Publication Date



Open access

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Epidemiology (Medicine)

Date of Defense


First Committee Member

Clyde B. McCoy

Second Committee Member

Lisa R. Metsch

Third Committee Member

Margaret Pereyra

Fourth Committee Member

James D. Wilkinson

Fifth Committee Member

David Purcell


This dissertation sought to identify correlates of perceived self-efficacy to disclose drug use to one’s HIV primary care provider (DISDR) among a sample of HIV-positive injection drug users (IDUs). Additionally the relationship between identified correlates and DISDR was evaluated to determine whether it persists longitudinally. Potential correlates consisted of individual characteristics (socio-demographic), health care service utilization, sex/drug use behaviors, and psychosocial characteristics. It was postulated that selected variables from these domains would be associated with DISDR. This study presents baseline and longitudinal data that suggest a positive association between self-efficacy to disclose injection drug use to one’s HIV primary care provider and the following variables: patient-provider relationship, attendance of a drug treatment program during the previous six months, “taking control of one’s healthcare,” and social support. However, current receipt of HIV medications and being recruited from the city of Miami were negatively associated with reporting a high DISDR. These findings will potentially inform interventions that can improve HIV treatment among drug users and inform policymakers and stakeholders regarding the importance of providing comprehensive HIV care in conjunction with substance abuse treatment options to achieve optimal health outcomes. A recommendation for further study is enclosed.


self-efficacy; patient provider relationship; injection drug use; HIV primary care; social support