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Abstract
Substance use among HIV-infected patients can hinder antiretroviral adherence and health outcomes, yet discussions with providers remain limited. In a cross-sectional study of 413 patients and 45 providers, most reported high comfort discussing substance use, but current drug or alcohol users were significantly less comfortable. Higher patient self-efficacy and activation increased comfort, while provider comfort was linked to caring for highly activated patients. These findings suggest that those most in need of intervention feel least comfortable discussing substance use, highlighting patient activation and provider engagement as key targets for improving communication in HIV care.