HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification

Psychiatr Serv. 2021 Dec 1;72(12):1385-1391. doi: 10.1176/ Epub 2021 Jun 15.


Objective: The objective of this study was to determine the availability and national distribution of HIV testing and counseling at substance use treatment facilities in the United States.

Methods: Analyses of data from the 2018 National Survey of Substance Abuse Treatment Services assessed HIV testing and counseling availability in U.S. substance use treatment facilities (excluding those in U.S. territories). Facilities were subcategorized by availability of mental health services and medication for opioid use disorders and compared by using logistic models. Descriptive statistics were calculated to characterize the availability of HIV testing and counseling by state, state HIV incidence, and facility characteristics.

Results: Among U.S. substance use treatment facilities (N=14,691), 29% offered HIV testing, 53% offered HIV counseling, 23% offered both, and 41% offered neither. Across states, the proportions of facilities offering HIV testing ranged from 9.0% to 62.8%, and the proportion offering counseling ranged from 19.2% to 83.3%. In only three states was HIV testing offered by at least 50% of facilities. HIV testing was significantly more likely to be offered in facilities that offered medication for opioid use disorder (48.0% versus 16.0% in those not offering such medication) or mental health services (31.2% versus 24.1% in those not offering such services). Higher state-level HIV incidence was related to an increased proportion of facilities offering HIV testing.

Conclusions: Only three in 10 substance use treatment facilities offered HIV testing in 2018. This finding represents a missed opportunity for early identification of HIV among people receiving treatment for substance use disorders.

Keywords: AIDS; Alcohol and drug abuse.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Counseling
  • HIV Infections* / diagnosis
  • HIV Infections* / epidemiology
  • HIV Testing
  • Humans
  • Mental Health Services*
  • Opioid-Related Disorders* / diagnosis
  • Opioid-Related Disorders* / epidemiology
  • Opioid-Related Disorders* / therapy
  • Substance Abuse Treatment Centers
  • United States