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Providing HIV prevention to substance users is effective in reducing HIV risk behaviors. Yet, with over three million American adults in substance abuse treatment, integration of HIV prevention within community-based programs is left up to the discretion of each individual professional and paraprofessional from different disciplines and with diverse training and workplace environments. The Affordable Care Act and Medicaid have made cost effective integration of HIV and substance abuse services a national priority. However, no study has identified factors associated with practitioners’ delivery of HIV prevention to substance using clients. Knowing these associations will contribute to developing training strategies and policies aimed at optimizing HIV and substance abuse service integration. This study addresses this gap using data from 287 practitioners working throughout New York City’s community based organizations.
Methods
We recruited 287 practitioners from 30 agencies funded to offer HIV prevention services in New York City. Cross-sectional, computerized, self-administered quantitative surveys were administered. Principal Components Factor analyses were performed with Varimax rotation using SPSS software. Composites were developed based upon factor analyses. Scale analysis was performed and alphas were calculated to determine reliability of composites. The outcome variable was, “To what extent do you offer HIV prevention to your substance using clients?” Multivariate linear regression was used to determine the relative influence of predictor variables on the outcome. We hypothesized that workplace characteristics, specialized HIV-related training, training in evidence based counseling and peer support were associated with offering HIV prevention.
Results
Sample: 176 female; 101 male; ; 4 transgender; 144 Black, 73 White, 10 Asian, 49 multi-racial, 1 Pacific Islander, 4 Native American. Mean age 41 years. Two doctorate, 96 bachelors, 75 masters, 67 H.S. diploma/GED, 37 associates, 4 <H.S. Having had training in HIV, training in evidence based counseling methods (p< .0001) and training in supportive counseling strategies, were significantly associated with offering HIV prevention interventions to substance using clients (p< .05). Peer support from colleagues was also associated with offering HIV prevention (p< .05). Younger age, offering ancillary non-clinical services and job satisfaction were associated with offering HIV prevention (p< .10).
Implications
This study demonstrates the robust associations between provider training, workplace environment, and providers’ use of HIV prevention counseling with substance using clients. By specifying the types of training, and the workplace characteristics that influence providers to offer HIV prevention, this study helps to address the challenge of service integration that we face in the U.S. today. Optimizing these types of training opportunities and enhancing workplace environment may be priority areas to target in substance abuse treatment programs.