health care participation...ddi 2 tablets twice a day take a half-hour before (didanosine) a full...
TRANSCRIPT
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
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)
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
12:00 PM
1:00
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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
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)
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
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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)
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
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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
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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)
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
9:00
10:00
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
54321
13 191817161514
27 28
20 262524232221
6 121110987
65
He
althy Life
style C
hoice
s
FDA Food Pyramid
March 2005
Sun Mon Tues Wed Thurs Fri Sat
54321
13 191817161514
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
Sun Mon Tues Wed Thurs Fri Sat
21
10 161514131211
24 302928272625
17 232221201918
3 987654
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
Sun Mon Tues Wed Thurs Fri Sat
1 765432
15 212019181716
29 3130
22 282726252423
8 14131211109
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
Sun Mon Tues Wed Thurs Fri Sat
4321
12 181716151413
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
14 201918171615
28 313029
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
Sun Mon Tues Wed Thurs Fri Sat
54321
13 191817161514
27 302928
20 262524232221
6 121110987
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
Sun Mon Tues Wed Thurs Fri Sat
321
11 171615141312
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