Substance abuse treatment in human immunodeficiency virus: The role of patient–provider discussions

{ "0" : "Department of Medicine, Oregon Health and Science University, Portland, OR 97239, USA" , "1" : "Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA" , "2" : "Agency for Healthcare Research and Quality, Rockville, MD 20850, USA" , "3" : "Community Medical Alliance, Boston, MA 02210, USA" , "4" : "Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA" , "6" : "HIV" , "7" : "Communication" , "8" : "Health services accessibility" , "9" : "African Americans" , "10" : "Substance-related disorders" , "11" : "Transportation"}
Journal of substance abuse treatment (Impact Factor: 2.9). 10/2008; 35(3):294-303. DOI: 10.1016/j.jsat.2007.11.005


Substance abuse treatment is associated with decreases in human immunodeficiency virus (HIV) risk behavior and can improve HIV outcomes. The purpose of this study was to examine factors associated with substance abuse treatment utilization, including patient–provider discussions of substance use issues. We surveyed 951 HIV-infected adults receiving care at 14 HIV Research Network primary care sites regarding drug and alcohol use, substance abuse treatment, and provider discussions of substance use issues. Although 71% reported substance use, only 24% reported receiving substance abuse treatment and less than half reported discussing substance use issues with their HIV providers. In adjusted logistic regression models, receipt of substance abuse treatment was associated with patient–provider discussions. Patient–provider discussions of substance use issues were associated with current drug use, hazardous or binge drinking, and Black race or ethnicity, though substance use was comparable between Blacks and Whites. These data suggest potential opportunities for improving engagement in substance abuse treatment services.

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    • "These medical needs can be complicated by substance use. Research suggests as many as 70% of people living with HIV/AIDS (PLHIVs) used illicit drugs or reported hazardous alcohol use in the previous year (Korthuis et al., 2008; Sohler et al., 2007). Illicit drug use is associated with negative outcomes for PLHIVs, including: lower adherence to antiretroviral therapy, poor immune suppression, disease progression, and mortality (Balsa, French, Maclean, & Norton, 2009; Brubacher et al., 2008; French et al., 2000; Haber et al., 2009; Kerr et al., 2005; Neblett et al., 2011; Palepu et al., 2001). "
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    ABSTRACT: Hospitals seem to be places where harm reduction approaches could have great benefit but few have responded to the needs of people who use drugs. Drawing on recent theoretical contributions to harm reduction from health geography, we examine how the implementation of harm reduction is shaped by space and contested understandings of place and health. We examine how drug use and harm reduction approaches pose challenges and offer opportunities in hospital-based care using interview data from people living with HIV and who were or had recently been admitted to a hospital with an innovative harm reduction policy. Our data reveal the contested spatial arrangements (and the related practices and corporeal relations) that occur due to the discordance between harm reduction and hospital regulatory policy. Rather than de-stigmatizing drug use at Casey House Hospital, the adoption of the harm reduction policy sparked inter-client conflict, reproduced dominant discourses about health and drug users, and highlights the challenges of sharing space when drug use is involved. The hospital setting produces particular ways of being for people who use and those who do not use drugs and the demarcation of space in a drug using context. Moving forward, harm reduction practice and research needs to consider more than just interactions between drug users and healthcare providers, or the role of administrative policies; it needs to position ethics at the forefront of understanding the collisions between people, drug use, place, and space. We raise questions about the relationship between subjectivity and spatial arrangements in mediating the success of harm reduction.
    Full-text · Article · May 2014 · The International journal on drug policy
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    • "The study identified those in need of alcohol and drug treatment in greater numbers among the unemployed , unmarried, or uninsured or from low-income families and further identified those not receiving needed treatment most prevalent among older adults, women, Hispanics, individuals with higher-than-average incomes, and individuals with private insurance (Han et al., 2011). The proportion of individuals living with HIV disease who also have substance use problems have been reported to be high (Bing et al., 2001; Chander et al., 2009), yet treatment programs are also underused by this group (Burnam et al., 2001; Korthuis et al., 2008; Palepu et al., 2006). Unmet need for substance use treatment varies widely by state. "
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    ABSTRACT: Background: 23.1 million individuals meet the diagnostic criteria for a substance use disorder and are in need of treatment, yet only about 10% receive treatment. Risk behaviors for HIV among illicit drug users are endemic. Less than half of AOD treatment programs offer testing for HIV or STIs. Methods: Data were from 1189 respondents who reported using 1 or more illicit drugs in the past 30 days and were sampled in the Countywide Risk Assessment Survey (CRAS) conducted by 51 HIV prevention contractors in Los Angeles County CA. Results: A logistic regression model determined that those respondents who accessed drug treatment were more likely to: use a needle exchange, use mental health, HIV, and STD treatment services. They were also more likely to be involved with child welfare. Those who accessed AOD treatment had more concurrent sex partners and used a greater number of drugs, particularly heroin, methamphetamine, and crack cocaine, than those who did not. They were also more likely to be HIV+. Conclusions: This analysis of data from a community-based sample of illicit drug users found further evidence of the critical importance of integrating AOD treatment and HIV services. Findings also indicate a need to screen for STIs among those accessing AOD treatment and to focus on safer sex practices regarding concurrent relationships. Mental health and child welfare agencies were found to be potential linkage points for HIV prevention services.
    Full-text · Conference Paper · Oct 2012
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    ABSTRACT: HIV is a chronic, life-threatening illness that necessitates regular and consistent medical care. Childhood sexual abuse (CSA) is a common experience among HIV-positive adults and may interfere with treatment utilization. This study examined rates and correlates of treatment utilization among HIV-positive adults with CSA enrolled in a coping intervention trial in New York City. The baseline assessment included measures of treatment utilization, mental health, substance abuse, and other psychosocial factors. In 2002-2004, participants (50% female, 69% African-American, M = 42.3 +/- 6.8 years old) were recruited. Nearly all (99%) received HIV medical care. However, 20% had no outpatient visits and 24% sought emergency services in the past 4 months. Among 184 participants receiving antiretroviral therapy (ART), 22% were less than 90% adherent in the past week. In a multivariable logistic regression model, no outpatient treatment was associated with African American race (AOR = 3.46 [1.42-8.40]), poor social support (AOR = 1.59 [1.03-2.45]), and abstinence from illicit drug use (AOR = 0.37 [0.16-0.85]). Emergency service utilization was associated with HIV symptoms (AOR = 2.30 [1.22-4.35]), binge drinking (AOR=2.92 (1.18-7.24)), and illicit drug use (AOR = 1.98 [1.02-3.85]). Poor medication adherence was associated with trauma symptoms (AOR = 2.64 [1.07-6.75]) and poor social support (AOR = 1.82 [1.09-2.97]). In sum, while participants had access to HIV medical care, a sizable minority did not adhere to recommended guidelines and thus may not be benefiting optimally from treatment. Interventions targeting HIV-positive adults with CSA histories may need to address trauma symptoms, substance abuse, and poor social support that interfere with medical treatment utilization and adherence.
    Full-text · Article · Apr 2009 · AIDS patient care and STDs
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