Search tips
Search criteria 


Logo of pubhealthrepLink to Publisher's site
Public Health Rep. 1993 Jul-Aug; 108(4): 492–500.
PMCID: PMC1403415

Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program.


The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. A computerized medical encounter data base, with frequencies of primary care visits and with diagnoses for each visit, was linked to the cohort study data base that contained information on patients' demographic characteristics, serologic status, and CD4+ T-lymphocyte counts. Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program. Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Arno PS, Shenson D, Siegel NF, Franks P, Lee PR. Economic and policy implications of early intervention in HIV disease. JAMA. 1989 Sep 15;262(11):1493–1498. [PubMed]
  • Francis DP, Anderson RE, Gorman ME, Fenstersheib M, Padian NS, Kizer KW, Conant MA. Targeting AIDS prevention and treatment toward HIV-1-infected persons. The concept of early intervention. JAMA. 1989 Nov 10;262(18):2572–2576. [PubMed]
  • Friedland GH. Early treatment for HIV: the time has come. N Engl J Med. 1990 Apr 5;322(14):1000–1002. [PubMed]
  • Northfelt DW, Hayward RA, Shapiro MF. The acquired immunodeficiency syndrome is a primary care disease. Ann Intern Med. 1988 Nov 15;109(10):773–775. [PubMed]
  • Paauw DS, O'Neill JF. Human immunodeficiency virus and the primary care physician. J Fam Pract. 1990 Dec;31(6):646–650. [PubMed]
  • Lewis CE, Montgomery K. The AIDS-related experiences and practices of primary care physicians in Los Angeles: 1984-89. Am J Public Health. 1990 Dec;80(12):1511–1513. [PubMed]
  • Smith MD. Primary care and HIV disease. J Gen Intern Med. 1991 Jan-Feb;6(1 Suppl):S56–S62. [PubMed]
  • Makadon HJ, Delbanco SF, Delbanco TL. Caring for people with AIDS and HIV infection in hospital-based primary care practice. J Gen Intern Med. 1990 Sep-Oct;5(5):446–450. [PubMed]
  • Brickner PW, Torres RA, Barnes M, Newman RG, Des Jarlais DC, Whalen DP, Rogers DE. Recommendations for control and prevention of human immunodeficiency virus (HIV) infection in intravenous drug users. Ann Intern Med. 1989 May 15;110(10):833–837. [PubMed]
  • Cooper JR. Methadone treatment and acquired immunodeficiency syndrome. JAMA. 1989 Sep 22;262(12):1664–1668. [PubMed]
  • Sorensen JL, Batki SL, Good P, Wilkinson K. Methadone maintenance program for AIDS-affected opiate addicts. J Subst Abuse Treat. 1989;6(2):87–94. [PubMed]
  • Selwyn PA, Feingold AR, Iezza A, Satyadeo M, Colley J, Torres R, Shaw JF. Primary care for patients with human immunodeficiency virus (HIV) infection in a methadone maintenance treatment program. Ann Intern Med. 1989 Nov 1;111(9):761–763. [PubMed]
  • O'Connor PG, Molde S, Henry S, Shockcor WT, Schottenfeld RS. Human immunodeficiency virus infection in intravenous drug users: a model for primary care. Am J Med. 1992 Oct;93(4):382–386. [PubMed]
  • Karan LD. Primary care for AIDS and chemical dependence. West J Med. 1990 May;152(5):538–542. [PMC free article] [PubMed]
  • Schoenbaum EE, Hartel D, Selwyn PA, Klein RS, Davenny K, Rogers M, Feiner C, Friedland G. Risk factors for human immunodeficiency virus infection in intravenous drug users. N Engl J Med. 1989 Sep 28;321(13):874–879. [PubMed]
  • Selwyn PA, Feingold AR, Hartel D, Schoenbaum EE, Alderman MH, Klein RS, Friedland GH. Increased risk of bacterial pneumonia in HIV-infected intravenous drug users without AIDS. AIDS. 1988 Aug;2(4):267–272. [PubMed]
  • Selwyn PA, Hartel D, Lewis VA, Schoenbaum EE, Vermund SH, Klein RS, Walker AT, Friedland GH. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N Engl J Med. 1989 Mar 2;320(9):545–550. [PubMed]
  • Selwyn PA, Hartel D, Wasserman W, Drucker E. Impact of the AIDS epidemic on morbidity and mortality among intravenous drug users in a New York City methadone maintenance program. Am J Public Health. 1989 Oct;79(10):1358–1362. [PubMed]
  • Selwyn PA, Alcabes P, Hartel D, Buono D, Schoenbaum EE, Klein RS, Davenny K, Friedland GH. Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection. N Engl J Med. 1992 Dec 10;327(24):1697–1703. [PubMed]
  • Feingold AR, Vermund SH, Burk RD, Kelley KF, Schrager LK, Schreiber K, Munk G, Friedland GH, Klein RS. Cervical cytologic abnormalities and papillomavirus in women infected with human immunodeficiency virus. J Acquir Immune Defic Syndr. 1990;3(9):896–903. [PubMed]
  • Solomon L, Frank R, Vlahov D, Astemborski J. Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus. Am J Public Health. 1991 Oct;81(10):1285–1290. [PubMed]
  • Gail MH, Rosenberg PS, Goedert JJ. Therapy may explain recent deficits in AIDS incidence. J Acquir Immune Defic Syndr. 1990;3(4):296–306. [PubMed]
  • Moore RD, Hidalgo J, Sugland BW, Chaisson RE. Zidovudine and the natural history of the acquired immunodeficiency syndrome. N Engl J Med. 1991 May 16;324(20):1412–1416. [PubMed]
  • Stein MD, Piette J, Mor V, Wachtel TJ, Fleishman J, Mayer KH, Carpenter CC. Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons. J Gen Intern Med. 1991 Jan-Feb;6(1):35–40. [PubMed]
  • Rosenberg PS, Gail MH, Schrager LK, Vermund SH, Creagh-Kirk T, Andrews EB, Winkelstein W, Jr, Marmor M, Des Jarlais DC, Biggar RJ, et al. National AIDS incidence trends and the extent of zidovudine therapy in selected demographic and transmission groups. J Acquir Immune Defic Syndr. 1991;4(4):392–401. [PubMed]
  • Schulman KA, Lynn LA, Glick HA, Eisenberg JM. Cost effectiveness of low-dose zidovudine therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection. Ann Intern Med. 1991 May 1;114(9):798–802. [PubMed]
  • Pepin J, Plummer FA, Brunham RC, Piot P, Cameron DW, Ronald AR. The interaction of HIV infection and other sexually transmitted diseases: an opportunity for intervention. AIDS. 1989 Jan;3(1):3–9. [PubMed]
  • Hook EW., 3rd Syphilis and HIV infection. J Infect Dis. 1989 Sep;160(3):530–534. [PubMed]
  • Byrne MA, Taylor-Robinson D, Munday PE, Harris JR. The common occurrence of human papillomavirus infection and intraepithelial neoplasia in women infected by HIV. AIDS. 1989 Jun;3(6):379–382. [PubMed]
  • Henry MJ, Stanley MW, Cruikshank S, Carson L. Association of human immunodeficiency virus-induced immunosuppression with human papillomavirus infection and cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1989 Feb;160(2):352–353. [PubMed]
  • Rhoads JL, Wright DC, Redfield RR, Burke DS. Chronic vaginal candidiasis in women with human immunodeficiency virus infection. JAMA. 1987 Jun 12;257(22):3105–3107. [PubMed]

Articles from Public Health Reports are provided here courtesy of Association of Schools of Public Health