. Advera m

ay be the an

swer w

hen

you…

•D

on’t feel like eatin

g.

•D

on’t h

ave the tim

e or energy to fix a balan

ced meal.

•A

re consisten

tly not eatin

g enou

gh of th

e right kin

ds of foods and recogn

ize the n

eed forgood n

utrition

.

Con

sult you

r physician

regarding you

r specific needs.

Advera®

is available in ch

ocolate, vanilla an

d orange cream

flavors. It tastes best chilled.

Nu

trition an

d H

IV(p

age two)

May 2005

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68

He

althy Life

style C

hoice

s

Nu

trition an

d H

IV(p

age three)

Preven

ting Illn

ess Cau

sed b

y Imp

roper F

ood H

and

ling

Gu

ard against food-born

e illnesses. W

hen

your im

mu

ne system

is suppressed, you

r bodybecom

es less effective at fightin

g bacteria that can

grow in

improperly h

andled foods. F

ood-born

e illnesses are preven

table wh

en food is stored, prepared, an

d served properly. Th

e fol-low

ing gu

idelines can

help you

lower you

r risk of food-borne illn

esses.

•S

tore foods at safe temperatu

res—cold food below

40°F, h

ot food above 140°F. Don

’t leavefood at room

temperatu

re for more th

an tw

o hou

rs.

•T

haw

frozen food in

a refrigerator or defrost in a m

icrowave oven

. Don

’t thaw

food atroom

temperatu

re.

•R

efrigerate or freeze perishable item

s as soon as possible. U

se airtight con

tainers, plastic

wrap, or alu

min

um

foil to protect opened foods.

•B

uy foods in

amou

nts th

at can be eaten

before they spoil. N

ever use food you

thin

k may

be spoiled. Don

’t use can

s with

bulges or th

ose with

leaks or dents alon

g the seam

s.

•W

ash you

r han

ds thorou

ghly w

ith w

arm, soapy w

ater before han

dling or eatin

g food.

•W

ash fresh

fruits an

d vegetables before eating or cookin

g them

.

•U

se a cuttin

g board made of plastic or m

arble, not w

ood. Use separate cu

tting boards for

raw an

d cooked foods. Wash

all food preparation u

tensils in

hot, soapy w

ater.

•T

horou

ghly cook m

eat, fish, pou

ltry, and eggs. D

on’t eat raw

meat, raw

seafood, or rawfish

dishes, su

ch as su

shi.

•A

void lun

cheon

meats an

d cheeses from

the deli case; th

ey may con

tain h

armfu

l bacteriafrom

improper food h

andlin

g. Use prepackaged, processed m

eats and ch

eeses instead.

•U

se only pasteu

rized milk produ

cts.

•H

eat leftovers thorou

ghly to an

intern

al temperatu

re of 165°F.

Solvin

g Prob

lems

Eat w

ell wh

en you

feel well. K

eep high

-calorie snacks (see pages 4 an

d 5, “Pow

er-Packin

gYou

r Diet”) available for w

hen

your appetite is good—

for example, raisin

s and oth

er driedfru

its, peanu

t butter or ch

eese with

crackers, yogurt, an

d nu

ts and seeds.

Som

etimes you

may h

ave symptom

s that in

terfere with

eating. T

he follow

ing su

ggestions

will h

elp you m

eet nu

tritional n

eeds, conserve en

ergy or soothe an

upset stom

ach du

ring

these tim

es.

Wh

en you

’re tired…

•T

ake advantage of th

e nu

tritious m

eals available in th

e frozen-food section

of your grocery

store.

•A

ccept friends’an

d relatives’offers to help prepare food.

•F

reeze leftovers and extra portion

s for later.

•C

heck in

to hom

e food-delivery services such

as “Meals on

Wh

eels” or carry-out an

d deliv-ery services offered by m

any restau

rants.

•U

se Advera®

as an oral su

pplemen

t or meal replacem

ent w

hen

you can

’t prepare or eat afu

ll meal.

June 2005

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26 30292827

19 252423222120

5 11109876

69

He

althy Life

style C

hoice

s

Nu

trition an

d H

IV(p

age four)

Wh

en you

’re nau

seated…

•W

ait un

til you feel better to eat fu

ll meals. E

at small, frequ

ent m

eals rather th

an th

reelarge on

es.

•S

ip cool beverages, such

as clear fruit ju

ices and drin

ks and carbon

ated beverages (ginger

ale, lemon

-lime). E

at fruit ices, dry toast (if you

r mou

th an

d/or throat is sore, du

nk toast

in ju

ice or tea to soften), or crackers to calm

your stom

ach.

•C

hoose blan

d foods that are n

ot greasy or too sweet, su

ch as broth

with

crackers, gelatinw

ith fru

it, and apple ju

ice.

•E

at cold main

courses—

chicken

salad instead of h

ot fried chicken

, for example. S

tay out

of the kitch

en w

hen

food is being prepared, an

d eat in w

ell-ventilated areas. T

he sm

ell offood or cookin

g can add to feelin

gs of nau

sea.

•A

sk your doctor abou

t medicin

e to control n

ausea.

Wh

en you

have d

iarrhea…

•C

onsider u

sing a reh

ydration produ

ct such

as Equ

aLYT

E®

En

teral Reh

ydration S

olution

that provides n

eeded electrolytes and flu

id to prevent deh

ydration. B

everages such

asfru

it juices (apricot an

d pear nectar, apple ju

ice) or Popsicles®

and gelatin

can be u

sed foraddition

al fluids.

•D

rink liqu

ids between

meals rath

er than

with

meals.

•B

ecause th

ey can m

ake diarrhea w

orse, decrease or avoid foods and drin

ks that con

tainfat, su

ch as cream

, sour cream

, cream sau

ce, lun

cheon

meats, bacon

, sausage, regu

larch

eeses, oil, mayon

naise, salad dressin

g, nu

ts, avocados, olives, peanu

t butter, bu

tter and

margarin

e, and h

igh-fat sn

ack foods such

as potato and corn

chips. T

ry lowfat altern

a-tives (ch

eeses, sour cream

, and salad dressin

gs, for example).

•D

ecrease or avoid lactose-contain

ing foods w

hile you

have diarrh

ea. Lactose-con

tainin

gfoods in

clude m

ilk; milk pow

der; ice cream; m

ilk-contain

ing desserts, sou

ps, and baked

goods; and ch

eese and yogu

rt. Try lactose-free or lactose-redu

ced dairy products.

•S

elect foods that are easily digested an

d absorbed such

as peeled, cooked fruits an

d veg-etables, ban

anas, applesau

ce, cooked cereal, and rice.

•E

at small, frequ

ent m

eals.

•A

sk your doctor, dietitian

, or nu

rse about u

sing A

dvera® w

hich

is nu

tritionally com

pletean

d low in

fat, and con

tains fiber to h

elp main

tain bow

el fun

ction.

•A

void foods that h

ave a laxative effect (prun

es and pru

ne ju

ice, raw fru

its and vegetables)

wh

en you

have diarrh

ea. Th

ey may m

ake the diarrh

ea worse.

•D

on’t eat or drin

k foods and beverages th

at contain

caffeine su

ch as coffee, tea, cola, an

dch

ocolate.

Wh

en you

r mou

th an

d th

roat are sore…

•D

rink sooth

ing beverages su

ch as apple ju

ice, fruit n

ectars, and m

ilk (if diarrhea is n

ot aproblem

). Asore m

outh

or throat m

ay be irritated by high

ly spiced foods and carbon

ateddrin

ks or liquids con

tainin

g salt (such

as broth or vegetable ju

ice), or those con

tainin

gacid (su

ch as oran

ge juice).

•D

rink liqu

ids and sem

isolid foods throu

gh a straw

.

•S

elect soft, moist foods su

ch as m

acaroni an

d cheese; casseroles; can

ned fru

its and ripe,

peeled, soft fresh fru

its* (banan

as, pears, peaches); scram

bled eggs; stews; m

ashed pota-

July 2005

Sun Mon Tues Wed Thurs Fri Sat

21

10 161514131211

31

24 302928272625

17 232221201918

3 987654

70

He

althy Life

style C

hoice

s

Nu

trition an

d H

IV(p

age five)

toes with

gravy; puddin

gs and cu

stards; and sh

erbets, yogurt, ice cream

, and m

ilkshakes.

Avoid sticky, h

ard-to-swallow

foods such

as peanu

t butter an

d dry, rough

foods such

aspopcorn

, potato chips, an

d raw vegetables th

at can irritate sen

sitive mou

ths an

d throats.

Du

nk toast, cookies, dou

ghn

uts, an

d crackers in m

ilk, tea, juice, or sou

p to soften th

eman

d make th

em easier to sw

allow.

•U

se melted bu

tter or margarin

e, gravy, broth, sau

ces, or syrup to m

oisten food.

•M

ake sure foods an

d beverages are at room tem

perature before eatin

g or drinkin

g them

.A

void foods that are very h

ot or very cold.

•U

se Advera®

as an oral su

pplemen

t or meal replacem

ent sipped th

rough

a straw.

•T

alk to your doctor abou

t medicin

e to nu

mb you

r mou

th an

d throat.

Wh

en you

r sense of taste ch

anges…

•If red m

eat tastes bitter, select other foods con

tainin

g protein su

ch as ch

eese, eggs, poul-

try, yogurt, tu

na, an

d peanu

t butter. T

ry marin

ating m

eat in soy sau

ce, win

e, or fruit

juice.

•S

erve protein foods cold or at room

temperatu

re.

•A

dd interest to foods w

ith season

ings an

d flavorings su

ch as basil, oregan

o, garlic, onion

,bacon

bits, and lem

on an

d lime ju

ices.

•A

dd fresh or can

ned fru

it to milksh

akes and ice cream

.

•D

rink liqu

ids with

solid foods.

•U

se Advera®

as an oral su

pplemen

t or meal replacem

ent.

*Avoid fresh

fruit if diarrh

ea is a problem.

August 2005

Sun Mon Tues Wed Thurs Fri Sat

654321

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21 272625242322

7 1312111098

71

He

althy Life

style C

hoice

s

Daily M

eal Plan

ner

Day of th

e week

Date

Breakfast

Steps to com

plete the m

eal

Lu

nch

Steps to com

plete the m

eal

Din

ner

Steps to com

plete the m

eal

September 2005

Sun Mon Tues Wed Thurs Fri Sat

321

11 171615141312

25 3029282726

18 242322212019

4 1098765

72

He

althy Life

style C

hoice

s

Week

ly Meal P

lann

erfor th

e week

of

Su

nd

ayT

hin

gs to buy

Breakfast

Lu

nch

Din

ner

Mon

day

Th

ings to bu

y

Breakfast

Lu

nch

Din

ner

Tu

esday

Th

ings to bu

y

Breakfast

Lu

nch

Din

ner

Wed

nesd

ayT

hin

gs to buy

Breakfast

Lu

nch

Din

ner

October 2005

Sun Mon Tues Wed Thurs Fri Sat

1

9 151413121110

30 31

23 292827262524

16 222120191817

2 876543

73

Th

ursd

ayT

hin

gs to buy

Breakfast

Lu

nch

Din

ner

Frid

ayT

hin

gs to buy

Breakfast

Lu

nch

Din

ner

Satu

rday

Th

ings to bu

y

Breakfast

Lu

nch

Din

ner

Addition

al items to bu

y:

He

althy Life

style C

hoice

s

Week

ly Meal P

lann

erfor th

e week

of(p

age two)

November 2005

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54321

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27 302928

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74

He

althy Life

style C

hoice

s

Grocery L

ist

Dairy

____________________________________________________________________________________________________________________________________

Prod

uce

________________________________________________________________________________________________________________________________________________________________________________

Meat an

d F

ish______________________________________________________________________________________________________________

Bak

ery/Bread

s________________________________________________________________________________________

Beverages

________________________________________________________________________________________

Deli

________________________________________________________________________________________

Can

ned

goods

____________________________________________________________________________________________________________________________________

Cereals

________________________________________________________________________________________

Frozen

foods

____________________________________________________________________________________________________________________________________

Pap

er prod

ucts

__________________________________________________________________________________________________________________________________________________________

Ch

ips/C

rackers

______________________________________________________________________________________________________________

Bak

ing su

pp

lies____________________________________________________________________________________________________________________________________

Pet food

/Clean

ers______________________________________________________________________________________________________________

Oth

er______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

December 2005

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321

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25 31 3029282726

18 242322212019

4 1098765

75

Notes

He

althy Life

style C

hoice

s

1._____________________________________________________________________

2._____________________________________________________________________

3._____________________________________________________________________

4._____________________________________________________________________

5._____________________________________________________________________

6._____________________________________________________________________

7._____________________________________________________________________

8._____________________________________________________________________

9._____________________________________________________________________

10._____________________________________________________________________

11._____________________________________________________________________

12._____________________________________________________________________

13._____________________________________________________________________

14._____________________________________________________________________

15._____________________________________________________________________

16._____________________________________________________________________

17._____________________________________________________________________

18._____________________________________________________________________

19._____________________________________________________________________

20._____________________________________________________________________

21._____________________________________________________________________

22._____________________________________________________________________

23._____________________________________________________________________

24._____________________________________________________________________

To D

o Tod

ay

76

Gro

up Eig

ht

INTRO

DU

CTIO

N TO

THE 1

2-STEPS

Skills to Be

Lea

rned

■Id

entifying

Wha

t Is and

Is Not C

ontro

llable

■U

nde

rstand

ing W

hen to

Let G

o a

ndW

hen to

Take

Actio

n

■Id

entifying

One

’s Perso

nal So

urceo

f Streng

th

■Incre

asing

Mo

tivatio

n for C

hang

e

HH

RP

+C

lient W

orkb

ook

HH

RP

+ Grou

ps:

1.R

eachin

g your goals ..............................................................................................................1

2.R

educin

g the h

arm of in

jection dru

g use .............................................................................7

3.H

arm redu

ction w

ith latex .................................................................................................12

4.N

egotiating h

arm redu

ction w

ith partn

ers .......................................................................225.

Preven

ting relapse to risky beh

avior .................................................................................276.

Health

care participation ....................................................................................................33

7.H

ealthy lifestyle ch

oices .....................................................................................................618.

Introdu

ction to th

e 12-Step P

rogram .................................................................................76

9.O

vercomin

g stigma .............................................................................................................80

10.M

otivation for ch

ange: overcom

ing h

elplessness .............................................................84

11.M

oving beyon

d grief ............................................................................................................8812.

Health

y social relationsh

ips and activities .......................................................................93

77

Introd

uction to

the 1

2-Ste

ps

1

Tw

elve Step

s in a J

ourn

ey of Recovery

“We adm

itted that we w

ere powerless over our addiction, that our lives had becom

e unmanageable.”

Accept w

hat cannot be changed – E

ffect of drugs and current H

IV+

status.

“We cam

e to believe that a pow

er greater than

ourselves cou

ld restore us to san

ity.”

Ho

pe for the future – B

elieve that a healing power exists.

“We m

ade a decision to tu

rn ou

r will an

d our lives over to th

e care of God as w

e un

derstood Him

.”

Make the decisio

n to heal yo

ur life.

“We m

ade a searchin

g and fearless m

oral inven

tory of ourselves.”

Identify what yo

u need to change abo

ut yourself.

“We adm

itted to God, to ou

rselves, and to an

other h

um

an bein

g the exact n

ature of

our w

rongs.”

Tell som

eone else w

hat you need to

change about yo

urself.

“We w

ere entirely ready to h

ave God rem

ove all these defects of ch

aracter.”

Be ready to

change – Cho

ose to

let go o

f your o

ld lifestyle.

“We h

um

bly asked Him

to remove ou

r shortcom

ings.”

Begin to

make the perso

nal changes necessary to heal yo

ur life.

“Made a list of all person

s we h

ad harm

ed, and becam

e willin

g to make

amen

ds to them

all.”

Identify harm yo

u’ve caused.

“Made direct am

ends to su

ch people w

hen

ever possible, except wh

ento do so w

ould in

jure th

em or oth

ers.”D

emo

nstrate your regret.

“Con

tinu

ed to take a personal in

ventory an

d wh

en w

e were

wron

g promptly adm

itted it.”M

aintain your new

healthier life.

12

11

10

9

8

7

6

5

4

3

2

“Sou

ght th

rough

prayer and m

editation to im

prove our

consciou

s contact w

ith G

od as we u

nderstood h

im, prayin

gon

ly for know

ledge of His w

ill for us an

d the pow

er tocarry th

at out.”

Co

ntinue to grow

to highest po

tential.

“Havin

g had a spiritu

al awaken

ing as th

e result of

these steps, w

e tried to carry this m

essage to oth-

ers, and to practice th

ese principles in

all our

affairs.”S

hare by doing.

1

Gro

up O

ne

REAC

HIN

G Y

OU

R GO

ALS

Skills to Be

Lea

rned

■Im

pro

ving M

em

ory a

nd C

once

ntratio

n

■Se

tting G

oa

ls

■Esta

blishing

Prioritie

s

■A

ction Initia

tion

78

Introd

uction to

the 1

2-Ste

ps

12-Step

Gam

e Blan

k W

orksh

eet

Rea

ching Yo

ur Go

als

2

Instru

ctions:

In an

swerin

g the qu

estion below

, write dow

n w

hatever

comes to you

r min

d, as quickly as possible; don

't be afraid to list thin

gs that

may seem

far-fetched. L

ist everythin

g that you

thin

k you w

ould really like

to have don

e with

your life.

Wh

at were you

r lifetime goals prior to u

sing dru

gs and testin

g positivefor H

IV?

1.

2.

3.

4.

5.

6.

7.

8.9.

10.

Lifetim

e Goals E

xercise

79

Notes

Introd

uction to

the 1

2-Ste

ps

Rea

ching Yo

ur Go

als

38

0

Prioritizin

g Lifetim

e Goals

Instru

ctions: S

elect your th

ree most im

portant goals an

d write th

em in

orderof im

portance below

, with

No. 1 bein

g the m

ost importan

t of the th

ree (a sample

No. 1 h

as been com

pleted for you).

Sam

ple G

oal

List activities n

ecessary to accomplish

this goal:

Exam

ples:T

ake prescribed medication

sA

lways u

se condom

s/latex S

tay in H

HR

P+

treatmen

t programK

eep doctor appointm

ents

Eat h

ealthy foods

Do relaxation

techn

iques

Rem

ain abstin

ent

Exercise

Take vitam

ins

Th

ink positively

Dru

g-free leisure activities

Oth

er

Activity I can

do durin

g the n

ext week tow

ards my goal:

(Write on

To-Do L

ist)

My th

ree most im

portan

t lifetime goals are:

Write G

oal No. 1 h

ere

List activities n

ecessary to accomplish

this goal:

Activity I can

do durin

g the n

ext week tow

ards my goal:

(Write on

To-Do L

ist)

Write G

oal No. 2 h

ere

List activities n

ecessary to accomplish

this goal:

Activity I can

do durin

g the n

ext week tow

ards my goal:

(Write on

To-Do L

ist)

Write G

oal No. 3 h

ere

List activities n

ecessary to accomplish

this goal:

Activity I can

do durin

g the n

ext week tow

ards my goal:

(Write on

To-Do L

ist)

Sta

y in

HH

RP+

treatm

ent p

rogra

m

Livin

g a

health

y life

style

Gro

up N

ine

OV

ERCO

MIN

G STIG

MA

Skills to Be

Lea

rned

■Und

ersta

nd the

Conse

que

nce o

f Stig

matiza

tion

■D

ecre

asing

the Stre

ngth o

f “Ad

dict”

Self-id

entity

■C

onne

cting w

ith “Co

re/Id

ea

l” Self

■Id

entifying

and

Streng

thening

Co

gnitive

,A

ffective

, and

Beha

viora

l Attrib

utes

of H

ea

lthier, N

on-d

rug U

sing, Life

style

■Re

de

fining the

Self a

s a N

on-d

rug U

ser

4

Rea

ching Yo

ur Go

als

Action

Initiation

Sch

edu

le the A

ctivity

•P

ut th

e activity on you

r to-do list.

•S

et a realistic deadline for com

pleting th

e activity.

•B

lock out tim

e.

Gettin

g Started

•L

eave yourself rem

inders.

•U

se self-affirmation

s such

as “I can do it.”

•Tell som

eone so th

at they can

encou

rage you.

•S

et a time lim

it (e.g., contract w

ith you

rself to engage in

activity for just

5 min

s.)

•R

elax/visualize you

rself engagin

g in activity.

•P

retend you

are an actor: A

ct “as if” you are som

eone w

ho en

gages inth

is activity.

•S

tart anyw

here, n

ot necessarily on

ly at the begin

nin

g.

•D

on’t expect perfection

.

En

gage in th

e Activity

•C

ross it off your to-do list.

•C

ongratu

late yourself.

•R

emin

d yourself th

at because of you

r effort and com

mitm

ent you

aren

ow on

e step closer to your goal.

81

Ove

rcom

ing Stig

ma

AM

irror into You

r “Ideal” S

elf(P

art I)

Th

ough

tsB

ehaviors

Feelin

gs

Characteristics of m

y “Ideal” Self

5

Rea

ching Yo

ur Go

als

Goal: _________________________________________________________________

To-D

o List

Date

1)_______________________________________

_______________________

2)_______________________________________

_______________________

3)_______________________________________

_______________________

4)_______________________________________

_______________________

5)_______________________________________

_______________________

6)_______________________________________

_______________________

Block

out tim

e

Work on

Step 1:

____________________ from ____:____ to ____:____ on

____________

Work on

Step 2:

____________________ from ____:____ to ____:____ on

____________

Work on

Step 3:

____________________ from ____:____ to ____:____ on

____________

Work on

Step 4:

____________________ from ____:____ to ____:____ on

____________

Work on

Step 5:

____________________ from ____:____ to ____:____ on

____________

Work on

Step 6:

____________________ from ____:____ to ____:____ on

____________

Step

-by-S

tep P

lann

ing W

orksh

eet

(time)

(time)

(date)

82

Ove

rcom

ing Stig

ma

(Part II)

Iam

:

Location

s to place self-affirm

ation card

s:

On

e week

from tod

ay I will rate m

y progress b

y rating th

e strength

of my “ad

dict” an

d “id

eal” selves:

1.2.3.

Mem

ory aid for visu

alization. I w

ill remem

ber to d

o my visu

aliza-tion

by:

I plan

to act “as if” I have th

is attribu

te by d

oing th

e followin

g:

How

mu

ch d

id I exp

erience m

y “add

ict” self in th

e past w

eek?

01

23

4n

ot at allm

oderatelyextrem

ely

How

mu

ch d

id I exp

erience m

y “ideal” self in

the p

ast week

?

01

23

4n

ot at allm

oderatelyextrem

ely

1.2.

I will visu

alize my “id

eal” self daily at ____ am

/pm

. My visu

alizationw

ill inclu

de (cop

y from h

and

out):

Th

ough

t

Beh

avior

Feelin

g

My S

elf-affirmation

Statem

ent

6

Notes

Rea

ching Yo

ur Go

als

83

Notes

Ove

rcom

ing Stig

ma

7

Gro

up Tw

o

REDU

CIN

G TH

E HA

RM

OF IN

JECTIO

N D

RUG

USE

Skills to Be

Lea

rned

■Id

entifying

the H

arm

of Inje

ction D

rug U

se

■Le

arning

Ha

rm Re

ductio

n Techniq

ues

(e.g

., nee

dle

clea

ning)

■Re

ducing

Cue

-elicite

d C

raving

84

Gro

up Te

n

MO

TIVA

TION

FOR C

HA

NG

E:O

VERC

OM

ING

HELPLESSN

ESS

Skills to Be

Lea

rned

■Und

ersta

nd the

Source

and

Conse

que

nces

of H

elp

lessne

ss

■Id

entify Situa

tions in W

hich You C

an

Beco

me

Emp

ow

ere

d

■A

ssess Re

ad

iness fo

r Cha

nge

■Incre

ase

Mo

tivatio

n to Pursue

a H

ea

lthyLife

style

8

Red

ucing the

Ha

rm o

f Injectio

n Drug

Use

How

to Bleach

-clean N

eedles

1. Rin

se syringe w

ith w

ater to remove an

y visible drug or blood.

2. Su

bmerge n

eedle; fill barrel of syringe w

ith bleach

.

3. Sh

ake/tap needle w

hile bleach

is in it to break u

p clots.

4. Keep bleach

in syrin

ge for at least 30 seconds.

5. Squ

irt out bleach

into w

aste cup (or in

to cooker if that is also

being clean

ed).

6. RE

PE

AT

Steps 2-5 u

sing n

ew bleach

and sh

ake/tap for anoth

er 30secon

ds.

7. Fill a disposable cu

p with

water an

d fill the syrin

ge.

8. Squ

irt out w

ater into w

aste cup (or cooker).

9. Rin

se again w

ith clean

water.

10. Eject w

ater into w

aste cup (or in

to cooker to rinse th

at with

water

also).

11. Take th

e syringe apart an

d clean th

e plun

ger in bleach

.

Rem

emb

er: Less th

an 30—

it’s still dirty!

85

Mo

tivatio

n for C

hang

e: O

verco

ming

He

lple

ssness

Instru

ctions: C

ircle one

of the respon

ses in each

of the fou

r boxes.

Sexu

al Practices

1.I h

ave no in

tention

to start usin

g con-

doms every tim

e I have sex.

2.I am

seriously con

sidering startin

g to use

condom

s soon, bu

t haven

’t made an

y defi-n

ite preparations yet.

3.I am

now

actively preparing m

yself tobegin

engagin

g in safer sexu

al practices,bu

t haven

’t started yet.

4.I’ve u

sed condom

s every time I h

ave sexfor less th

an six m

onth

s.

5.I’ve been

usin

g condom

s every time I h

avesex

forlon

ger than

six mon

ths.

Illegal Dru

g Use

1.I h

ave no in

tention

to quit u

sing all ille-

gal drugs.

2.I am

seriously con

sidering qu

itting all

illegal drugs bu

t haven

’t made an

y defi-n

ite preparations yet.

3.I am

now

actively preparing m

yself toqu

it usin

g all illegal drugs, bu

t haven

’tqu

it yet.

4.I h

ave now

stopped usin

g all illegal drugs

and h

ave been com

pletely abstinen

t forless th

an six m

onth

s.

5.I stopped u

sing all illegal dru

gs and h

avebeen

completely abstin

ent

for more th

ansix m

onth

s.

Health

Care

1.I h

ave no in

tention

to see a doctor regu-

larly, take all medication

s as directed and

be active in m

y own

health

care.

2.I am

seriously con

sidering becom

ing

more active in

my h

ealth care, bu

th

aven’t m

ade any defin

ite preparations

yet.

3.I

am n

ow actively preparin

g myself to

form a partn

ership w

ith m

y health

careprovider so th

at I can participate m

oreactively, bu

t haven

’t done so yet.

4.I h

ave now

begun

participating actively

in m

y health

care and h

ave been 100%

complian

t with

all med

ical recomm

end

a-tion

s for less than

six mon

ths.

5.I h

ave been participatin

g actively in m

yh

ealth care an

d have been

100% com

pli-an

t with

med

ical recomm

end

ations

form

ore than

six mon

ths.

Sh

aring D

rug P

araph

ernalia

1.I h

ave no in

tention

to stop sharin

g drug

paraphern

alia with

other people (e.g.,

needles, cookers, cotton

, rinse w

ater).

2.I am

seriously con

sidering n

ot sharin

gparaph

ernalia an

y more, bu

t haven

’tm

ade any defin

ite preparations yet.

3.I am

now

actively preparing m

yself tostop sh

aring paraph

ernalia, bu

t haven

’tstopped yet.

4.I stopped sh

aring dru

g paraphern

aliaan

d haven

’t shared

anyth

ing

for lessth

an six m

onth

s.

5.I stopped sh

aring dru

g paraphern

aliaan

d haven

’t shared

anyth

ing

for more

than

six mon

ths.

Stage:

Stage:

Stage:

Stage:

Read

iness A

ssessmen

t

9

A= A

bstin

ence

B= B

uy or ob

tain n

ew n

eedles

C= C

lean n

eedle w

ith fu

ll-strength

bleach

A= A

bstin

ence

Becau

se any dru

g use is dan

gerous, th

e best way to preven

t harm

is by abstainin

g from dru

gs.

B = B

uy or ob

tain n

ew n

eedles – N

ever share n

eedles/w

orks.

Oth

er than

abstainin

g from in

jection dru

g use, th

e second best w

ay of avoiding h

arm is by alw

aysu

sing a n

ew n

eedle—n

ever share n

eedles or works an

d don’t reu

se needles even

if not sh

ared with

others. T

here are tw

o reasons to alw

ays use n

ew/sterile n

eedles. First, it is th

e best way to be

sure a n

eedle is not con

tamin

ated. Secon

d, because u

sed needles (even

ones th

at have been

cleaned) are less sh

arp, they are m

ore likely to harm

/collapse your vein

s than

new

ones.

•N

everassu

me a n

eedle bough

t on th

e street is new

even if it is in

a wrapper.

•B

esides getting n

ew n

eedles from a dru

g store, the best w

ay to be sure you

're getting a

sterile needle is by u

sing n

eedle exch

ange p

rograms.

C = C

lean you

r need

le/work

s with

full-stren

gth h

ouseh

old b

leach.

Wh

en you

're not abstin

ent an

d don't h

ave a new

needle, th

e next best w

ay of reducin

g the h

arm of

injection

drug u

se is by cleanin

g your n

eedles/works w

ith bleach

.

Proced

ure:

1.T

horou

ghly rin

se the syrin

ge with

water to rem

ove any apparen

t blood or drug.

2.S

ubm

erge needle; fill barrel of syrin

ge with

bleach.

3.S

hake/tap n

eedle wh

ile bleach is in

it to break up clots.

4.K

eep bleach in

syringe for at least 30 secon

ds. R

emem

ber: Less th

an 30, it’s still d

irty!5.

Squ

irt out bleach

into w

aste cup (or cooker).

6.R

epeat

Steps 2–5 u

sing n

ew bleach

and sh

ake/tap for anoth

er 30 second

s.7.

Fill a disposable cu

p with

water an

d fill the syrin

ge.8.

Squ

irt out w

ater into w

aste cup (or cooker).

9.R

inse again

with

clean w

ater.10.

Eject w

ater into w

aste cup (or cooker).

11.T

ake the syrin

ge apart (remove th

e plun

ger) to improve th

e cleanin

g procedure.

Ad

dition

al tips:

1.N

ever dilute th

e bleach w

ith w

ater; diluted bleach

is less effective for killing H

IV.2.

Never re-u

se bleach or rin

se water.

3.C

lean you

r needles before th

e blood inside th

em h

as a chan

ce to dry; dried blood is harder

to clean ou

t of the n

eedle. 4.

Never pu

t needle in

to the rin

se water bottle; fill disposable cu

ps with

rinse w

ater.5.

If you are u

nable to get bleach

, do not in

ject drugs; oth

er cleanin

g meth

ods are not as

effective at killing H

IV.6.

Heatin

g drug solu

tion in

a cooker for at least 15 seconds m

ay also help to in

activate HIV.

Th

e AB

Cs of R

edu

cing th

e Harm

of Injection

Dru

g Use

Red

ucing the

Ha

rm o

f Injectio

n Drug

Use

86

Mo

tivatio

n for C

hang

e: O

verco

ming

He

lple

ssness

List th

e poten

tial ben

efits of chan

ge:

My cu

rrent S

tage of Ch

ange:

In th

e space provided below, w

rite the

nam

e of the stage (precon

templation

, contem

plation, action

, preparation,

or main

tenan

ce) from you

r Readin

ess Assessm

ent.

Sexu

al practicesH

ealth care

Dru

g use

Sh

aring “w

orks”

Th

e beh

avior I’m m

ost am

biva

lent

abou

t chan

ging is: S

elect the

behavior, from

the fou

r above, that you

are least motivated to ch

ange an

dw

rite it here.

(b) Total the n

um

ber of potential ben

efits of chan

ge and en

ter here:

(c) Su

btract costs (a) from ben

efits (b) and en

ter results h

ere:

List th

e reasons for n

ot wan

ting to ch

ange you

r beh

avior (costs):

(a) Total nu

mber of costs of ch

ange an

d enter h

ere:

(d) Total the number of strategies for graduation and enter here:

1.2.3.4.5.

6.7.8.9.10.

1.2.3.4.5.

6.7.8.9.10.

1.2.3.4.5.

6.7.8.9.10.

List b

elow th

e strategies you w

ill use to h

elp you

gradu

ate to the

next stage for ch

angin

g this risk

y beh

avior:

Write in

the n

ame of th

e next S

tage of Ch

ange h

ere:

Stage of C

han

ge Grad

uation

Gam

e Work

sheet

10

Red

ucing the

Ha

rm o

f Injectio

n Drug

Use

Sou

rce: NID

AC

omm

un

ity-based Ou

treach M

odel Man

ual: N

ational In

stitute on

Dru

g Abu

se, NIH

Pu

blication N

um

ber 00-4812, printed S

eptember 2000.

Red

ucin

g Your R

isk of In

fection

•If you

inject dru

gs, you can

get infected w

ith H

IV, HB

V, or HC

V by sh

ar-in

g needles, syrin

ges, and oth

er injection

equipm

ent th

at someon

e elseh

as used.

•N

ever share an

y of your equ

ipmen

t. You can

also get HIV, H

BV, an

d HC

Vby sh

aring cookers, cotton

s, or rinse w

ater.

•D

irect sharin

g occurs w

hen

you u

se anoth

er person’s syrin

ge after he or

she h

as used it.

•In

direct sharin

g occurs w

hen

fluids are m

ixed with

out actu

ally passing a

syringe from

one person

to anoth

er.

•R

outes of in

direct sharin

g inclu

de:–

Pu

tting syrin

ges in th

e same con

tainer;

–U

sing a plu

nger from

a previously u

sed syringe to m

ix the dru

gsolu

tion;

–U

sing a u

sed syringe to distribu

te or return

the dru

g;–

Draw

ing dru

g from a sh

ared cotton filter;

–R

eturn

ing th

e drug to a sh

ared cooker;–

“Beatin

g the cotton

” and “scrapin

g the cooker;” an

d–

Rin

sing a syrin

ge in oth

er people’s water.

•D

o not pu

t your n

eedle in som

eone else’s syrin

ge rinse w

ater, cotton, or

cooker. HIV, H

BV, or H

CV

can live in

blood in all th

ese places.

•D

o not sh

are drugs th

at have been

drawn

up in

a syringe som

eone else

has u

sed.

•D

isinfectin

g used syrin

ges with

bleach can

reduce th

e risk of transm

is-sion

, but a disin

fected syringe is n

ot as safe as a new

, sterile needle an

dsyrin

ge.

Th

e AB

Cs of R

edu

cing th

e Harm

of Injection

Dru

g Use

(page tw

o)

87

Notes

Mo

tivatio

n for C

hang

e: O

verco

ming

He

lple

ssness

11

Notes

Red

ucing the

Ha

rm o

f Injectio

n Drug

Use

88

Gro

up Ele

ven

MO

VIN

G BEY

ON

D G

RIEF

Skills to Be

Lea

rned

■Und

ersta

nding

the Sta

ges o

f Grie

f

■Fa

cing a

nd C

op

ing w

ith Fea

rs ab

out H

IV

■Id

entifying

and

Prioritizing

That W

hichH

as Pe

rsona

l Me

aning

12

89

Gro

up Thre

e

HA

RM RED

UC

TION

WITH

LATEX

Skills to Be

Lea

rned

■Id

entifying

the H

arm

of U

nsafe

Sexua

l Practice

s

■Le

arning

Ha

rm Re

ductio

n Techniq

ues

(e.g

., cond

om

sele

ction a

nd a

pp

licatio

n)

Mo

ving b

eyo

nd G

rief

Mon

.Tu

es.W

ed.T

hu

r.F

ri.S

at.S

un

.

“Lettin

g Go of F

ear” Clien

t Work

sheet

Stages of grief:

Place an

“x” in on

e of the boxes below

to indicate th

e stage of grief you are

curren

tly in w

ith regard to H

IV in

fection:

Fears ab

out H

IV:

In th

e space below, list th

e three th

ings you

fear most abou

t HIV

:

Th

is week I w

ill do the follow

ing:

I will do th

is on:

Step

toward

letting go of fear:

Select on

efear from

those you

listed above and, in

the space below

, describeon

estep you

can take th

is week

to begin lettin

g go of that fear (e.g., m

akean

appointm

ent to talk to you

r health

care provider or coun

selor, go to asu

pport group m

eeting, go to th

e library and read abou

t HIV

). Be sp

ecific.

Den

ialA

nger

Bargain

ing

Depression

Acceptan

ceH

ope

Mon

.Tu

es.W

ed.T

hu

r.F

ri.S

at.S

un

.

I will do th

is on:

1.2.3.

Lifetim

e goals:

List th

ree thin

gs that are im

portant to you

to accomplish

in you

r life. Be

realistic!1.2.3.

Th

is week I w

ill do the follow

ing:

Step

s toward

accomp

lishin

g lifetime goals:

Select on

egoal from

the goals you

listed above and, in

the space below

,describe on

e step you can

take this w

eek toward accom

plishin

g this goal.

Be sp

ecific.

13

90

Ha

rm Re

ductio

n with La

tex

A= A

bstin

ence

B= d

on’t exch

ange B

ody F

luid

s

C= alw

ays use a C

ond

om

A= A

bstin

ence

Th

e only w

ay to completely preven

t all harm

is abstinen

ce.

B = d

on’t exch

ange B

ody flu

ids

Oth

er than

abstainin

g from sex, th

e best way of avoidin

g harm

isby en

gaging in

sexual practices th

at do not in

volve the exch

ange of

Body flu

ids (e.g., mu

tual m

asturbation

).

C = alw

ays use C

ond

oms

If you are goin

g to engage in

vaginal or an

al intercou

rse or vaginal

or anal oral sex, alw

ays use a con

dom an

d other latex protection

.

Th

e AB

Cs of R

edu

cing H

arm w

ith L

atex

Mo

ving b

eyo

nd G

rief

Am

usin

g E

pita

ph

s: R.I.P

. (Rest In

Peace)

Here lies a m

an who w

hile he livedW

as happy as a linnetH

e always lied w

hile on the earthA

nd now he’s lying in it

She lived with her husband of fifty years

And died in the confident hope

Of a better life

Here lies N

edT

here is nothing more to be said—

Because w

e like to speak well of the dead

Here lies an A

theistA

ll dressed upA

nd no place to go

Epitaph found in a G

eorgia cemetery:

I told you I was sick!

Here lies the body

Of Jonathan B

lakeStepped on the gas

Instead of the brake

Here lies L

ester Moore

Four slugs from

a .44N

o Les N

o More

Here lies

Johnny Yeast

Pardon m

eF

or not rising

W. C

. Fields:

On the w

hole,I’d rather be in P

hiladelphia

On a dentist’s tom

bstone:

Stranger,A

pproach this spot with gravity

John Brow

n is filling his last cavity

John Dryden’s epitaph for his w

ife:H

ere lies my w

ifeH

ere let her lie!N

ow she’s at rest

And so am

I.

A w

idower placed tw

o messages, one

year apart, on his wife’s tom

bstone:

In 1890, he wrote:

The light of m

y life has gone out

In 1891, he wrote:

I have struck another match

Found in H

ookstown, P

A,

on tombstone w

ith an etching of am

arijuana plant on it:

Hi!

Stay highB

ye

A contented m

an:H

ere I lie snug as a bug in a rug.

The contented m

an’s relativein a nearby grave:

Here I lie snugger than that other bugger.

I made an ash of m

yself

Here lies

Ezekial A

ikleA

ged 102

The G

ood Die Y

oung

14

91

Ha

rm Re

ductio

n with La

tex

Imp

ortant p

oints to rem

emb

er:1.

Th

eon

lyw

ayto

completely

prevent

harm

isabstin

ence.

2.S

afersex

=n

oexch

ange

ofbodily

fluids.

3.T

he

firststep

toh

aving

safersex

isbein

gsober.

4.B

esidesn

oth

aving

sex,th

ebest

way

toprotect

yourself

against

sexually tran

s-m

itteddiseases

(ST

Ds)

isby

always

usin

glatex or polyu

rethan

e condom

s.

5.C

ondom

sth

atare

kepton

allth

ew

ayth

rough

sexh

elppreven

tth

e spreadof

sexually

transm

ittedviru

ses,in

cludin

gH

IV,h

epatitisB

and C

,an

doth

erS

TD

s.

6.S

TD

soften

cause

genital

lesions

orsores

that

make

iteasier

foryou

to getin

fectedw

ithH

IV,an

dh

epatitisB

and

C,

and

alsom

akeit

easier foryou

toin

fectoth

ersif

youare

alreadyin

fected.

7.U

seon

lylatex

or polyureth

ane con

doms.

Con

doms

made

oflam

bskin,

sheepskin

,an

d other

natu

ralm

aterialsdo

not protect

youfrom

getting

HIV,

hepatitis B

orC

,or

other

sexually tran

smitted

diseases.

8.A

lways

check

expirationdate

oncon

dompackage.

9.S

torecon

doms

ina

cool,dry

place;ou

tof

directsu

nligh

t.

10.U

seon

lyw

ater-basedlu

bricants;

never

use

oil-basedlu

bricants

with

latex.

11.U

selu

bricants

inside

partner

and

inside

tipof

condom

forin

creased sensation

.

12.P

ut

oncon

dombefore

any

genital

contact.

13.D

on’t

opencon

dompackage

with

teeth;

youcan

tearth

econ

dom.

14.R

ollcon

domdow

nover

penis

tobase;

don’t

pull

it.

15.P

ull

out

ofvagin

a/anu

s/mou

thrigh

tafter

ejaculatin

g/comin

g.

16.T

iekn

otin

condom

and

disposeof

it.

17.N

everreu

sem

aleor

female

condom

s,an

dn

everu

seboth

atth

esam

e time.

18.F

emale

condom

sare

polyureth

ane,

baglikedevices

that

areplaced

in th

efem

alegen

italcan

alto

protectit

fromsem

inal

fluid

and

blood.

19.F

emale

condom

sredu

ceth

erisk

ofacqu

iring

diseases,su

chas

HIV, h

epatitisC

and

B,

and

other

ST

Ds,

and

ofbecom

ing

pregnan

t.

20.F

ororal

sex,u

sen

on-lu

bricatedcon

doms for oral-pen

is contact, an

d use

dental

dams

for oral-vaginal an

d oral-anal con

tact. If no den

tal dams are available, a piece

ofcon

domor

latexglove

or non

microw

avableplastic

wrap, su

ch as S

aran W

rap©cou

ld be used; w

ash off th

e talcum

powder if u

sing latex).

21.U

selatex

glovesfor

han

d-to-genital/h

and-to-an

alcon

tact. Wash

talcum

off exteriorof glove prior to u

se.

22.C

leanlu

bricant

applicatorsan

dsex

toysafter

use.

23.S

permicides,

such

asdiaph

ragmjelly

and

contraceptive

sponges,

do not kill

HIV

orh

epatitisB

orC

,so

they

shou

ldn

everbe

used

instead of

condom

s.

24.A

voidh

aving

sexdu

ring

aw

oman

’sm

enstru

alperiod.

25.D

on

otcon

sum

ebreast

milk.

Th

e AB

Cs of R

edu

cing H

arm w

ith L

atex(p

age two)

Mo

ving b

eyo

nd G

rief

Rem

emb

er Me b

y Wh

at I Valu

ed

PA

RT

I.T

he h

ouse is on

fire—w

hat d

o you save?

Imagin

e that you

r hou

se is on fire. A

ll your loved on

es and pets are safe.

You h

ave three m

inu

tes to select just th

reeitem

s from you

r hou

se that you

wou

ld wan

t to save. Write you

r choices below

:

PA

RT

II.E

pitap

h.

Write an

amu

sing epitaph

based on th

e three item

s you ch

ose to save. Be

creative, let go of your fear, an

d have fu

n.

15

Ha

rm Re

ductio

n with La

tex

How

to Use a C

ond

om

92

Notes

Mo

ving b

eyo

nd G

rief

16

How

to Use a C

ond

om(p

age two)

Ha

rm Re

ductio

n with La

tex

93

Gro

up Tw

elve

HEA

LTHY

SOC

IAL RELA

TION

SHIPS

AN

D A

CTIV

ITIES

Skills to Be

Lea

rned

■Id

entifying

and

Mainta

ining H

ealthy

Socia

l Rela

tionship

s

■C

om

munica

ting H

IV Sta

tus

■Id

entifying

and

Enga

ging

in He

althy

Socia

l Activitie

s

17

94

Ha

rm Re

ductio

n with La

tex

Usin

g the M

ale Con

dom

1.U

se a new

condom

with

each act of in

tercourse an

d check th

e expiration date.

2.C

arefully open

the con

dom package. (A

void damagin

g it with

fingern

ails, teeth,

or other sh

arp objects).

3.P

ut th

e condom

on as soon

as the pen

is is erect and before an

y genital con

tactw

ith th

e partner.

4.P

inch

the reservoir tip to en

sure th

at no air is trapped in

the tip of th

e condom

.(T

his can

cause th

e condom

to break).

5.U

se only w

ater-based lubrican

ts (e.g., K-Y

Jelly or glycerin) w

ith latex con

doms

(oil-based lubrican

ts {e.g., petroleum

jelly, shorten

ing, m

ineral oil, m

assage oils,body lotion

s, or cooking oil} w

eaken latex an

d shou

ld never be u

sed).

6.H

old the rim

of the con

dom firm

ly against th

e base of the pen

is durin

g with

-draw

al, and w

ithdraw

wh

ile the pen

is is still erect to prevent spillage.

7.W

hen

removin

g the con

dom, be certain

to milk th

e condom

off from th

e base ofpen

is, to ensu

re that sem

en does n

ot spill out. D

ispose of condom

properly.

8.A

void furth

er sexual con

tact with

your partn

er un

til both of you

wash

your sex

organs an

d any oth

er areas that cam

e in con

tact with

body fluids.

Sou

rces:C

enters for D

isease Con

trol and P

revention

(http://w

ww

.cdc.gov/mm

wr/preview

/mm

wrh

tml/rr5106a1.h

tm)

Am

erican S

ocial Health

Association

(http://w

ww

.ashastd.org/stdfaqs/con

dom_m

.htm

l)h

ttp://ww

w.safersex.org

He

althy So

cial Re

latio

nships a

nd A

ctivities

Are You

Infected

with

US

R’s?

1.O

n th

e reverse side of this w

orksheet, w

rite your first n

ame in

the cen

ter.

2.Iden

tify your u

nh

ealthy an

d health

y relationsh

ips (usin

g the person

’sin

itials).

3.T

hen

answ

er the follow

ing qu

estions:

a)D

oes the n

um

ber of drug-u

sers you spen

d time w

ith ou

tnu

mber

the n

um

ber of non

-drug u

sers you spen

d time w

ith?

b)

Do th

e activities you en

gage in w

ith you

r drug-u

sing “frien

ds” and

acquain

tances h

elp you to protect you

r health

?

c)D

oes the person

you spen

dth

e most

time w

ith en

courage you

and

help you

to protect your h

ealth?

If you an

swered “yes”, protect an

d nu

rture th

is relationsh

ip. If youan

swered “n

o”, it may be tim

e to make an

importan

t decision—

to choose

between

this relation

ship or you

r recovery.

YesN

o

Un

health

yH

ealthy

YesN

o

YesN

o

1.2.3.4.5.6.

1.2.3.4.5.6.

18

95

Ha

rm Re

ductio

n with La

tex

Th

e female con

dom is a sleeve-like device m

ade of polyureth

ane. It h

as a small closed en

d,an

d a larger open en

d. Each

end con

tains a flexible rin

g. Use th

is simple step-by-step gu

ideto u

sing fem

ale condom

s to assure th

at you are u

sing th

em properly du

ring vagin

al and/or

rectal intercou

rse.

Here’s H

ow:

1.T

he fem

ale condom

mu

st be properly positioned before an

y contact occu

rs between

the

penis an

d vagina an

d/or rectum

. Th

e female con

dom m

ay be used for both

vaginal an

drectal sexu

al intercou

rse.

2.F

or vaginal u

se, squeeze th

e smaller rin

g and in

sert it into th

e vagina. T

he large en

dsh

ould be placed over th

e vaginal open

ing to protect th

e outer gen

italia from in

fection.

3.F

or rectal use th

e small rin

g shou

ld be removed. P

lace the con

dom over th

e erectpen

is. Th

e condom

will be in

serted with

your partn

er’s penis.

4.B

e sure th

e penis goes directly in

to the large rin

g to preclude u

nprotected sexu

alcon

tact between

the pen

is and th

e vagina or rectu

m.

5.R

emove th

e condom

imm

ediately after sexual in

tercourse an

d before standin

g up. To

avoid semen

leakage the large ou

ter ring sh

ould be tw

isted. Carefu

lly pull th

e condom

out an

d dispose of it.

Tip

s:

1.T

ake your tim

e and pu

sh th

e female con

dom u

p to wh

ere you can

feel the pu

bic bone.

You w

ill feel the pu

bic bone by cu

rving you

r index fin

ger wh

en it is a cou

ple of inch

esin

side the vagin

a. If the fem

ale condom

is too slippery to insert, let it go an

d start over.

2.M

ake sure th

e condom

is inserted (n

ot twisted) in

to the vagin

a.

3.U

se care wh

en storin

g condom

s. Th

ey shou

ld not be kept in

places with

extreme

temperatu

res either h

ot or cold. Do n

ot store them

in a pocket or billfold.

4.U

se a new

condom

for each act of sexu

al intercou

rse. Do n

ot use th

e same con

dom for

vaginal an

d rectal sex.

5.N

ever use a m

ale condom

and a fem

ale condom

at the sam

e time.

6.A

lways u

se water-based lu

bricants w

ith con

doms. O

il-based lubrican

ts will destroy

latex condom

s. Lu

bricants are n

ot needed w

hen

condom

s are used for oral sex.

7.N

ever throw

a used con

dom in

to your toilet, th

ey can easily clog u

p your pipes an

drequ

ire expensive plu

mbin

g repairs.

8.T

he fem

ale condom

can be in

serted up to 8 h

ours before sex. H

owever, m

ost wom

enin

sert the con

dom betw

een 2 to 20 m

inu

tes before sex. It is for one-tim

e use. U

se an

ew fem

ale condom

with

each sex act.

Wh

at You N

eed:

•W

ater-based lubrican

t•

Fem

ale condom

Sou

rces:C

enters for D

isease Con

trol and P

revention

(http://w

ww

.cdc.gov/mm

wr/preview

/mm

wrh

tml/rr5106a1.h

tm)

Th

e Fem

ale Con

dom C

ompan

y (http://w

ww

.femaleh

ealth.com

/theprodu

ct.htm

l)A

merican

Social H

ealth A

ssociation (h

ttp://ww

w.ash

astd.org/stdfaqs/condom

_f.htm

l)h

ttp://ww

w.safersex.org

Usin

g the F

emale C

ond

om

He

althy So

cial Re

latio

nships a

nd A

ctivities

19

96

Ha

rm Re

ductio

n with La

tex

Con

dom

Negotiation

with

Your P

artner

He

althy So

cial Re

latio

nships a

nd A

ctivities

Plan

nin

g a “Fu

n-d

ay” Team

Work

sheet

10:00 AM

10:30

Tim

e

Select d

ay for activities:S

aturd

ayS

un

day

Total h

ours

(min

imu

m five h

rs)T

otal cost $(m

aximu

m $30)

Sp

ecify the A

ctivityE

stimate C

ostP

reparation

sR

equ

ired

11:00

11:30

12:00 PM

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:30

7:00

7:30

8:00

20

97

Con

dom

Negotiation

with

Your P

artner

(page tw

o)

Ha

rm Re

ductio

n with La

tex

He

althy So

cial Re

latio

nships a

nd A

ctivities

Exercise L

og

Activity

Du

rationD

ate

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

____________________________________ _____________________ __________

21

Notes

Ha

rm Re

ductio

n with La

tex

Notes

He

althy So

cial Re

latio

nships a

nd A

ctivities

98

22

Gro

up Fo

ur

NEG

OTIA

TING

HA

RM RED

UC

TION

WITH

PARTN

ERS

Skills to Be

Lea

rned

■H

arm

Red

uction N

eg

otia

tion a

ndC

om

munica

tion Skills

■Ero

ticizing Sa

fer Se

xual Pra

ctices

HH

RP

+C

lient W

orkb

ook

Sch

edu

les:

NA

Sch

edules

Needle E

xchan

ge Location

s

Tran

sportation S

chedu

les

23

1.L

earn as m

uch

as you can

about H

IV, HB

V, HC

V, and oth

er ST

Ds. T

hat

will m

ake it easier to talk about safer sex.

2.D

ecide wh

en you

wan

t to talk. Th

e best time is n

ot just before h

aving

sex or wh

en you

are high

.

3.D

ecide in you

r own

min

d wh

at you w

ill and w

on’t do du

ring sex.

4.G

ive your partn

er time to th

ink abou

t wh

at you’re sayin

g. Don

’t rush

.

5.P

ay attention

to how

your partn

er un

derstands w

hat you

’re saying.

6.S

low dow

n if you

need to.

7.T

alk about th

e times th

at make it h

ard to have safer sex. T

hese m

ay betim

es wh

en you

don’t h

ave condom

s or have u

sed alcohol or dru

gs. Try

to decide wh

at to do at those tim

es so you can

both redu

ce the risk of

contractin

g HIV, H

BV, an

d HC

V.

8.If you

r partner does n

ot wan

t to practice safer sex, ask yourself if th

is isth

e type of person you

really wan

t to have sex w

ith. W

hen

drugs an

dalcoh

ol are used, be m

ore attentive to preven

tion beh

aviors such

as usin

gcon

doms.

9.If you

r partner gets an

gry or threaten

s you w

hen

you raise th

e issue of

condom

s, seek help from

a violence preven

tion program

.

Please refer to G

roup 3 H

and

out, C

ondom

Negotiation

with

Your P

artner (pg.

16), for other strategies.

How

to Talk

with

Your P

artner ab

out S

afer Sex

Sou

rce: NID

AC

omm

un

ity-based Ou

treach M

odel Man

ual: N

ational In

stitute on

Dru

g Abu

se, NIH

Pu

blication N

um

ber 00-4812, printed S

eptember 2000.

Ne

go

tiating

Ha

rm Re

ductio

n with Pa

rtners

PL

AC

E-H

OL

DE

R

LO

CA

LN

AS

CH

ED

UL

E

24

101 Ways to M

ake L

ove with

out “D

oin It”

Ne

go

tiating

Ha

rm Re

ductio

n with Pa

rtners

1.Tell th

e other person

that you

loveth

em2.

Give or get a h

ug

3. Make th

e other person

feel importan

tan

d respected4.

Kiss

5.H

ave fun

together

6.Tell th

e other person

that you

care7.

Hold h

ands

8.G

o for a long bike ride

9.G

ive a special gift10.

Be th

ere wh

en a frien

d is needed

11.S

pend tim

e together

12.G

o to a movie

13.W

alk arm in

arm in

the w

oods14.

Sh

are dreams w

ith each

other

15.S

nu

ggle up togeth

er16.

Sit togeth

er in th

e park17.

Have a special tape of love son

gs18.

Talk open

ly about you

r feelings

19.T

ake a walk togeth

er20.

Go ou

t to eat21.

Have a picn

ic22.

Play a gam

e of Frisbee

23.G

ive complim

ents

24.R

elax in a w

hirlpool

25.G

o swim

min

g26.

Just be close

27.G

o grocery shoppin

g28.

Cook a m

eal together

29.Tou

ch each

other in

a loving w

ay30.

Do h

omew

ork together

31.P

lan an

d go on a road trip togeth

er32.

Th

row a party togeth

er33.

Bake cookies

34.G

o to the library

35.B

rowse in

a mu

seum

36.Ju

st be there

37.F

ind ou

t wh

at’s special for the oth

erperson

and do it

38.E

xercise together

39.G

aze at each oth

er40.

Wash

each oth

er’s cars41.

Go fish

ing

42.T

alk to each oth

er43.

Listen

to hu

rts44.

Do a w

ork project together

45.C

hoose a special, favorite son

g46.

Listen

to joys47.

Hold on

e anoth

er close48.

Use eye con

tact to share a private

thou

ght

49.W

rite each oth

er letters50.

Talk on

the teleph

one

51.T

rust on

e anoth

er52.

Give or receive a prom

ise ring

53.M

eet other’s fam

ily54.

Go h

iking togeth

er55.

Make sacrifices for on

e anoth

er56.

Walk

57.H

ide a love note w

here th

e other w

illfin

d it58.

Sen

d candy

59.R

espect each oth

er60.

Go for a m

oonligh

t walk

61.G

ive each oth

er sexy look62.

Write a poem

63.S

end flow

ers64.

Eat din

ner by can

dlelight

65.G

o to a concert

66.W

atch th

e sun

rise together

67.T

ake a drive together

PL

AC

E-H

OL

DE

R

NE

ED

LE

EX

CH

AN

GE

PR

OG

RA

M S

CH

ED

UL

E

25

101 Ways to M

ake L

ove with

out “D

oin It”

(page tw

o)

Ha

rm Re

ductio

n with La

tex

68.G

ive each oth

er pet nam

es69.

Go sigh

tseeing

70.R

ent a video

71.D

o thin

gs for each oth

er with

out bein

g asked72.

Propose m

arriage73.

Wh

isper someth

ing n

ice into th

e other’s ear

74.B

e best friends

75.T

ake a carriage ride throu

gh th

e park76.

Go ou

t dancin

g77.

Play m

usic togeth

er78.

Flirt w

ith each

other

79.L

augh

at someth

ing fu

nn

y together

80.B

e faithfu

l81.

Impress each

other

82.M

ake a list of thin

gs you like abou

t each oth

er83.

Read a book an

d discuss it

84.M

eet each oth

er’s friends

85.G

o riding

86.C

ook each oth

er’s favorite foods87.

Fin

d out w

hat m

akes the oth

er happy

88.M

ake each oth

er gifts89.

Be carin

g90.

Watch

the su

nset

91.D

edicate a song on

the radio

92.S

end a fu

nn

y card93.

Sh

are lifetime goals w

ith each

other

94.P

lay “footsie”95.

Sh

are private jokes96.

Th

ink abou

t each oth

er97.

Fin

d out w

hat m

akes the oth

er sad98.

Go skatin

g99.

Trade class rin

gs100.

Sh

are an ice cream

cone

101.H

ave your pictu

re taken togeth

er

Bu

s Sch

edu

les

Destin

ation:

Bu

s Nu

mb

er:B

us S

top:

Dep

arture T

imes:

Arrival T

imes:

Direction

s:

Destin

ation:

Bu

s Nu

mb

er:B

us S

top:

Dep

arture T

imes:

Arrival T

imes:

Direction

s:

26

Notes

Ne

go

tiating

Ha

rm Re

ductio

n with Pa

rtners

FOREXAMPLEONLY

Referral L

ist

In psych

iatric emergen

cy:

Yale New

Haven

Hospital: 688-2222

20 York Street

New

Haven

, CT

06519E

mergen

cy medical an

d psychiatric care.

West H

aven V

AM

edical Cen

ter: 932-571190 C

ampbell A

venu

eW

est Haven

, CT

06516E

mergen

cy medical an

d psychiatric care for veteran

s.

Hotlin

es:

Crisis in

tervention

and su

icide prevention

:In

foline: 1-800-203-1234

419 Wh

alley Aven

ue

New

Haven

, CT

06511

For profession

al help m

anagin

g depression:

Con

necticu

t Men

tal Health

Cen

ter (CM

HC

): 974-7300 or 974-771334 P

ark Street

New

Haven

, CT

06519M

any differen

t coun

seling services are offered in

cludin

g family an

d individu

al therapy.

Dixw

ell New

hallville

Com

mu

nity M

ental H

ealth S

ervices: 776-8390660 W

inch

ester Squ

areN

ew H

aven, C

T 06511

Individu

al and fam

ily coun

seling.

West H

aven V

AM

edical Cen

ter: 932-5711 x3887 (triage)90 C

ampbell A

venu

eW

est Haven

, CT

06516P

rovides both in

patient an

d outpatien

t psychiatric care for veteran

s.

Nation

al ST

D H

otline: 1-800-227-8922

Cen

ter for Disease C

ontrol

Atlan

ta, GA

30333O

ffers inform

ation on

sexually tran

smitted diseases

MA

NA

GIN

G U

NH

EA

LT

HY

EM

OT

ION

S

27

Gro

up Five

PREVEN

TING

RELAPSE TO

RISKY

BEHA

VIO

R:

RECO

VERY

AS A

JOU

RNEY

Skills to Be

Lea

rned

■C

rea

te a

Roa

d M

ap

for the

Journe

yo

f Reco

very

■Le

arn Re

lap

se Pre

ventio

n Skills

■Id

entify Ea

rly Wa

rning Sig

ns

■U

nde

rstand

See

ming

ly Irrele

vant D

ecisio

ns

FOREXAMPLEONLY

Plan

ned P

arenth

ood of Con

necticu

t: 387-313150 F

itch S

treetN

ew H

aven, C

T 06515

Inform

ation an

d coun

seling arou

nd issu

es of hu

man

sexuality, fam

ily plann

ing an

d pregn

ancy

AID

S In

terfaith N

etwork: 624-4350

1303 Ch

apel Street

New

Haven

, CT

06511W

eekly Su

pport Grou

p for AID

S; C

oun

seling In

dividual &

Fam

ily; Cloth

ing; F

ood; M

edical transportation

; Th

ey also provide a nu

mber of oth

er services.

Dom

estic Violen

ce Services of G

reater New

Haven

: 789-8104P.O

. Box 1329

New

Haven

, CT

06505P

rovide support grou

ps, crisis interven

tion cou

nselin

g, protective services.

Paren

ts An

onym

ous: 1-800-841-4314

60 Lorrain

e St.

Hartford, C

T 06105

Self-h

elp group for paren

ts un

der stress wh

o wan

t to improve th

eir relationsh

ips with

their ch

ildren.

Sexu

al Assau

lt Interven

tion: 624-2273

131 Dw

ight S

treetN

ew H

aven, C

T 06511

MA

NA

GIN

G U

NH

EA

LT

HY

EM

OT

ION

S(page tw

o)

28

Preve

nting Re

lap

se to

Risky Beha

vior

Ru

les of the R

oad: M

y personal w

arnin

g signs th

at there m

ay be a high

risk situation

ahead

are as follows:

Extern

al warn

ings

Intern

al warn

ings

Tools an

d S

kills I N

eed for M

y Jou

rney of R

ecovery:

Navigators:

Gu

ides I can

trust for m

y journ

ey of recovery are:

Nam

e Teleph

one

Ways I C

an M

ake M

y En

vironm

ent S

afe, Reliab

le, and

Su

pp

ortive:

Person

al Road

Map

for Jou

rney of R

ecovery

1)2)3)

4)5)6)

1)2)3)1)2)3)

FOREXAMPLEONLY

UC

ON

N E

xtension

: 789-7865305 S

kiff St.

North

Haven

, CT

06473F

ree inform

ation on

gardenin

g, health

, nu

trition.

Arts C

oun

cil of Greater N

ew H

aven: 772-2788

70 Au

dubon

St.

New

Haven

, CT

06511C

ultu

ral events calen

dar

City of N

ew H

aven P

arks and R

ecreation: 946-8020

720 Edgew

ood Ave.

New

Haven

, CT

06511In

formation

on program

s run

by the city parks; offers a n

um

ber of different season

alactivities.

City of N

ew H

aven L

ibraries: 946-8130133 E

lm S

treetN

ew H

aven, C

T 06510

Books, In

formation

, Videos, M

usic, th

e libraries offer a nu

mber of differen

t education

alprogram

s.

Adu

lt Edu

cation: 946-5884

Wilbu

r Cross H

igh S

chool

New

Haven

, CT

06511E

venin

g classes in a n

um

ber of different areas in

cludin

g art and m

usic. F

or evenin

gcom

puter classes ca11 946-8748, M

-Th

7-9pm

Paren

ts With

out P

artners: (860) 645-7722

P.O. B

ox 274H

artford, CT

06101M

embersh

ip organization

that provides dan

ces and su

pport for single paren

ts.

Mu

seum

s:

Peabody M

useu

m of N

atural H

istory: 432-5050170 W

hitn

ey Aven

ue

New

Haven

, CT

06511

Mystic M

arinelife A

quariu

m: (860) 572-5955

Coogan

Bou

levardM

ystic, CT

06355

Th

e Ch

ildren’s M

useu

m: 562-5437

567 State S

treetN

ew H

aven, C

T 06511

LE

AR

NIN

G H

OW

TO

HA

VE

FU

N W

ITH

OU

TD

RU

GS

29

Preve

nting Re

lap

se to

Risky Beha

vior

Person

al Road

Map

for Jou

rney of R

ecovery(p

age two)

Em

ergency P

rocedu

re to Red

uce H

arm if I’m

in a H

igh R

iskS

ituation

:

1.In

high

risk sexual situ

ations, I w

ill always u

se condom

s.

2.If in

jecting dru

gs, I will alw

ays use n

ew or bleach

-cleaned n

eedle.

3.If I feel lost, in

danger of doin

g someth

ing risky, or h

ave already done

someth

ing risky, I w

ill callfor h

elp.(Teleph

one N

o.)

4.W

hile w

aiting for h

elp to arrive, I will rem

ind m

yself of the ben

efits ofresu

min

g my jou

rney of recovery, an

d the n

egative consequ

ences to

myself an

d others of con

tinu

ing to take th

is detour.

Person

al benefits of recovery

Negative con

sequen

ces of detour

1)2)3)

1)2)3)

FOREXAMPLEONLY

Referral L

ist

AP

T V

ocational S

ervices: 781-4670904 H

oward A

venu

eN

ew H

aven, C

T 06519

Provides vocation

al coun

seling/train

ing to A

PT

clients.

State of C

onn

ecticut D

epartmen

t of Labor: 789-7738

37 Marn

e Street

Ham

den, C

T 06514

Th

ey offer career coun

seling, job train

ing, an

d job placemen

t services.

New

Haven

Private In

dustry C

oun

cil: 624-1493580 E

lla T. Grasso B

oulevard

New

Haven

, CT

06519T

hey offer em

ploymen

t assistance an

d job trainin

g.

VO

CA

TIO

NA

LSE

RV

ICE

S

30

Preve

nting Re

lap

se to

Risky Beha

vior

Each

team w

ill have 10 m

inu

tes to create a story abou

t a guy (or gal)

nam

ed S

id w

ho is H

IV-p

ositive and

is in a d

rug ad

diction

treatmen

tp

rogram.

Begin

nin

g:

Th

e story begins w

ith S

id deciding to en

gage in a particu

lar activity:

On

ce upon

a time, th

ere was a gu

y/gal n

amed

Sid

, wh

o was goin

g to:

(Write th

e activity that you

r coun

selor has assign

ed to your team

here)

Mid

dle:

Th

e story un

folds with

Sid h

aving to m

ake several decisions related to th

isactivity th

at could poten

tially put h

is recovery at risk.

On

his w

ay to(activity)

Sid

decid

es to:(w

rite decisions below

)

Seem

ingly irrelevan

t decision

s. On

e point for each

seemin

gly irrelevant

decision th

e team can

identify th

at migh

t jeopardize Sid’s recovery w

hile

pursu

ing th

is activity:

En

din

g:

Th

e story shou

ld have a h

appy endin

g! Th

e story ends w

ith S

id successfu

llycopin

g with

the above situ

ations an

d engagin

g in th

e activity with

out

relapse.

SID

Storytellin

g Gam

e Work

sheet

1)2)3)

6)7)8)4)5)

9)

10)

FOREXAMPLEONLY

Sch

edu

les of NA

and

12-Step

Meetin

gs

Twelve S

tep Clu

b: 934-875663 H

amilton

Street

New

Haven

, CT

06511D

rop-in S

ocial center for recoverin

g substan

ce abusers. A

Aan

d NA

groups h

eld on site.

Inform

ation available at:

867 Jones H

ill Rd. (C

VS

Plaza)

West H

aven, C

T 06516

AL

-AN

ON

Fam

ily Grou

ps: (888) 825-2666.N

ew H

aven, C

TH

elps family m

embers of su

bstance abu

sers solve their com

mon

problems.

Narcotics A

non

ymou

s Grou

p Meetin

gs: (800) 627-3543P.O

. Box 1075

Woodbu

ry, CT

06798

Alcoh

olics An

onym

ous: 624-6063

Call for m

eetings, 24 h

our an

swerin

g service.

SOC

IAL

SUP

PO

RT

31

Preve

nting Re

lap

se to

Risky Beha

vior

SID

Storytellin

g Gam

e Work

sheet

(page tw

o)

Sid

successfu

lly copes with

each of th

ese situation

s by:

Tools an

d/or sk

ills dem

onstrated

by S

id.

On

e point for each

tool or skillth

at Sid dem

onstrates in

the story th

at helped h

im preven

t or reduce h

arm to

self or others.

• Team

elects a storyteller to tell their story of S

id to the grou

p.

• Team

with

the m

ost points w

ins th

e game.

Note:

Bon

us poin

ts award

ed for creativity an

d participation

of all team

mem

bers.

1)2)3)

6)7)8)4)5)

9)

10)

FOREXAMPLEONLY

Yale New

Haven

Hospital: 688-4242

20 York Street

New

Haven

, CT

06510P

rotective Services : A

dult . O

ffers compreh

ensive m

edical care and crises in

tervention

coun

seling.

Protective S

ervices: Ch

ildren. C

hild sexu

al abuse iden

tification an

d treatmen

t. Cou

nselin

gfor th

e family an

d child.

Birm

ingh

am G

roup - th

e Um

brella: 736-9944 or 736-2601435 E

ast Main

Street

An

sonia, C

T 06401

Th

ey offer self-help grou

ps, individu

al and fam

ily coun

seling, em

ergency sh

elter forbattered w

omen

, and a sexu

al assault crises in

tervention

hotlin

e.

Coordin

ating C

oun

cil for Ch

ildren In

Crises: 624-2600

900 Gran

d Aven

ue

New

Haven

, CT

06511T

hey offer fam

ily education

, protective services for battered wom

en, protective services for

children

, and sexu

al assault in

tervention

and treatm

ent plan

nin

g.

Departm

ent of C

hildren

and F

amilies: 789-7678

2105 State S

treetH

amden

, CT

06514T

hey offer paren

ts support grou

ps, wom

en’s su

pport services and sh

elter, protective servicesfor ch

ildren an

d emergen

cy shelter.

Con

necticu

t Men

tal Health

Cen

ter (CM

HC

): 789-7300 or 789-771334 P

ark Street

New

Haven

, CT

06519C

ompreh

ensive m

ental h

ealth services, fam

ily life education

and su

pport groups for

parents, an

d protective services for children

.

Dom

estic Violen

ce Services of G

reater New

Haven

: 789-8104 or 865-1957P.O

. Box 1329

New

Haven

, CT

06505P

rovide support grou

ps, crisis interven

tion cou

nselin

g, protective services.

Hospital of S

t. Raph

ael Men

tal Health

Resou

rce Cen

ter: 784-8700O

ffer a weekly th

erapy group for m

en w

ho w

ant to en

d their violen

ce towards w

omen

. Fees

are determin

ed on a slidin

g scale.

AN

GE

R M

AN

AG

EM

EN

T

32

Notes

Preve

nting Re

lap

se to

Risky Beha

vior