To test the hypothesis that at-risk drinking is associated with a smaller probability of prior HIV testing and access to antiretroviral treatment (ART) among injection drug users (IDUs) entering treatment for drug abuse. HIV infected IDUs (N = 643) entering detoxification or methadone maintenance treatment in New York City between 1997 and 2002 comprised the participants. Multivariate logistic regression was used to assess whether receiving ART was associated with at-risk drinking. A significantly smaller proportion of at-risk drinkers, compared to nondrinkers and moderate drinkers, reported receiving ART. Multivariate logistic regression analyses showed a significant interaction between alcohol and cocaine use in relation to reported ART. At-risk drinkers who used crack cocaine were less likely to receive ART compared to nondrinkers who did not use crack cocaine. HIV treatment programs should address at-risk drinking through screening for alcohol use and educating staff to improve the lower rate of ART reported by at-risk drinking IDUs.
