Integrating Prevention in HIV Medical Care: Findings from a clinicians' survey

Background: Enhancing prevention activities with HIV-positive persons is one means by which the number of new HIV infections can be reduced. This study assessed HIV clinicians' attitudes toward providing HIV prevention services, self-assessment of skills and effectiveness at working with sexual risk and drug use behaviors, as well as structural barriers to providing these services.

Methods: The anonymous wed-based survey contained 33 questions and was administered in September 2006. The survey inquired about the respondents' demographics, attitude, skill and comfort with engaging in sexual and drug use conversations with patients. Surveys were sent to 136 nurse practitioners, physicians and physician assistants in the Ryan White Care Act Title I HIV primary care system in Philadelphia.

Results: Seventy-nine (58%) clinicians completed the survey. Ninety-four percent of clinicians believe performing prevention efforts is an important role. Forty-two percent would like to screen for high risk behaviors more often and 46% would like to be more effective. Clinicians identified the following barriers: higher priority medical issues (19-31%); not enough time (25-27%); and patients unwilling to discuss (19-23%). Clinician identified the following items of assistance: written materials for clinicians and patients about risk behaviors (50%); prevention service referral information (46%); and counseling specialist on-site (40%).

Conclusion: The data suggests that clinicians understand the need to perform prevention activities. However, clinicians are limited in the extent of implementation by clearly identified barriers. To address prevention efforts in the medical clinic, it is sound to begin by assessing the current activities, barriers and aids to implementation.