Abstract
Recent Centers for Disease Control (CDC) guidelines recommend that HIV care practitioners provide HIV prevention counseling to patients at routine medical visits. However, research shows that HIV care practitioners provide such counseling infrequently, presenting a challenge for clinics implementing these guidelines. Our qualitative study of 19 HIV care providers at an infectious diseases clinic in the southeastern US explored providers’ beliefs about their patients’ HIV transmission behaviors, expected outcomes of conducting HIV prevention counseling, and perceived barriers and facilitators to counseling. Providers’ concern about HIV transmission among their patients was high but did not “translate into action” in the form of counseling. They anticipated poor outcomes from counseling, including harm to patient–provider relationships, and failure of patients to change their behavior. They also listed barriers and facilitators to counseling, most importantly time, state reporting policies, and conversational triggers. Implications for implementation of CDC guidelines and clinic-based “Prevention with Positives” programs are discussed.
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References
Adams, A., Ockene, J. K., Wheeler, E. V., & Hurley, T. G. (1998). Alcohol counseling. Journal of General Internal Medicine, 13, 692–702.
Berlin, F. S., Malin, H. M., & Dean, S. (1991). Effects of statutes requiring psychiatrists to report suspected sexual abuse of children. American Journal of Psychiatry, 148, 449–453.
Bing, E. G., Burnam, M. A., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., et al. (2001). Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Archives of General Psychiatry, 58, 721–728.
Bluespruce, J., Dodge, W. T., Grothaus, L., Wheeler, K., Rebolledo, V., Carey, J. W. et al. (2001). HIV prevention in primary care: Impact of a clinical intervention. AIDS Patient Care and STDs, 15, 243–253.
Boekeloo, B. O., Bobbin, M. P., Lee, W. I., Worrell, K. D., Hamburger, E. K., & Russek-Cohen, E. (2003). Effect of patient priming and primary care provider prompting on adolescent-provider communication about alcohol. Archives of Pediatric and Adolescent Medicine, 157, 433–439.
Bull, S. S., Rietmeijer, C., Fortenberry, J. D., Stoner, B., Malotte, K., Vandevanter, N., et al. (1999). Practice patterns for the elicitation of sexual history, education, and counseling among providers of STD services: Results from the Gonorrhea Community Action Project. Sexually Transmitted Diseases, 26, 584–589.
Centers for Disease Control, Prevention. (2003). Incorporating HIV prevention into the medical care of persons living with HIV. MMWR, 52(RR12), 1–24.
Dawson-Rose, C., & Myers, J. (2004). Prevention with positives in clinical settings. Presented at the Center for AIDS Prevention Studies 4th Annual HIV Prevention Conference, San Francisco, CA.
DeRosa, C. J., & Marks, G. (1998). Preventive counseling of HIV-positive men and self-disclosure of serostatus to sex partners: New opportunities for prevention. Health Psychology, 17, 224–231.
Duffus, W. A., Barragan, M., Metsch, L., Krawczyk, C. S., Loughlin, A. M., Gardner, L. I., et al. (2003). Effect of physician specialty on counseling practices and medical referral patterns among physicians caring for disadvantaged human immunodeficiency virus-infected populations. Clinical Infectious Disease, 36, 1577–1584.
Eckstrom, E., Hickam, D. H., Lessler, D. S., & Buchner, D. M. (1999). Changing physician practice of physical activity counseling. Journal of General Internal Medicine, 14, 376–378.
Fisher, J. D., Cornman, D. H., Osborn, C. Y., Amico, K. R., Fisher, W. A., & Friedland, G. A. (2004). Clinician-initiated HIV risk reduction intervention for HIV-positive persons: Formative research, acceptability, and fidelity of the Options project. Journal of Acquired Immune Deficiency Syndrome, 37, S78–S87.
Golin, C. E., Smith, S. R., & Reif, S. (2004). Adherence counseling practices of generalist and specialist physicians caring for people living with HIV/AIDS in North Carolina. Journal of General Internal Medicine, 19, 16–27.
Janssen, R. S., & Valdeserri, R. O. (2004). HIV prevention in the United States: Increasing emphasis on working with those living with HIV. Journal of Acquired Immune Deficiency Syndrome, 37, S119–S121.
Kalichman, S. C., Rompa, D., Luke, W., & Austin, J. (2002). HIV transmission risk behaviours among HIV-positive persons in serodiscordant relationships. International Journal of STDs and AIDS, 13, 677–682.
Klerman, L. V., & Rooks, J. P. (1999). A simple, effective method that midwives can use to help pregnant women stop smoking. Journal of Nurse-Midwifery, 44, 118–123.
Kreuter, M. W., Chheda, S. G., & Bull, F. C. (2000). How does physician advice influence patient behavior? Evidence for a priming effect. Archives of Family Medicine, 9, 426–433.
Margolis, A. D., Wolitski, R. J., & Gomez, C. A. (2001). Are healthcare providers talking to HIV-seropositive patients about safer sex? AIDS, 15, 2335–2337.
Marks, G., Crepaz, N., & Janssen, R. S. (2006). Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS, 20, 1447–1450.
Mayer, K. H., Safren, S. A., & Gordon, C. M. (2004). HIV care providers and prevention: Opportunities and challenges. Journal of Acquired Immune Deficiency Syndrome, 37, S130–S132.
Metsch, L. R., Pereyra, M., del Rio, C., Gardner, L., Duffus, W. A., Dickinson, G., et al. (2004). Delivery of HIV prevention counseling by physicians at HIV medical care settings in 4 US cities. American Journal of Public Health, 94, 1186–1192.
Meyer, T. A. (2000). Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions. American Journal of Health-System Pharmacy, 57, S18–S22.
Morin, S. F., Koester, K. A., Steward, W. T., Maiorama, A., McLaughlin, M., Myers, J. J., et al. (2004). Missed opportunities: Prevention with HIV-infected patients in clinical care settings. Journal of Acquired Immune Deficiency Syndrome, 36, 960–966.
Napravnik, S., Edwards, D., Stewart, P., Stalzer, B., Matteson, E., & Eron, J. J. Jr. (2005). HIV-1 drug resistance evolution among patients on potent combination antiretroviral therapy with detectable viremia. Journal of Acquired Immune Deficiency Syndrome, 40, 34–40.
Natter, J., Fiano, T., Gamble, B., & Wood, R. W. (2002). Integrating HIV prevention and care services: The seattle “Collaboration Project”. Journal of Public Health Management and Practice, 8, 15–23.
NC Communicable Disease Rules NCAC 7A.0209. (2006) Control measures—HIV. Retrieved from http://www.epi.state.nc.us/epi/gcdc.html. Accessed 9 June 2006.
NC General Statutes CH130A-144. (2006) Investigation and control measures. Retrieved from http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter_130A/GS_130A-144.html. Accessed 6 February 2006.
NC General Statutes CH130A-135. (2006) Physicians to report. Retrieved from http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter_130A/GS_130A-135.html. Accessed 6 February 2006.
Ozer, E. M., Adams, S. H., Gardner, L. R., Mailloux, D. E., Wibbelsman, C. J., & Irwin, C. E. (2004). Provider self-efficacy and the screening of adolescents for risky health behavior. Journal of Adolescent Health, 35, 101–107.
Richardson, J. L., Milam, J., McCutchan, A., Stoyanoff, S., Bolan, R., Weiss, J., et al. (2004). Effects of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: A multi-clinic assessment. AIDS, 18, 1179–1186.
Rodriguez, M. A., Sheldon, W. R., Bauer, H. M., & Perez-Stable, E. J. (2001). The factors associated with disclosure of intimate partner abuse to clinicians. Journal of Family Practice, 4, 338–344.
Schwarzer, R. (2001). Social cognitive factors in health-related behaviors. Current Directions in Psychological Science, 10, 47–51.
Steward, W. T., Koester, K. A., Myers, J. J., & Morin, S. F. (2006). Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings. AIDS Behavior, 10, 3–12.
Verhoeven, V., Bovjin, K., Helder, A., Peremans, L., Hermann, I., Van Royen, P., et al. (2003). Discussing STIs: Doctors are from Mars, patients from Venus. Family Practice, 20, 11–15.
Walsh, J., Swangard, D. M., David, T., & McPhee, S. J. (1999). Exercise counseling by primary care physicians in the era of managed care. American Journal of Preventive Medicine, 16, 307–313.
Whetten, K., Reif, S. S., Napravnik, S., Swartz, M. S., Thielman, N. M., Eron, J. J. Jr., et al. (2005). Substance abuse and symptoms of mental illness among HIV-positive persons in the Southeast. South Medical Journal, 98, 9–14.
Zebris, J., & Maurer, W. (2004). Quality assurance in the endoscopy suite: Sedation and monitoring. Gastrointestinal Endoscopy Clinics of North America, 14, 415–429.
Acknowledgments
We thank Kim Koester for her editorial comments. We acknowledge the HRSA program, grant No. H97HA01289–02, for funding the project as well as the support of 9P30 AI 50410–04. Dr. Golin’s salary was supported in part by NIMH grant No. K23 MH01862–01.
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Grodensky, C.A., Golin, C.E., Boland, M.S. et al. Translating Concern into Action: HIV Care Providers’ Views on Counseling Patients about HIV Prevention in the Clinical Setting. AIDS Behav 12, 404–411 (2008). https://doi.org/10.1007/s10461-007-9225-8
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DOI: https://doi.org/10.1007/s10461-007-9225-8