Delivery of behavioral HIV prevention services in New York City outpatient substance abuse treatment clinics: Providers’ perspectives on opportunities and challenges.

The association between sexual HIV risk and substance use is well documented, giving providers (e.g., counselors or physicians) of substance abuse treatment an opportunity to address HIV education and prevention. This study identified: (1) providers’ HIV prevention practices, (2) barriers, and (3) promoters to offering HIV prevention in substance abuse treatment. Semistructured qualitative interviews with one director, one medical provider, and four counselors, from each of six outpatient clinics affiliated with the National Drug Abuse Treatment Clinical Trials Network (CTN) (N=36) were transcribed and coded according to thematic content analysis. Providers’ practices included: (1) recommending condoms, (2) explaining HIV transmission, (3) HIV testing, and (4) assessing risk. Barriers included: (1) believing that clients know enough about HIV, (2) believing that clients are not at risk, (3) lacking information, (4) outdated training (i.e., >5 years ago), (5) HIV stigma, and (6) avoidance. While some providers recommended condoms and HIV testing, many avoided discussing HIV.

Conclusions: HIV prevention practices in substance use treatment vary among clinics and providers. These results suggest a need for training to improve understanding of HIV transmission, effective counseling practices, and to build capacity for HIV testing or linkages with HIV service agencies.