The impact of HIV infection on medical services in drug abuse treatment programs.

The HIV/AIDS epidemic has had a profound impact on the organization and delivery of clinical services in drug abuse treatment programs. The need for emphasis on HIV prevention vs. treatment services has varied with the geographic distribution of HIV infection among drug injectors. On-site primary medical care services have been developed in some treatment programs, whereas other programs have had to formalize arrangements for referral or contractual care with outside medical providers. No single model of care is necessarily appropriate for all drug treatment programs, and, along with the potential benefit, each may pose structural challenges that need to be addressed. The advent of the AIDS epidemic may have served, in an inadvertently positive way, to draw attention to the increasingly illogical separation between drug abuse treatment and the larger medical care system. This review will examine the epidemiologic, clinical, organizational, and policy issues generated by the increased medical needs of drug users with HIV infection in treatment program settings.