摘要：Objectives. We investigated physicians’ delivery of HIV prevention counseling to newly diagnosed and established HIV-positive patients. Methods. A questionnaire was developed and mailed to 417 HIV physicians in 4 US cities. Results. Overall, rates of counseling on the part of physicians were low. Physicians reported counseling newly diagnosed patients more than established patients. Factors associated with increased counseling included having sufficient time with patients and familiarity with treatment guidelines. Physicians who perceived their patients to have mental health and substance abuse problems, who served more male patients, and who were infectious disease specialists were less likely to counsel patients. Conclusions. Intervention strategies with physicians should be developed to overcome barriers to providing counseling to HIV-positive patients. Studies have shown an increase in reported risk behavior among HIV-positive individuals receiving care. 1– 5 Similarly, there has been a recent resurgence of syphilis among people with HIV in many cities across the United States. 6– 8 These data emphasize the importance of alternative strategies to prevent the continued spread of HIV/AIDS in the United States. National strategies have recognized the importance of incorporating HIV prevention into the medical care setting. 9, 10 This approach is consistent with a recent Institute of Medicine report that emphasized the need for prevention services among persons living with HIV and the new HIV prevention strategy of the Centers for Disease Control and Prevention (CDC). 11, 12 Studies consistently demonstrate that patients view their physician as a trusted and authoritative source of health information. 13, 14 Studies in other disease prevention areas have shown that brief interventions delivered by physicians can translate into behavior change. 15– 17 Recognizing this potential, federal organizations have recommended that physicians play a more active role in delivering prevention messages to their HIV-positive patients. 9– 12, 18, 19 For example, in 1991, the US Public Health Service established as a goal that 75% of primary care and mental health care clinicians provide appropriate counseling regarding prevention of HIV and other sexually transmitted diseases by 2000. 20 Relatively little is known about the risk reduction practices of HIV care providers with their HIV-positive patients. Earlier studies showed that primary care physicians do not routinely assess or intervene with their patients regarding their risks for HIV infection. 21– 23 In 2 studies of HIV-positive individuals, 24, 25 approximately 25% and 29% of participants, respectively, reported that a provider had not talked with them about safe sex. However, these studies did not provide information on provider-reported practices, nor did they distinguish delivery of prevention counseling to newly diagnosed and established patients. To our knowledge, there has been, to date, no comprehensive physician study focusing on the delivery of HIV prevention counseling to HIV-positive patients by physicians within HIV medical care clinics. The current study, which focused on physician practices in 4 major US cities, investigated physicians’ delivery of prevention counseling to newly diagnosed and established HIV-positive patients.
