Disparities in Health Services for HIV/AIDS, Hepatitis C Virus, and Sexually Transmitted Infections: Role of Substance Abuse Treatment Programs.

Despite substantial advances in prevention and even greater enhancements in the range of therapeutic options, today many Americans continue to suffer a disproportionately greater burden of the most prevalent preventable illnesses, especially many infectious diseases. The 2004 case rate for the acquired immunodeficiency syndrome (AIDS) per 100,000-population is 6.0 for whites, 56.4 for blacks, 18.6 for Hispanics, 3.7 for Asians and Pacific Islanders, and 7.9 for American Indians and Alaskan Natives 1. Human immunodeficiency virus (HIV) infection borne by women has tripled since 1985 from 8% to more than 26% in 2005 2. The highest hepatitis C virus (HCV) incidence rates and prevalence rates occur among Hispanic Americans and African Americans, respectively 3. Disparities also exist among many sexually transmitted infections (STI), as women sustain three times higher rates than men for chlamydial infections and African Americans and Latinos suffer higher rates of gonorrhea4. Among the many factors associated with gender and ethnic/racial disparities in these infections, substance use and access to care are prominent in prevention and treatment 5–12. Interestingly, substance abuse treatment has been associated with infection-related benefits, largely mediated through reducing behaviors placing individuals at risk of acquiring these infections or reducing the challenges to adherence to the treatments for these infections 13–15. There is also evidence that locating infection-related health services in substance abuse treatment programs may also contribute to the infection-related benefits of substance abuse treatment 16–18. Clinicians, who provide infection-related health services in substance abuse treatment programs, are likely to be more experienced and sensitive to the concerns of this patient population. In light of the foregoing, we examined the availability of infection-related services in substance abuse treatment programs that do and do not tailor addiction services for women and non-white ethnic/racial populations.