Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 36, Issue 4, Pages 960-966Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/00126334-200408010-00010
Keywords
prevention with positives; prevention in primary care settings
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Objective: To assess current practices related to prevention with HIV-positive patients in Ryan White-funded primary care settings and the barriers to providing such services. Method: Exit surveys about HIV prevention services were conducted with 618 HIV-infected patients at 16 primary HIV care clinics receiving Ryan White CARE Act funding. To place the exit survey findings in context, qualitative in-depth interviews were conducted with 16 clinic administrators, 32 primary care providers, 32 support service providers, and 64 patients. Results: One quarter of patients reported having had a general discussion of safer sex and ways to prevent transmission to others during that day's primary care visit. However, only 6% reported discussing specific sexual activities. HIV prevention counseling was less common than counseling for adherence to antiretroviral therapy, emotional issues, and diet and nutrition (P < 0.001). Patients in clinics with established procedures for HIV prevention counseling were significantly more likely to report receiving such services (odds ratio = 2.17). Qualitative interviews identified barriers to providing prevention services as lack of time, training, funding for staffing, and providers' understanding of their roles and responsibility. Conclusions: HIV prevention counseling is not routine in most clinics, and the low frequency of such services represents missed opportunities for HIV prevention.
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