Screening and brief intervention (SBI) for alcohol reduction is an important health promoting strategy for patients with HIV, and HIV care providers are optimally situated to support their patients' reduction efforts. We report results from analyses that use data collected from providers (n ¼ 115) in 7 hospital-based HIV care centers in the New York City metropolitan area in 2007 concerning their routine use of 11 alcohol SBI components with their patients. Providers routinely implemented 5 or more of these alcohol SBI components if they (1) had a specific caseload (and were therefore responsible for a smaller number of patients), (2) had greater exposure to information about alcohol's effect on HIV, (3) had been in their present positions for at least 1 year, and (4) had greater self efficacy to support patients' alcohol reduction efforts. Findings suggest the importance of educating all HIV care providers about both the negative impact of excessive alcohol use on patients with HIV and the importance and value of alcohol SBIs. Findings also suggest the value of promoting increased self efficacy for at least some providers in implementing alcohol SBI components, especially through targeted alcohol SBI training.

Ex-offenders experience various difficulties in successfully reentering communities post-incarceration. For those with a history of opioid misuse, despite various interventions, long-term recovery rates are relatively low. Additionally, the difficulties ex-offenders experience reintegrating with their families and communities are further compounded by the stigma and structural barriers posed by prior criminal and drug use histories. This qualitative study, using in-depth interviews conducted during an 18-month period between mid 2004 and late 2005 examines the process of creating and maintaining abstinence among 25 former heroin users, mostly Latino and African American New York City ex-offenders who have remained abstinent from heroin use for a period of 5 yr or longer. Focusing primarily on the story of one female respondent and in participants' own words, the factors that they found to be most salient in enhancing their recovery efforts (positive peer support, motivational tools, exercise, meditation, skills enhancement) are examined. The study findings suggest that reentry programs and policies can help ex-offenders sustain long-term abstinence and prosocial lifestyles by supporting the various coping strategies that they identify as being particularly valuable.

astone-twerell, Don C. Des JarlaIs, Marya gwaDz, holly hagan, anDrew osborne, anDrew rosenbluM Given the high prevalence of hepatitis C virus (HCV) infection among drug users, HCV testing is critical in this population. While many drug treatment programs offer HCV testing, patients often do not utilize this essential program-facilitated service. Summarizing data collected in semi-structured interviews and surveys with patients in 25 programs, this paper identifies barriers and facilitators to being tested for HCV through the program. Barriers include the patient's belief that she/he is not HCV infected, fear of needles, fear of obtaining a positive HCV test result, fear of disclosure of such a result, and fear of inappropriate or disrespectful treatment during the testing process. In addition, 38% of HCV sero-unaware or sero-negative patients completing the survey did not know that HCV testing was offered through their programs. Salient facilitators for those tested through their programs include support from staff in explaining the importance of testing and help in understanding and coping with test results.

HIV-infected patients have considerable need for alcohol reduction support, and HIV care providers are strategically placed to implement a “prevention for positives” alcohol reduction approach through alcohol screening and brief interventions (SBIs). To facilitate this approach, we provided alcohol SBI education and training to HIV care providers in four hospital-based, New York City HIV Care Centers in 2007. Interviews with the medical directors and 14 of the HIV care providers who attended the training identified barriers to implementing alcohol SBIs. These included limited time for alcohol screening, patients’ incomplete disclosure of alcohol use, providers’ perceptions that alcohol use is not a major problem for their patients, and provider specialization that assigns patients with problematic alcohol use to specifically designated providers. Identified facilitators for alcohol SBI implementation included adequate time to conduct the SBI; availability of information, tools, and key points to emphasize with HIV-infected patients; and use of a brief alcohol screening tool.

Abstract:Although HIV care providers are strategically situated to support their patients' alcohol reduction efforts, many do not do so, sometimes failing to view this support as consistent with their roles. Using data collected from 112 HIV providers in 7 hospital-based HIV Care Centers in the NYC metropolitan area, this paper examines the correlates of providers' role legitimacy as patients' alcohol reduction supporters. Results indicate that providers (1) responsible for a very large number of patients and (2) with limited confidence in their own ability to give this assistance, but high confidence in their program's ability to do so, were less likely to have a high level of role legitimacy as patients' alcohol reduction supporters. Findings suggest the types of providers to target for alcohol reduction support training.