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
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.
"Apparently some clinics have been more successful than
others in integrating prevention into the routine care of HIV
patients," the authors wrote, noting that two clinics reached
over 90 percent of patients with safer sex messages, while
another reached 76 percent of patients. There was no correlation
between the number of patients at a clinic and reports of
provider communication about prevention.
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
Back to other CDC news for October 24, 2002
This article was provided by CDC National Prevention Information Network.
It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.