Abstract
Consensus guidelines in HIV care call for clinicians to provide a brief sexual risk behavioral intervention in each visit. Studies based on participant reports find this occurs infrequently, but studies based on direct observation of clinical encounters are lacking. We conducted a mixed method study that used audio recordings of 116 routine outpatient visits by 58 different patients with HIV, in five different practice sites. Transcripts of the visits were coded and analyzed using a quantitative system. In addition, we conducted a qualitative analysis of the dialogue segments in which sexual risk behaviors arose as a topic. Discussion of sexual risk behavior occurred in 10 visits, and was generally quite brief. Two visits featured substantial counseling about sexual risk reduction; two others included substantial discussion which was not evidently directed at the patient’s changing behavior. Cues suggesting a need or opportunity for such discussion that physicians did not follow up on occurred in seven additional visits. Interactions about sexual risk had less patient engagement than interactions about other health behaviors. Physicians seldom provide sexual risk reduction counseling in HIV care, even where specific indications are present.
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Institute of Medicine. No time to lose: getting more from HIV prevention. Washington, DC: National Academy of Sciences; 2001.
Cleary PD, Van DN, Rogers TF, Singer E, Shipton-Levy R, Steilen M, et al. Behavior changes after notification of HIV infection. Am J Public Health. 1991;81:1586–90.
Marks G, Burris S, Peterman TA. Reducing sexual transmission of HIV from those who know they are infected: the need for personal and collective responsibility. AIDS. 1999;13:297–306.
Kalichman SC, Kelly JA, Rompa D. Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychol. 1997;16:369–73.
Baskin ML, Braithwaite RL, Eldred L, Glassman M. Introduction to the special supplement: prevention with persons living with HIV. AIDS Educ Prev. 2005;17:1–5.
Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2003;52:1–24.
Morin SF, Koester KA, Steward WT, Maiorana A, McLaughlin M, Myers JJ, et al. Missed opportunities: prevention with HIV-infected patients in clinical care settings. J Acquir Immune Defic Syndr. 2004;36:960–6.
Grodensky CA, Golin CE, Boland MS, Patel SN, Quinlivan EB, Price M. Translating concern into action: HIV care providers’ views on counseling patients about HIV prevention in the clinical setting. AIDS Behav. 2008;12:404–11.
Drainoni ML, Dekker D, Lee-Hood E, Boehmer U, Relf M. HIV medical care provider practices for reducing high-risk sexual behavior: results of a qualitative study. AIDS Patient Care STDS. 2009;23:347–56.
Fisher JD, Fisher WA, Cornman DH, Amico RK, Bryan A, Friedland GH. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. J Acquir Immune Defic Syndr. 2006;41:44–52.
Richardson JL, Milam J, McCutchan A, Stoyanoff S, Bolan R, Weiss J, et al. Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004;18:1179–86.
Vranceanu AM, Safren SA, Lu M, Coady WM, Skolnik PR, Rogers WH, et al. The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV. AIDS Patient Care STDS. 2008;22:313–21.
Wilson IB, Laws MB, Safren SA, Lee Y, Lu M, Coady W, et al. Provider focused intervention increases HIV antiretroviral adherence related dialogue, but does not improve antiretroviral therapy adherence in persons with HIV. J Acquir Immune Defic Syndr. 2010;53:338–47.
Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12:86–94.
Roter DL, Hall JA, Katz NR. Patient-physician communication: a descriptive summary of the literature. Patient Education & Counseling. 1988;12:99–119.
Connor M, Fletcher I, Salmon P. The analysis of verbal interaction sequences in dyadic clinical communication: a review of methods. Patient Educ Couns. 2009;75:169–77.
Beck RS, Daughtridge R, Sloane PD. Physician–patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25–38.
Kiesler DJ, Auerbach SM. Integrating measurement of control and affiliation in studies of Physician–patient interaction: the interpersonal circumplex. Soc Sci Med. 2003;57:1707–22.
Ford S, Hall A, Ratcliffe D, Fallowfield L. The Medical Interaction Process System (MIPS): an instrument for analysing interviews of oncologists and patients with cancer. Soc Sci Med. 2000;50:553–66.
Searle JR. Speech acts. An essay in the philosophy of language. Cambridge: Cambridge University Press; 1969.
Austin JL. How to do things with words. Oxford: Oxford University Press; 1962.
Laws MB, Lu M, Coady W, Bradshaw Y, Safren SA, Skolnik PR, et al. Impact of an intervention on Physician–patient dialogue related to antiretroviral (ARV) adherence. Oral presentation, 3rd international conference on HIV treatment adherence, Jersey City, NJ, March 17–18, 2008.
Laws MB, Howe E, Bradshaw Y, Safren S, Skolnik P, Wilson I. Physician responses to non-adherent behavior by patients in HIV care: effective and ineffective strategies. 9 A.D. Miami, Florida: International Association of Physicians in AIDS Care; 2009.
Laws MB, Epstein L, Lee Y, Rogers W, Wilson IB. Visit length and constructs of patient-centeredness in HIV care. Boston, MA: Centers for AIDS Research 4th National Social and Behavioral Sciences Research Network (SBSRN) Scientific Meeting; 2009.
Malitz FE, Eldred L. Evolution of the special projects of national significance prevention with HIV-infected persons seen in primary care settings initiative. AIDS Behav. 2007;11:S1–5.
Myers JJ, Shade SB, Rose CD, Koester K, Maiorana A, Malitz FE, et al. Interventions delivered in clinical settings are effective in reducing risk of HIV transmission among people living with HIV: results from the Health Resources and Services Administration (HRSA)’s Special Projects of National Significance initiative. AIDS Behav. 2010;14:483–92.
Pringle M, Stewart-Evans C. Does awareness of being video recorded affect doctors’ consultation behaviour? Br J Gen Pract. 1990;40:455–8.
Jordan B, Henderson A. Interaction analysis: foundations and practice. The Journal of the Learning Sciences. 1995;4:39–103.
Acknowledgments
We gratefully acknowledge the important contributions of Emily Howe, who managed data processing and coding of the data for the original intervention trial on which this analysis is based, and Tatiana Taubin who conducted supplemental coding for this study. This work was supported by grants from NIDA (5R01DA015679) NIMH (1R21MH073420-01A1), by the Lifespan/Tufts/Brown Center for AIDS Research (5P30AI042853), and by the Tufts CTSA (UL1 RR025752). Dr. Wilson was also supported by a Midcareer Investigator Award in Patient-oriented Research (K24 RR020300).
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Barton Laws, M., Bradshaw, Y.S., Safren, S.A. et al. Discussion of Sexual Risk Behavior in HIV Care is Infrequent and Appears Ineffectual: A Mixed Methods Study. AIDS Behav 15, 812–822 (2011). https://doi.org/10.1007/s10461-010-9844-3
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DOI: https://doi.org/10.1007/s10461-010-9844-3