October 24, 2002
With recent improvements in HIV therapy, more people are seeking HIV testing and, if infected, medical care. Thus, HIV clinics have become an increasingly important setting for delivering prevention messages to HIV-positive patients. In the current study, the researchers sampled HIV-positive men and women in care at HIV clinics and examined their reports of whether clinic health care providers talked with them about practicing safer sex and disclosing their seropositive status to sex partners.
The baseline interviews were conducted in 1998-1999 at six public HIV clinics in California whose caseload of active patients ranged from 500 to 2,500 per clinic. The researchers approached 2,027 patients; 886 were enrolled, provided informed consent, and received $10. In private interviews, participants indicated whether any provider in an applicable category -- 1) physician; 2) physician assistant, nurse practitioner or nurse; or 3) social worker, health educator, psychologist, or psychiatrist -- had ever talked with them about using safer sex and disclosing their seropositive status to sex partners. After exclusions, the analytic sample (n=839) focused on men who had sex with men, heterosexual men, and women who had sex with men.
Of the full sample, 29 percent (33 percent of MSM) reported that no applicable HIV clinic provider had ever talked with them about safer sex. Providers were less likely to talk with patients about disclosure than safer sex. Given limited time per patient, providers may focus on sexual behavior as the "bottom line" in transmission risk; some providers, however, may not feel fully prepared to deal with the issue of disclosure.
After statistically adjusting for other variables, black and Hispanic patients were more likely than white patients to report that a provider talked with them about prevention or disclosure. The researchers hypothesized that this may mean that providers are giving more attention to ethnic groups that are increasingly affected by the epidemic; that they mistakenly believe whites are better informed; or that minority patients are more likely to initiate conversations about prevention with providers. A smaller percentage of MSM than heterosexual men or women reported that providers had talked with them about safer sex; this may indicate that some providers are uncomfortable discussing homosexual behavior or that they mistakenly assume that MSM already know about prevention and need no further information.
Patients whose viral load was above the median in the sample and those who reported unprotected anal or vaginal intercourse with at-risk partners were no more likely that their counterparts to receive safer sex counseling from providers. This prompts concern, since these patients pose a greater risk for HIV transmission. The authors suggest that providers give prevention messages to all patients, regardless of viral load, because some patients now engaged in safer sex may relapse to risky sex.
The authors site other studies on tobacco and alcohol use, physical activity and eating habits which show that health care providers can play a significant role in helping patients adopt and maintain healthy behaviors. "We believe that HIV care providers, given adequate resources and training, can play the same beneficial role with their HIV-positive patients," the authors concluded. "It is imperative to identify efficacious prevention messages and interventions that can be used in HIV clinic settings."
09.27.02; Vol. 16: P. 1953-1957; Gary Marks; Jean L. Richardson; Nicole Crepaz; Susan Stoyanoff; Joel Milam; Carol Kemper; Robert A. Larsen; Robert Boland; Penny Weismuller; Harry Hollander; Allen McCutchan