HIV risk reduction in outpatient drug abuse treatment: Individual and geographic differences

In the national Drug Abuse Treatment Outcome Studies (DATOS), many clients in outpatient methadone treatment (OMT) and outpatient drug-free (ODF) moda lities were admitted with multiple sex and needle-risk behaviors, but they reduced these risks significantly during treatment. Using hierarchical line ar model regression analysis, we examined client and treatment program char acteristics as predictors of initial risk levels and of reductions over tim e. Clients who used cocaine frequently before treatment or had antisocial p ersonality disorder entered treatment with elevated risks. In both modaliti es, cocaine users reduced risky behaviors significantly, but antisocial cli ents did so only in OMT. Treatment programs located in cities with higher p revalence rates of HIV/AIDS admitted clients with lower baseline levels of risk behavior than found in other cities. OMT programs in lower prevalence cities achieved higher rates of risk reduction than programs in higher prev alence cities. Reduction of sex and needle risks in both the Oh rr and ODF modalities indicates the importance of outpatient drug abuse treatment to n ational HIV prevention policy.