When someone starts treatment for opioid use disorder, it’s a big step forward. Medications like buprenorphine can help people reduce or stop opioid use and regain stability in their lives. But this moment of care offers more than just addiction treatment—it’s also a chance to protect overall health. My new paper (along with my incredible collaborators Jessie Wang, Sruthi George, Laura White and Sabrina Assoumou) now published in Drug and Alcohol Dependence shows that we may be missing a critical opportunity to prevent HIV.
Why HIV Prevention Matters Here
People with opioid use disorder can have a higher risk of HIV. This risk can come from sharing injection equipment or from unprotected sex.
There’s a highly effective prevention option called pre-exposure prophylaxis, or PrEP. It’s a medication that, when taken regularly, can prevent HIV infection.
In theory, starting buprenorphine treatment in a clinic or primary care setting should make it easier to offer PrEP at the same time. Patients are already seeing a provider, often discussing their health risks, and may be open to preventive care.
What Our Study Looked At
We analyzed a large U.S. database of insurance claims from 2014 to 2022. We looked at nearly 120,000 times when people started buprenorphine treatment and focused on whether patients received PrEP during the first nine weeks of treatment—a key window when patients are engaging with care.
What We Found
The results were striking:
- Only 0.1% of buprenorphine treatment episodes included PrEP use.
- About 6% of patients had clear signs they were at higher risk for HIV.
- But even in that higher-risk group, just 0.2% received PrEP.
In other words, even when patients likely needed HIV prevention, almost none received it.
Another important finding: when PrEP was used, it was usually started before buprenorphine treatment—not during it.
What This Means
This gap suggests a major missed opportunity in healthcare.
People starting addiction treatment are already connected to medical care. They are in a setting where providers could:
- Ask about HIV risk
- Offer testing
- Start PrEP if appropriate
But in practice, this rarely happens.
Why the Gap Exists
Our study doesn’t pinpoint exact causes, but possible reasons include:
- Providers may not routinely screen for HIV risk
- Time pressures in primary care
- Pressure from the healthcare system to focus on other issues
- Lack of awareness or training about PrEP
There’s also the reality that not everyone at risk is identified in medical records and so we can’t
How We Can Do Better
The good news is that this problem is fixable.
Healthcare systems could:
- Build HIV screening and PrEP discussions into addiction treatment visits
- Train providers to offer both services together
- Use care teams or outreach programs to support patients
- Provide additional support to primary care clinics to offer HIV prevention and addiction treatment services
Because primary care clinics are already at the front lines working with patients experiencing addiction and risk for HIV, they are key to making our systems work better.
The Bottom Line
This study highlights a simple but powerful idea:
When someone seeks care for opioid use disorder, it’s also a chance to prevent HIV. Right now, we’re missing that chance almost every time.
Better integration of addiction treatment and HIV prevention could make a real difference—helping people stay healthy in more ways than one.
So, What’s Next?
There are lots of ways we can take these findings and put them into action. In fact, putting these ideas into action is exactly why I do research! Stay tuned for some exciting news about an upcoming project focused on increasing access to service that integrate HIV prevention and addiction treatment.
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