Our research team has performed nationally representative surveys of outpatient substance abuse treatment programs for many years. Among other things, we examine the prevalence of evidence-informed practices such as screening for HIV among program clients. More than 5,000 injection drug users become HIV-infected every year in the U.S. (some of whom are men who have sex with men, and who might have been infected via that route).
The Centers for Disease Control and Prevention (CDC) has been pushing routine screening in substance abuse treatment centers and other providers since at least 2006. Our latest analysis, just published online in Health Services Research, shows recent trends:
Our findings are pretty concerning. The dangers of AIDS don’t hit the front page as much as they did in the pre-HAART era. This damn thing is still with us, killing many thousands of Americans every year. Seek, test, and treat is a key strategy to reduce mortality and morbidity among those already infected, and to reduce the rate of subsequent infection by informing people living with HIV of their serostatus, and engaging these men and women into systems of care.
The traditional network of specialty opiate addiction treatment providers had many shortcomings. The Affordable Care Act wisely aspires to link such treatment more intimately with conventional medical care. These units were, however, quite focused on HIV. As substance use patterns change, and as new players play a greater treatment role, we must ensure that HIV screening is properly addressed. Right now, we’re really not getting the job done.