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Provider Fatalism Reduces the Likelihood of HIV-Prevention Counseling in Primary Care Settings

We examined the relationship between provider fatalism, a belief that behavior change among HIV-infected patients is unlikely, and HIV-prevention counseling in 16 publicly funded clinics. HIV-seropositive patients (N = 618) completed surveys assessing prevention counseling in the past 6 months. Additionally, 144 interviews were conducted with providers, administrators, and patients to examine beliefs about prevention counseling. We summed the number of fatalistic comments made by providers and administrators in each clinic, and assigned these counts as clinic-level fatalism scores to survey participants. Patients in high fatalism clinics were less likely to report prevention counseling than patients in low fatalism clinics. This difference remained significant even after controlling for clinic characteristics or patients' sexual risk and health status. However, clients in high fatalism clinics were more likely to be White, gay, educated, and older. Provider fatalism is a barrier that must be addressed when implementing HIV-prevention counseling in primary care settings.

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ACKNOWLEDGMENTS

Data collection for the project was supported by a grant (6H4AHA00016-03-05) from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) program. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of HRSA or the SPNS Program. Wayne T. Steward was supported by a training grant from the National Institute of Mental Health (5T32MH019105). The authors wish to acknowledge the support of Faye Malitz, Katherine Marconi, and Pam Kowalski from HRSA Office of Science and Epidemiology, who served as project officers and provided guidance to the project. Collaborators from the Centers for Disease Control and Prevention (CDC) included Ken Hunt, Dogan Eroglu, Sam Dooley, and Kathy Rauch. The UCSF field staff included Angela Allen, Maricarmen Arjona, Andrew Herring, Cecilie Rowitz, Tanya Stallworth, and Sheri Storey. The authors thank Carol Dawson-Rose, Andre Maiorana, Tor Neilands, Nicolas Sheon, and three anonymous reviewers for helpful advice on earlier drafts of the paper, and the participating clinics for their cooperation and technical assistance.

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Steward, W.T., Koester, K.A., Myers, J.J. et al. Provider Fatalism Reduces the Likelihood of HIV-Prevention Counseling in Primary Care Settings. AIDS Behav 10, 3–12 (2006). https://doi.org/10.1007/s10461-005-9024-z

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KEY WORDS:

  • Fatalism
  • prevention with people living with HIV
  • clinic-based prevention
  • provider beliefs