[procaare] Are HIV Care Providers Talking About Safer Sex & Disclosure?

[ProCAARE <procaare@usa.healthnet.org>]

"Are HIV Care Providers Talking with Patients About Safer Sex and Disclosure?"
A Multi-Clinic Assessment"

AIDS (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
****************

 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.

"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 clinic settings."

Source: [AEGiS] CDC HIV/STD/TB Prevention News Update 10/24/02

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