A qualitative case study on HIV treatment and prevention perceptions within a substance use treatment facility

Abstract

People with substance use disorders (SUD) are disproportionately impacted by HIV due to overlapping structural, behavioral, and access disparities. Despite advances in antiretroviral therapy and pre-exposure prophylaxis, barriers to HIV testing, prevention, and engagement in care persist. We conducted a qualitative sub-study, within a larger status-neutral HIV intervention (SNI) project, to explore HIV-related knowledge, stigma, and healthcare experiences among individuals receiving SUD treatment. Semi-structured interviews were conducted at CenterPointe, a residential SUD treatment facility, using purposively sampled adults receiving SUD treatment, who previously completed a preliminary quantitative survey. Interviews explored HIV knowledge/perception, HIV testing, medical mistrust, and barriers to HIV prevention/care engagement and were audio-recorded, transcribed, and analyzed using thematic analysis. Four participants completed interviews, generating 226 unique codes and 5 themes: (1) HIV knowledge/perception, with fragmented HIV knowledge and stigma-driven risk perception as subthemes, (2) SUD stigma leads to multilevel care barriers/negative healthcare experiences, (3) foundational trust for healthcare management, (4) barriers to HIV testing/prevention, and (5) support for HIV testing/prevention in SUD treatment facilities. Participants demonstrated motivation to engage in care; however, informational and institutional barriers limited access. Misconceptions of HIV transmission and risk were common, and prior stigmatizing healthcare experiences contributed to avoidance of care. Participants endorsed a desire for routine HIV testing and education within SUD treatment settings. Integrating SNI including education, testing, and linkage-to-care services within SUD treatment facilities may address information and structural barriers while leveraging existing patient motivation to engage in HIV treatment or prevention services. Residential SUD patients have high motivation for HIV care engagement. HIV prevention barriers are primarily institutional and informational, not motivational. Prior substance use stigma from healthcare providers drives active care avoidance. Routine, status-neutral HIV screening inside SUD treatment settings was supported. Trusted relationships with SUD treatment staff provide a safe space for care.