"Opt Out" HIV Screening

In September the CDC revised its HIV testing recommendations. They now recommend that all persons age 13 through 64 be screened for HIV. They also recommend annual screening for "high risk" people. An "Opt Out" model is proposed. I understand this to mean that when routine blood work is to be obtained an HIV test will also be done. The patient will be informed of this and consent for the HIV test will be included in the general consent to blood work. The patient may opt out of the HIV test. This is meant to apply in any medical facility including drug treatment facilities.
Here are my questions:
Are any of you doing this?
If so how are results disclosed and who handles the disclosure?
What measures are taken to avoid a positive result being inferred merely by triggering the disclosure system?
Counselors at my clinic have also raised concerns that patients enrolling in a methadone clinic are "too early" in their recovery to handle learning they have HIV.
Any thoughts?

A Harm Reductionist approach to buprenorphine

This won't be new to any of you who have EVER heard me speak on buprenorphine however my harm reduction based approach to buprenorphine therapy for opiate addiction in primary care is now officially published someplace you can cite! Click on the highlighted bit to see a PDF of the publication. Be patient it is slow to open. Some of my other slide sets are also available to view and canabalize at will.
Happy Harm Reducing and Hannukah!

NYS - DOH Substance Use and HIV Guidelines

I am resending my last post as I did not give it a title:

link to NYS - DOH Substance Use and HIV Guidelines
http://www.hivguidelines.org/Content.aspx?PageID=262
the chapter : Working with the Active User - just released 10/06

and thanks to Melinda/Ro for getting this going
nancy murphy

Needle Exchange in a Methadone Clinic

Greetings!

I have been so excited since the conference, and I returned to my methadone clinic here at San Francisco General Hospital determined to begin distributing clean needles to our patients who want them. Amazingly, I have strong support from the clinic leadership, and we are developing a protocol. Apparently, no other methadone clinic in California is currently distributing clean needles. Thus far there don't seem to be any insurmountable obstacles. At this point we are looking at providing needles for our own patients only, as there are too many complicated issues with serving other patients. However we hope that these clean needles will find distribution to other users in the broader community.

I'm interested in thoughts from any of you out there and advice about potential challenges. Also advice about needle disposal kits and other adjunctives would be great.

We are also moving forward with a naloxone distribution program which I hope to see in place for the new calendar year.

Thanks to all for the huge boost of energy coming out of our gathering!

--Brad Shapiro

bloggng in from the uk

Hi from the UK Ro and everyone else!

I hope the exams go well Ro, its a good idea to invite your fellow students and teachers to contribute to our blog - a good way of opening up the discussion. I've been telling my colleagues at the university of Greenwich here in London all about the recent conference - our meeting and the blog of course - they are really interested but generally have not had an opportunity to explore HR much yet - many of them work in mental health, child health etc etc.

However if I can get some of them to participate here then it would be a good way to find out more from other international and perhaps UK-based colleagues. I'm going to 'prod' (safely!) my dear colleague, Peter Phillips, also in London, who attended our recent meeting to start blogging here as well - although like Ro, he's busy preparing for his PhD defense in a few weeks time - GOOD LUCK Pea! :)

Hope to hear a lot more from all you guys soooooooon!

Olive McKeown (London) oliviamck@hotmail.com

Hello Ro here. I just wanted to check in with everyone. I'm studying like mad for my comprehensive exams. I am working on my masters in Chinese Medicine @ ACTCM in SF. We have a community clinic at our school and have off sites @ St.James infirmary, Haight Ashbury Free Clinic, and the Women's Community Clinic and free community ear detox clinics @ our campus in Potrero Hill. I am currently trying to get the admin. at school to require a HR training for all interns that work at the off sites. I will be inviting a few classmates and teachers(LAC's/OMD's) to join our group. I hope everyone is doing well. I'll be able to participate a bit more after my comps on DEC 15.

Good to see the Blog!

Hello all

I think this is an excellent beginning - and considering my lack of blogging skills, it seems to be pretty easy to figure out- so I am looking forward to some interesting exchanges with the group and other bloggers.

I am delighted I was able to make it to the meeting in Oakland recently where the idea for this blog came about and I found meeting with the group a very worthwhile and interesting experience. I had never been to the USA before and meeting up with others with similar views on harm-reduction, practice and education of health professionals / workers was a really wonderful experience. I am particularly interested in how we can influence substance and harm-reduction elements of curricula for health professionals at pre-registration (basic) and post-quailfying / post-grad levels.

I can't believe that I am posting one of the first blogs....but I hope we will see many others very soon. I look forward to logging on to read your messages on a regular basis.

Olive McKeown

A Meeting of The Minds

Friends and Fellow Harm Reductionists:
Here are the minutes of our meeting which I am posting on Nancy's behalf.

Minutes from Networking Meeting of Health Care Providers in Harm Reduction
Harm Reduction Conference – Oakland, CA 11-06
Facilitator: Sharon Stancliff
Minutes: Nancy Murphy

On Friday Nov 10, 2006 a meeting of approximately 30 people was held to discuss how to begin the formation and continuation of a group called
Health Care Providers in Harm Reduction.

The main focus of the meeting was to establish the group and ongoing communication and then to determine longer term goals and when/where/how the group might meet again after the first goal is accomplished.

Melinda Campopino and Ro Guilano (hope I have the spelling correct) agreed to take the email list and create a blog for the group. The details of how this will work, how others might join, who will be insiders/outsiders, how to post, etc will be sent to the group by the above.

Sharon Stancliff was to speak to folks at HRC about having this blog be a link on the HRC webpage.

It was agreed that all who were at the meeting would make an effort to invite a friend to join the group and make 2 postings to the blog and work to keep the momentum of the meeting and group going.

Topics of Interest to the Group:

How the group could use their collective knowledge to be a resource and mutual support for each other/others.
How the group might be of use around issues of teaching, training, placements, precepting, curriculum development and consultation (to name a few).
Possibly have an area called: “Stories from the Field”.
Possibly have an are area for posting papers, resources, etc.
Possibly have links to other resources – such as information on HRC. website or other related materials / areas.
Upcoming and related conferences – 2007 conferences: methamphetamine conference (salt lake city); international harm reduction conference (Poland); drug policy alliance (new orleans).
Be prepared to get postings to the blog from those who will have a difference of opinion.

If you know anyone who was at the meeting and has NOT received an electronic invitation to post on the blog please tell them to visit the blog and leave a comment so I can track them down and get them on board.