Mesfin S. Mulatu, PhD, MPH1, Dionne C. Godette, PhD2, Kimberly R. Thomas, MPH, CHES1, Shubha Rao,

MD, MPH1

1Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA,

USA2Department Health Promotion & Behavior, University of Georgia, Athens, GA,

USA

Paper presented at the XVIII International Conference on AIDS, Vienna, Austria

July 18-23, 2010

Trends in and Determinants of the Availability of HIV Prevention Services

in Substance Abuse Treatment Facilities, United States, 2002 – 2008

National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention

Division of HIV/AIDS Prevention

• The role of substance use in HIV transmission and the contributions of substance abuse treatment (SAT) as an HIV prevention strategy are very well recognized

• Research on national level trends and determinants of HIV prevention services in SAT facilities in the U.S. is limited

• Objectives of the study are to answer two questions: – What are the trends of the availability HIV testing and

HIV/AIDS education, counseling, or support services in U.S. SAT facilities?

– What organizational factors are associated with the availability of these HIV prevention services in U.S. SAT facilities?

• Data from the National Survey of Substance Abuse Treatment Services (2002-2008) were used (average N = 13,661 facilities/yr)

BACKGROUND

MAJOR FINDINGS: Extent and Trends

Percent of Facilities Offering HIV Prevention Services

HIV Testing

HIV/AIDS ECS*

One or

Both

2002 33.4 55.5 61.3

2003 34.0 57.2 63.1

2004 31.2 56.2 61.1

2005 31.0 54.7 59.8

2006 30.1 53.4 58.6

2007 29.7 56.0 60.5

2008 29.3 55.1 59.5

Ave. 31.3 55.4 60.6

Adj. Odds of Offering HIV Prevention Services in 2003-2008 vs. 2002 Levels

2002 2003 2004 2005 2006 2007 20080.7

0.8

0.9

1.0

1.1

1.2

1.3

HIV Testing

HIV/AIDS ECS*

* ECS = education, counseling, or support Adj. = adjusted for organizational factors

**

*

* **

ns nsns

****

****

**

• Were owned by government • Were owned by non-profit • Provided payment assistance • Received public funding • Accepted government insurance • Were larger in size • Were affiliated with hospitals • Had inpatient programs • Had residential programs • Had opiate maintenance/detox prog. • Were accredited by prof. organization • Were licensed by state agency

FINDINGS: Organizational Determinants

HIV prevention services were more likely to be offered in facilities that

Potential Underlying Factors

Lower Profit Motivation

Multiple Funding Sources

Capacity to Leverage

Longer Opportunity

Oversight / Regulation

SUMMARY AND IMPLICATIONS

• More than a third of U.S. SAT facilities do not offer HIV prevention services -- a major gap in reaching a population at high risk

• Trends (2002 -2008) indicate that the availability of HIV prevention services is declining at worst or remaining stable at best – despite recommendations for such services by public health agencies

• Organizational factors are important determinants of the availability of HIV prevention services in U.S. SAT facilities

• Further research into organizational and broader contextual (e.g., policy) barriers and facilitators of offering HIV prevention services in U.S. SAT facilities may provide useful information for expanding these services

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

For details, please visit:Poster No: MOPDC103

Or send an e-mail to:Mesfin S. Mulatu, PhD, MPHmmulatu@cdc.gov

National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention

Place Descriptor Here

CONTACTS