Variations in primary care physicians HIV risk assessment practice by patient type

Background: Since the advent of antiretroviral medication the incidence of AIDS cases has declined sharply in the U.S. while the prevalence of HIV and AIDS continues to increase. Despite increased options for HIV treatment, limited research has been conducted among primary care physicians and their risk assessment practices of high-risk patients. Methods: A survey was mailed to a national, random sample of 1400 practicing primary care physicians (i.e. family practice, internal medicine, pediatric medicine and obstetrician-gynecologists). Our aim was to assess the proportion of physicians that “Always/Often” asked eight HIV risk assessment questions of five high-risk patient subgroups (i.e. men who have sex with men [MSM], injection drug users [IDUs], HIV+ patients, patients with symptoms/diagnosis of a sexually transmitted disease [STD] and continuing adult patients). Results: Physicians reported they were more likely to “Always/Often” ask 7 of 8 HIV risk assessment questions of patients presenting with an STD and least likely to ask these questions among MSM, and IDU patients. When individual comparisons of the high-risk subgroups was compared to continuing adult patients for each of the eight risk assessment questions studied, physicians "Always/Often" asked the fewest aggregate number of questions of their male patients that have sex with men (1 of 8 questions) and injection drug users (3 of 8 questions). Conclusion: Patients who are at highest risk of contracting and transmitting HIV are not receiving adequate patient care because physicians are infrequently conducting HIV risk assessments even when aware of their patients high-risk status.