BACKGROUND: In addition to structural interventions such as syringe services and naloxone distribution, harm reduction (HR) is also a OBJECTIVES: The aim of this study was to describe the ways healthcare workers (HCWs) characterize interactions with PWH who use drugs and if these characterizations reflect relational HR or missed opportunities to improve the patient-provider relationship. DESIGN: We used a qualitative descriptive design to characterize HCWs' descriptions of their interactions with PWH who use drugs. METHODS: We interviewed providers ( RESULTS: We discovered that HCWs characterize positive patient-provider interactions that both reflect HR principles and may not align with the principles of HR. Examples include when patients appear comfortable with and trusting of their provider, when patients feel heard by their provider, and when providers feel they are responsive to patient needs. However, other HCWs described positive interactions as counter to relational HR. CONCLUSION: HCW descriptions of positive interactions in line with relational HR in their conceptualization of patient-provider interactions with PWH who use drugs have the potential to guide efforts in increasing the acceptability of HR in HIV care. Given evidence showing HR improves outcomes for those who use substances, findings suggest missed opportunities to incorporate relational HR into the patient-provider relationship in HIV primary care settings. REGISTRATION: NCT05404750.