Sex, Risk and Responsibility: Provider Attitudes and Beliefs Predict HIV Transmission Risk Prevention Counseling in Clinical Care Settings

Abstract

We examined factors associated with the frequency of HIV "prevention with positives" (PwP) counseling delivered by providers participating in demonstration projects at 26 clinics. Three hundred and fifteen primary care and support service providers completed a survey assessing the frequency of PwP delivered at initial medical care visits and at regular care visits. Providers reported delivering PwP counseling to more patients at initial visits (67%) than to those returning for regular care (53%; t = 11.8, p < 0.001). During initial and regular care visits, providers reporting a sense of responsibility for conducting PwP and those regularly discussing the risk of reinfection with patients reported significantly more frequent PwP counseling. Providers expressing a belief that no matter how much counseling was delivered, some HIV-infected patients would still infect others (prevention fatalism) reported significantly less frequent counseling at all visits. To improve the quality and quantity of HIV PwP counseling, providers training should address attitudinal barriers and facilitators to counseling and the importance of addressing risk routinely.

HIV Care Providers' Implementation of Routine Alcohol Reduction Support for Their Patients

“…Consistent with the current findings, self efficacy has been shown to be an important predictor of performance in a great variety of occupational fields, 49 including HIV=AIDS. 50 Fortunately, training in SBI can increase some providers' confidence in performing alcohol screening procedures, and in conducting brief alcohol reduction interventions. 37 Our analyses also indicate that those providers without specific caseloads routinely implemented fewer alcohol reduction components.…”

Prevention With Positives: A Review of Published Research, 1998-2008

“…Several lessons were repeatedly mentioned, including (a) obtaining buy-in from clinic providers before beginning the program, (b) addressing provider attitudes and beliefs about risk reduction, (c) attempting to identify and overcome any resistance from providers who are uncomfortable with counseling, (d) providing training in the selected counseling technique, (e) anticipating changes to clinic flow with the introduction of the program, and (f) providing a clear outline of staff responsibilities for the project (Myers et al, 2007). These results may be used to inform clinical practice until complete results are available.…”

Attitudes Toward HIV Among Health Professions Students in the Southeastern United States: Implications for Interprofessional Education

“…This environment could both facilitate healthcare providers' expression of unfavorable attitudes toward marginalized populations (e.g., PLWH, lesbian, gay, bisexual, and transgender [LGBT] patients) and prevent providers from expressing more favorable attitudes toward these groups. Indeed, there is evidence of more negative attitudes toward HIV among providers who practice in the Southeastern U.S. (Talley, Ritzdorf, & Muma, 2010) whereas national data shows more positive attitudes among providers (Myers et al, 2007). Unfortunately, negative attitudes about HIV prevent providers from delivering optimal healthcare and decrease PLWH's willingness to access healthcare (e.g., Ding et al, 2005;Wong et al, 2004), which together can perpetuate health inequities among PLWH in the southeastern U.S.…”