Primary Care Physicians and Their HIV Prevention Practices

Abstract

A national random-sample survey of 4011 primary care physicians was conducted to determine the extent to which they are providing HIV prevention and clinical services, and to learn what characteristics and attitudes might impede the provision of such services. Physicians were asked about their history-taking practices for new adult and adolescent patients, including asking about the use of illicit drugs (injection and noninjection), the number of sexual partners, use of condoms and contraceptives, past episodes of sexually transmitted diseases (STDs), sexual orientation, and sexual contact with partner(s) at high risk for HIV. A preliminary analysis was conducted and reported earlier by the Centers for Disease Control and Prevention (CDC), focusing on the HIV-prevention services being provided by primary care physicians. This report provides additional analyses from this study, focusing on characteristics and attitudes that may prevent physicians from providing these services. Male physicians and the physicians' belief that patients would be offended if asked questions about their sex behaviors were strongly predictive of not asking new patients about their sex and drug behaviors. The physician's specialty was also a strong predictor-OB/GYNs were predictive of asking these questions and GP/FPs were predictive of not asking the questions. Physicians who indicated that a majority of their patients were white were less likely to report asking patients about their sex and drug behaviors. The authors conclude that a substantial number of primary care physicians are missing important opportunities to prevent HIV transmission by not adequately assessing patients' risks and not providing necessary risk-reduction counseling during their physician-patient encounters. Physician's attitudes and beliefs about their patients, as well as their level of experience with HIV, may help to explain these observations.

Compliance with a New York State 2010 HIV Testing Law: Is There Racial/Ethnic Bias in HIV Testing? Experience of Monroe County, New York, 2012

“…Prior studies have shown that HIV testing rates are higher for patients receiving health services from obstetricians/gynecologists. [33][34][35] As others have discussed, during a routine gynecological exam, it may be easier to recommend HIV testing in the context of general screening for sexually transmitted infections since sexual activity is assumed. Pregnancy may also increase the likelihood of HIV testing, given that the CDC and the American College of Obstetrics and Gynecology recommend opt-out HIV testing for pregnant women.…”

Predictors of Inconsistent Contraceptive Use among Adolescent Girls: Findings from a Prospective Study

“…Other research indicates that clinicians often miss opportunities to provide risk behavior counseling during preventive care visits with high-risk adolescent patients [48]. Factors related to physician discussions of sexual risk with their patients included comfort level (with belief that patients would be offended if asked about their sexual behaviors predicting not asking patients about these behaviors) and physician specialty (with OB/GYNs being more likely than GP/FPs to ask questions about their patient's sexual behaviors) [49]. Given that adolescents have expressed positive beliefs about physician counseling on risk behaviors and a willingness to discuss risk behaviors if asked about them in a confidential manner [46], efforts to increase clinicians' consistent practice of risk assessment and counseling should be supported.…”

HIV Medical Care Provider Practices for Reducing High-Risk Sexual Behavior: Results of a Qualitative Study

“…In addition, physicians who had a majority of Caucasian patients were less likely to address these issues. 23 In the four-city study, physicians were more likely to provide prevention counseling to newly-diagnosed rather than established patients. 16 Another predictor of prevention counseling included having lower patient loads.…”