Substance use & HIV — harm reduction, treatment, and honest care.

There is a version of this conversation you have probably already had. A provider asks what you are using, you tell some of the truth, and the room changes. Suddenly your viral load is a moral report card and your prescription refill has conditions attached to it. Somewhere in there, the thing you actually came in for — staying alive, staying undetectable, getting your wound looked at — disappears.

That version is not evidence-based. It is not what the federal HIV treatment guidelines say. It is not what nearly thirty years of syringe program research says. And it is not what the people who built harm reduction — most of them people who use drugs, many of them people living with HIV — fought for.

This page is the other version. It covers what the science says about opioids, stimulants, alcohol, cannabis, injecting, and chemsex alongside HIV treatment; which medications work and which drug interactions are real; how to stay alive through the fentanyl and xylazine era; and what Florida law actually allows. It assumes you are the person making the decisions.

The framing: two epidemics, one person

HIV and drug use in America have been described as parallel epidemics for forty years, which is a tidy phrase that hides something important: they are not parallel for the person living them. They are the same Tuesday. The same missed appointment. The same landlord, the same probation officer, the same insurance denial, the same shame.

Public health has historically responded by splitting you in two. HIV care over here, addiction treatment over there, mental health somewhere with a six-week waitlist. Each system asks you to be stable enough to deserve the other one. Addiction programs have required people to be housed; HIV clinics have required people to be sober; housing programs have required both. The technical term for this is a cascade of care. The lived term is being sent away.

The reason harm reduction reads as radical in that context is only that it starts from a different premise. The National Harm Reduction Coalition defines it as "a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use," and — the part people skip — "also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs."1 Its first principle accepts, "for better or worse, that licit and illicit drug use is part of our world" and chooses "to work to minimize its harmful effects rather than simply ignore or condemn them."1

Note what that is not. It is not anti-treatment. It is not pro-drug. The same framework "incorporates a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs 'where they're at,' and addressing conditions of use along with the use itself."1 Abstinence is on the list. It is just not the entry fee.

NIDA's own leadership has said the quiet part out loud. Writing about the intersection of HIV and methamphetamine, the institute described the guiding philosophy of harm reduction as "meeting people where they are" — providing care regardless of substance use or other behaviors that confer some health risk — and argued that this principle "should also apply to the prevention and treatment of HIV and substance use disorders."14

The numbers, without the scare quotes

Numbers matter here for one reason: they show that this is a mainstream part of the HIV epidemic, not a footnote about other people.

HIV and injecting

CDC reported 3,864 new HIV diagnoses in 2018 among adults and adolescents who inject drugs — roughly 10% of the 37,968 new diagnoses that year. Of those, 2,492 were attributed to injection drug use and 1,372 to a combination of male-to-male sexual contact and injection drug use. Diagnoses among people who inject drugs held roughly stable from 2014 through 2018.6

"Stable" is doing a lot of work in that sentence. Stable is what the national picture looks like when local outbreaks are being contained — and what it looks like right before one isn't. KFF documented the mechanism plainly: HIV diagnoses attributed to injection drug use rose from 2,392 in 2014 to 2,635 in 2015, and about 75% of that increase was associated with a single outbreak in one rural Indiana county.8

Overdose

The overdose numbers have moved dramatically, and in the direction nobody expected. CDC's National Center for Health Statistics estimated 69,973 drug overdose deaths in the United States during 2025 — down almost 14% from the 81,313 estimated for 2024, and the third consecutive annual decline. Opioid-involved deaths fell from an estimated 55,296 to 44,564. Deaths involving cocaine and psychostimulants such as methamphetamine also decreased. Almost all states saw declines; Rhode Island, New York, North Carolina, Alabama, and Vermont dropped 25% or more, while New Mexico, Arizona, and Colorado rose 10% or more.7

That is roughly 192 people a day, and it is the best news in this field in a decade. It is also not evenly distributed, and it is not self-sustaining. The interventions credited with it — naloxone saturation, medications for opioid use disorder, syringe programs, drug checking — are exactly the ones that get defunded when the numbers improve.

What harm reduction actually is (and isn't)

Harm reduction is often described as a philosophy, which makes it sound optional. In practice it is a set of concrete, boring, verifiable services: sterile syringes and injection equipment, naloxone, fentanyl test strips, wound care, safer-use supplies, drug checking, HIV and hepatitis C testing, low-barrier prescribing, peer navigation, and a door that does not lock behind you when you use again.

SAMHSA's federal harm reduction framework, released in 2024, put the model into policy — built around leadership by people with lived and living experience of drug use, low-barrier and non-coercive access, and a focus on any positive change as defined by the person themselves. Its overdose materials are practical rather than moral: recognize the signs, give naloxone or another opioid overdose reversal medication, call 911, support breathing, stay.17

The National Harm Reduction Coalition's principles are worth reading in full if you have ever been made to feel like your care was conditional. They include non-judgmental provision of services, the recognition that "the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people's vulnerability to and capacity for effectively dealing with drug-related harm," and the insistence that people who use drugs have "a real voice in the creation of programs and policies designed to serve them."1

Three things harm reduction is not

• It is not the opposite of treatment. CDC found that new syringe program users are five times more likely to enter treatment for substance use — and about three times more likely to stop using drugs — than people who don't use a program.3 Harm reduction is frequently the on-ramp.
• It is not a permission slip. Nobody hands you a syringe as an endorsement. The point is that the syringe you get is sterile.
• It is not soft on outcomes. The outcome it measures is whether you are alive, uninfected, and in contact with care. Those are harder outcomes than abstinence, not easier ones.

Opioids and medications that work

If you have opioid use disorder and HIV, medication is the intervention with the strongest evidence behind it — for overdose, for retention in care, and for viral suppression. Three medications are FDA-approved: buprenorphine, methadone, and naltrexone. The federal HIV guidelines describe methadone or buprenorphine as generally first-line agents.2

How they differ, practically

• Buprenorphine (4–24 mg sublingually, once or twice daily) can be prescribed in primary care and HIV clinics. Prescribing requires specific training but no longer requires an X waiver — a change that matters enormously for access. It carries lower overdose risk than methadone and significantly better retention than daily oral naltrexone.2
• Methadone is individually dosed and available only through licensed opioid treatment programs. It has better retention than buprenorphine or naltrexone; doses above 100 mg are associated with staying in treatment. QTc prolongation is the monitoring concern.2
• Naltrexone requires being off opioids before starting, which is the whole problem. One meta-analysis found oral naltrexone equivalent to placebo; the guidelines describe extended-release injectable naltrexone as an alternative for people recently released from correctional facilities when other options are not available.2

The head-to-head data are clarifying. In X:BOT — a 570-person, 24-week randomized trial published in The Lancet — 65% of participants assigned to extended-release naltrexone relapsed by week 24 versus 57% assigned to buprenorphine-naloxone. But most of that gap came from a single point of failure: 70 of 79 relapses in the naltrexone arm were people who never got successfully started on it. Once initiated, the investigators concluded, "both medications were equally safe and effective."9

CHOICES tested the same question inside HIV care. Across six US HIV primary care clinics, 114 people with untreated HIV and opioid use disorder were randomized to clinic-based extended-release naltrexone or to usual care with buprenorphine or methadone. Initiation again favored usual care (73% vs 47%). Viral suppression at 24 weeks was 52.7% with naltrexone and 49.2% with usual care — non-inferiority was not demonstrated, but the headline the authors drew was about medication itself: the trial "affirms the importance of medications for OUD treatment for achieving HIV viral suppression in people who use drugs."10

Stimulants: methamphetamine and cocaine

Stimulants are where the treatment landscape gets honest about its limits. There is no FDA-approved pharmacotherapy for cocaine use disorder, and no specifically recommended pharmacotherapy for stimulant use disorder in people living with HIV.2 Anyone who tells you otherwise is selling something.

What exists is a set of partial signals. Methylphenidate, modafinil, bupropion, and naltrexone have limited evidence for reducing methamphetamine use or cravings. A randomized trial of extended-release injectable naltrexone plus extended-release oral bupropion produced more methamphetamine-negative urine samples than placebo, though overall response was low. And daily mirtazapine, tested over 36 weeks in men who have sex with men, reduced both methamphetamine-positive urine tests and sexual risk behaviors.2

Contingency management: the intervention that works and nobody funds

The most effective stimulant treatment is behavioral and involves paying people. Contingency management provides material incentives — vouchers, prize draws, gift cards — contingent on objectively verified behavior change, usually a negative urine test.

The NIDA Clinical Trials Network tested it in 113 people with methamphetamine use disorder, randomized to 12 weeks of usual treatment or usual treatment plus contingency management using escalating prize draws that reset after a missed or positive sample. Both groups stayed in treatment equally long, but the contingency management group submitted significantly more negative samples and was abstinent longer — five weeks versus three.12

A 2021 JAMA Psychiatry systematic review and meta-analysis of 74 reports covering 10,444 adults receiving medication for opioid use disorder found contingency management associated with better end-of-treatment outcomes across all six problems studied, with medium-to-large effects for stimulant use (Cohen d = 0.70), cigarette use (0.78), illicit opioid use (0.58), and medication adherence (0.75). The authors concluded that policies enabling contingency management in community treatment services "are sorely needed."11

In HIV care specifically, the federal guidelines note that contingency management is effective at decreasing stimulant use among people living with HIV, though sustained effects after the incentives stop are less clear — and that adding a positive-affect intervention to contingency management decreased viral load among gay, bisexual, and other men who have sex with men.2 Motivational interviewing and CBT also show decreased stimulant use and improved ART adherence.2

The critical clinical point, stated flatly in the guidelines: people living with HIV who use stimulants can achieve viral suppression and should be prescribed ART even if stimulant use is ongoing.2

Alcohol — the one that gets missed

Alcohol is the most common substance used by people living with HIV, and the one least likely to come up in an HIV appointment.2 It interacts with liver health, hepatitis B and C, adherence, mental health, and sleep — and unlike most drugs in this article, it is fully legal, socially expected, and served at fundraisers.

Three medications are FDA-approved for alcohol use disorder, and the interaction picture is reassuring:

• Naltrexone (50–100 mg daily or monthly depot) is described in the federal guidelines as having the greatest efficacy of all FDA-approved medications for alcohol use disorder. It is safe in people living with HIV, is not associated with significant interactions with antiretrovirals, and is not associated with irreversible liver toxicity — though it is not recommended in decompensated liver disease and warrants caution with elevated transaminases.2
• Acamprosate (666 mg three times daily; reduced to 333 mg three times daily if creatinine clearance is 30–50 mL/min, contraindicated below 30) has no significant antiretroviral interaction.2
• Disulfiram (250 mg daily) requires one specific caution: antiretroviral oral solutions containing ethanol or propylene glycol — including some formulations of fosamprenavir, lopinavir/ritonavir, and ritonavir — can trigger a reaction.2

And integrating alcohol treatment into HIV care produces measurable HIV outcomes. In integrated stepped-care, at 52 weeks participants had more alcohol-abstinent days, fewer drinks per drinking day, and fewer heavy drinking episodes — along with increased odds of viral suppression (odds ratio 5.58; 95% CI 1.11–27.99).2 Wide confidence interval, real signal.

As with everything else here: ongoing alcohol use is not a contraindication to ART.2

Cannabis in this context

Cannabinoids are among the most commonly used substances by people living with HIV, and cannabis occupies an unusual position in this conversation because for many people it is a symptom management tool rather than a problem — appetite, nausea, nerve pain, sleep.2 It also has its own dedicated evidence base, which we cover separately in HIV & cannabis.

Two things belong here rather than there. First, cannabis is frequently the disclosure people lead with because it feels safest to admit — which means a provider who reacts badly to it has just told you what would happen if you mentioned anything else. Second, in a polysubstance environment, "just weed" is not always just weed. Cannabis products are not the primary vector for illicitly manufactured fentanyl, but counterfeit pills sold as anything are, and mixing depressants remains the most reliable route to a fatal outcome.15

Injecting: what actually reduces harm

If you inject, the risks stack: HIV, hepatitis C, bacterial and fungal infections, endocarditis, abscesses and soft-tissue wounds, vein damage, and overdose. Almost every one of them is reduced by having your own sterile equipment every single time.

The federal HIV guidelines put syringe services programs squarely inside HIV care rather than adjacent to it: for people actively injecting, engagement in a syringe services program "can facilitate access and adherence to ART," and programs can be adapted to provide or link to rapid initiation and maintenance of effective treatment.2

Xylazine changed the calculation

Xylazine — a veterinary sedative increasingly found in the illicit fentanyl supply — is not an opioid, so naloxone does not reverse its sedation. It is associated with severe necrotizing wounds that need real care, not shame. And it has a genuine antiretroviral interaction that most people have never been told about: xylazine is a CYP3A4 substrate, so combining it with the CYP3A4 inhibitors used to boost some HIV regimens (ritonavir, cobicistat) may elevate xylazine levels and prolong its half-life. The federal guidelines advise clinicians to weigh the risks and benefits of ritonavir- or cobicistat-containing regimens for people in areas with high rates of xylazine-adulterated fentanyl.2 That is an actionable conversation to have with your HIV provider, and one you may have to start.

Practical harm reduction for injecting, from federal sources: never use alone, and make sure people around you know you have used so they can give naloxone or call for help; do not mix drugs — stimulant with stimulant, depressant with depressant, or stimulants with depressants all raise the risk of death; do not assume a familiar source is a safe source, because your body may respond differently every time; test your drugs; and keep naloxone on you and at home.15

Chemsex, party and play, and the sexual health crossover

Methamphetamine and sex are entangled for a lot of gay, bisexual, and other men who have sex with men, and pretending otherwise has cost lives. NIDA reported that a 2020 study in JAIDS found one-third of new HIV transmissions among sexual and gender minorities who have sex with men occurred in people who regularly use methamphetamine. Methamphetamine use is more prevalent among gay and bisexual men than other men; the pattern once associated primarily with white gay men is increasingly present among Black and Hispanic men who have sex with men. Beyond behavior, there is evidence methamphetamine may make the body more vulnerable to acquiring HIV and may contribute to disease progression.14

The reason those numbers persist is not that nobody has explained the risk. NIDA's own analysis is unusually candid about why fear-based messaging fails. Psychologist Sarit Golub, quoted in that piece, argued that telling gay and bisexual men about the risks of combining drugs and sex can be perceived as instilling fear and shame, alienating rather than empowering them — and can disregard a person's totality of needs, "for connection, for pleasure, and for confidence in a world that judges and shames."14

NIDA also names what methamphetamine is doing for people: coping with depression, anxiety, and trauma; enhancing sexual experience and a sense of connectedness; temporarily boosting self-confidence for people carrying stigma and shame about their sexuality or other parts of their lives.14 You cannot replace something without knowing what it did.

Practical crossover moves: get on PrEP if you are HIV-negative, or get to undetectable if you are living with HIV — both hold regardless of what you use; know that a history of stigma in healthcare leads people to hide substance use and sexual practices from providers, so finding a clinic where you don't have to is a clinical intervention, not a luxury;14 and watch the depressant stack, because GHB, ketamine, and MDMA all run partly through CYP450 pathways. Overdoses from interactions between club drugs such as MDMA or GHB and protease inhibitor–based ART have been reported, and benzodiazepines with ritonavir or cobicistat boosting produce significantly higher concentrations and prolonged sedation.2

Overdose: naloxone, drug checking, and the twelve minutes that matter

The federal HIV guidelines say clinicians should prescribe naloxone for overdose prevention for all people using opioids beyond short-term treatment of acute pain, and note that adulterants such as xylazine increase overdose risk. Even though naloxone reverses only opioid effects, that alone may be enough to reverse the overdose — which is why the guidelines call for universal access and active prescribing.2

Drug checking

Fentanyl test strips are small paper strips that detect fentanyl in cocaine, methamphetamine, heroin, pills, powders, and injectables. CDC describes them as a low-cost harm reduction tool to be used in combination with other strategies. Method: set aside at least 10 mg of the drug in a clean, dry container; add water (half a teaspoon for most drugs, a full teaspoon per 10 mg for methamphetamine, MDMA, or ecstasy); dip the wavy end for about 15 seconds; lay the strip flat for two to five minutes; read it. A single pink line on the left means fentanyl or an analog was detected — CDC's guidance is that discarding the batch is much safer. Two pink lines mean none was detected.15

The limits are real and worth knowing. Strips cannot tell you how much fentanyl is present, do not distinguish fentanyl from its analogs, may miss some analogs such as alfentanil or carfentanil, may perform worse with large amounts of methamphetamine, MDMA, or diphenhydramine, and can miss fentanyl that isn't evenly distributed. A negative result is information, not a guarantee.15

Syringe services programs: the most litigated settled science in America

There is no serious scientific controversy left here, which makes the political fight over syringe programs a fight about something else.

CDC's summary of nearly thirty years of research is that comprehensive syringe services programs are safe, effective, and cost-saving; do not increase illegal drug use or crime; and reduce the spread of HIV, viral hepatitis, and other infections. Programs are associated with an estimated 50% reduction in HIV and hepatitis C infections — and transmission is reduced by over two-thirds when programs are combined with medications that treat opioid dependence. New participants are five times more likely to enter treatment and about three times more likely to stop using drugs. On the crime question, studies in Baltimore and New York City found that crime rates did not change based on whether an area had a syringe program.3

Scott County: what happens without one

Between November 18, 2014 and November 1, 2015, HIV was diagnosed in 181 people in a rural Indiana community of about 4,200. Peters and colleagues, reporting in the New England Journal of Medicine, found that 87.8% reported injecting extended-release oxymorphone and 92.3% were coinfected with hepatitis C. Each additional time a person was named as a syringe-sharing partner raised risk (adjusted risk ratio 1.9; P<0.001). A public health emergency was declared on March 26, 2015, and Indiana's first syringe services program was established in response.4

The program worked fast: 277 people enrolled and more than 90,000 syringes were distributed and returned between April and October 2015. The outbreak also moved federal policy — Congress overturned the longstanding ban on federal funding for syringe services programs in its wake.5

Scott County is cited constantly as a cautionary tale, and it is. But the honest reading is narrower and harsher: the outbreak happened in a place where the intervention was illegal, and it stopped when the intervention became legal. That is not a mystery. That is a policy choice with a body count.

Integrated care: what good actually looks like

The federal HIV guidelines are unusually prescriptive about what your care should include. Screening for substance use disorders should be a routine part of clinical care (rated AII). Providers should be nonjudgmental (AIII). People should be screened for co-occurring mental health conditions (AII). Evidence-based pharmacotherapy for substance use disorders should be offered as part of comprehensive HIV care (AI) — the strongest rating in the system. And once-daily or single-tablet regimens with high resistance barriers, low liver toxicity, and low interaction potential are preferred (AIII).2

That last one is a substance-use-specific design choice, and it is in your favor: fewer pills, fewer times a day, more forgiveness for a missed dose, less to go wrong when your week goes wrong.

What to ask for by name

Reentry: the most dangerous two weeks

If you or someone you love is coming out of jail or prison, this is the section to read twice.

Binswanger and colleagues followed 30,237 people released from Washington State prisons between 1999 and 2003, linking corrections records to the National Death Index. Overall mortality was 777 deaths per 100,000 person-years — an adjusted risk of death 3.5 times that of other state residents. In the first two weeks after release, the risk of death was 12.7 times higher than for other residents, and the relative risk of death specifically from drug overdose was 129 (95% CI, 89–186). Overdose was the leading cause of death.18

The mechanism is straightforward and preventable. Tolerance drops during incarceration. Medications for opioid use disorder are frequently interrupted or never offered. Release day arrives with no naloxone, no prescription, no appointment, and often no ID or insurance. Then someone uses what used to be their normal amount.

What changes the odds: continuing or starting medication for opioid use disorder before release rather than after; naloxone in hand on day one, for the person leaving and for whoever they are going home to; a first HIV appointment already scheduled with a filled prescription, not a referral slip; and the plain arithmetic said out loud — your tolerance is lower than it was, so a former dose is now a potentially fatal dose. The federal guidelines specifically name extended-release naltrexone as an option for people recently released from correctional facilities when other options are not available.2

Who gets left out

Harm reduction services were built by and largely for a specific set of people, and coverage remains uneven. Some patterns worth naming:

• Women. Programs designed around men often miss women entirely. Florida's largest syringe program responded by adding a dedicated women's clinic day with female clinicians, mental health support, and family planning after finding women were under-enrolled.21
• Black and Hispanic communities. Methamphetamine use among Black and Hispanic men who have sex with men has been increasing, while the cultural script for meth-and-sex programming was written around white gay men.14
• Transgender and gender-diverse people. Stigma in healthcare — around drug use, sexuality, race, and gender — leads people to withhold substance use and sexual history from providers, which is precisely the information that makes care safe.14 Programs that offer gender-affirming care alongside harm reduction remove one reason to stay away; Florida's IDEA Exchange clinic lists gender-affirming care among its services.21
• Long-term survivors and older adults. Polypharmacy is the issue here. More medications means more chances for a boosted regimen to collide with a benzodiazepine, a sedative, or an adulterant.2
• People in rural areas. Scott County was rural. Florida law even builds rural distance into its referral timelines, acknowledging that a 72-hour referral window may not be achievable where services are far apart.19

Florida: legal, restricted, and privately funded

Florida is a useful case study in what a syringe program law looks like when it passes over sustained objection.

The state's first legal program, the IDEA Exchange, opened on December 1, 2016 — World AIDS Day — as a pilot operated by the University of Miami Miller School of Medicine, authorized by the Infectious Disease Elimination Act. It provides anonymous exchange of new syringes for used ones, HIV prevention, testing and treatment, hepatitis C testing and treatment, substance use disorder treatment, wound care, medication management, appointment reminders, and peer navigation for services including housing and health insurance.21 HIV.gov, profiling the program, described its mission as providing the tools necessary to reduce the spread of HIV, hepatitis C, and other blood-borne diseases through harm reduction in South Florida.22

In 2019 the legislature extended authorization statewide. Under Florida Statute 381.0038, a county commission may authorize a syringe exchange program within its boundaries — at fixed sites or mobile health units — and a program may not operate without that authorization. The county must pass an ordinance, enter a letter of agreement with the Department of Health, enlist the county health department, and contract with a licensed hospital, a licensed health care clinic, an accredited Florida medical school, a licensed addictions receiving facility, or a 501(c)(3) HIV/AIDS service organization.19

What the law requires — and what it withholds

Programs must operate a strict one-to-one exchange: one sterile needle and syringe unit for each used one returned. They must provide educational materials on HIV, viral hepatitis, and other blood-borne diseases; on-site counseling or referrals for drug abuse prevention, education, and treatment; on-site HIV and viral hepatitis screening or referrals available within 72 hours (extendable in rural counties); and kits containing an emergency opioid antagonist, or referrals to programs that provide them. Participants' personal identifying information may not be collected for any purpose. Annual reports go to the county commission and the Department of Health by August 1, with a statewide compilation to the Governor, Senate President, and House Speaker by October 1.1920

Two provisions matter enormously in practice. The protective one: possession, distribution, or exchange of needles or syringes as part of an authorized program is not a violation of Florida's drug laws — though that protection does not extend to needles obtained outside the program or redistributed outside it.19

The limiting one: state, county, and municipal funds may not be used to operate an exchange program. Programs must be funded through grants and donations from private sources.19 Florida has legalized the single most cost-saving HIV prevention intervention available to it and declined to pay for it. Every syringe distributed in this state is a philanthropic act.

The one-to-one requirement is the other binding constraint. CDC's evidence base concerns comprehensive programs with adequate supply; a person who cannot return used syringes — because they were confiscated, discarded in a hurry, or taken in a sweep — cannot get sterile ones.3

If you are in Florida: the Department of Health maintains the official IDEA program information, including establishment and reporting requirements.20 Because authorization is county-by-county, availability depends on where you live — and pushing your county commission is a concrete, winnable form of advocacy.

What to do with this

Start with whatever is closest to hand. Nothing on this list requires you to have made a decision about your drug use.

This week

• Get naloxone. Pharmacy without a prescription, over-the-counter Narcan, a community program, or a syringe services program.1516 Get two. Give one away.
• Tell one person when you have used, so someone can act if you stop breathing.15
• Call 1-800-662-HELP (4357) if you want options — free, confidential, 24/7, English and Spanish, referral only.15
• Keep taking your ART. Not conditional on anything else in this article.2

Next appointment

• Ask for a medication conversation — buprenorphine or methadone for opioids, naltrexone for alcohol.2
• Ask for regimen simplification toward once-daily, single-tablet, high resistance barrier.2
• Ask for a full interaction check, and bring the Liverpool checker if you have to.13
• Ask about a syringe services program your clinic works with.2

If your provider responds badly

You are allowed to change providers. A clinician who meets honest disclosure with judgment has told you something useful about the rest of your care with them. Ryan White clinics, community health centers, LGBTQ+ health centers, and syringe program-affiliated clinics tend to be the most practiced at this. Community publications like POZ, Positively Aware, and TheBody have carried first-person accounts of drug use and HIV for decades if you want to hear from people who have been in the chair before you.