Primary HIV prevention reduces the incidence of transmission (e.g., fewer people become HIV infected), whereas secondary HIV prevention reduces the prevalence and severity of the disease through early detection and prompt intervention (e.g., fewer HIV-positive people progress to AIDS). For HIV-infected clients in substance abuse treatment, a comprehensive approach to HIV prevention must include three goals: (1) living substance free and sober, (2) slowing or halting the progression of HIV/AIDS, and (3) reducing HIV risktaking.This third goal is crucial for the client in several ways:Different individuals may be infected with different strains of HIV. Because HIV mutates frequently, an individual can be infected with treatment-resistant forms of the virus. The possibility exists that treatment-resistant forms of the virus can be spread even to individuals who are already infected with HIV, and, if this is the case, further treatment options could be reduced. (See Chapter 3 for more information about resistance.)Behaviors that put an individual at risk for HIV will also put him at risk for other infections, such as hepatitis B or C, which can complicate treatment of HIV/AIDS.Clients do not want to transmit HIV to the people who are close to them.In addition to the ways in which HIV prevention efforts directly help the client, the benefit to family and community is obvious. HIV prevention for those already infected is a key component of treatment for both the client and community.Substance abuse treatment personnel may be among the few people the recovering abuser trusts. By taking the opportunity to advise each client on HIV risk reduction, whether that client is known to be HIV infected or not, the substance abuse treatment professional assists both the individual and all those connected to him. HIV has been spreading rapidly among substance abusers since the start of the pandemic but can be slowed if they are taught the skills to prevent transmission.Risk reduction originally was called harm-reduction counseling by its creator, Edith Springer, in the late 1980s and was popularized by pioneering syringe exchange advocates David Purchase and Dan Bigg in the early 1990s. The term harm reduction was first associated with the approach of identifying and supporting any positive change by substance abusers toward less frequent substance use or abstinence. In this respect, the harm-reduction approach endorsed the social work adage of meeting the client where he is.In the mid-1990s, the term harm reduction was unfortunately associated with a brief and unsuccessful drug legalization/decriminal- ization movement. In an effort to distinguish the more specific service provision response from the larger, disparate political movement, advocates renamed the approach risk reduction. The concept of risk reduction was further expanded to include both substance-related and sex behavior-related risks for HIV infection. Risk-reduction interventions have included media campaigns (Bortolotti et al., 1988; Power et al., 1988), syringe exchange programs (Des Jarlais et al., 1996; Watters et al., 1994), and substance abuse treatment (Ball et al., 1988; Booth et al., 1998; Hartgers et al., 1992; Iguchi et al., 1996).Immune System