HIV This Week

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. 2007 Jun 19; [Epub ahead of print]

Recent Centers for Disease Control (CDC) guidelines recommend that HIV care practitioners provide HIV prevention counselling to patients at routine medical visits. However, research shows that HIV care practitioners provide such counselling infrequently, presenting a challenge for clinics implementing these guidelines. Our qualitative study of 19 HIV care providers at an infectious diseases clinic in the southeastern US explored providers' beliefs about their patients' HIV transmission behaviours, expected outcomes of conducting HIV prevention counselling, and perceived barriers and facilitators to counselling. Providers' concern about HIV transmission among their patients was high but did not "translate into action" in the form of counselling. They anticipated poor outcomes from counselling, including harm to patient-provider relationships, and failure of patients to change their behaviour. They also listed barriers and facilitators to counselling, most importantly time, state reporting policies, and conversational triggers. Implications for implementation of CDC guidelines and clinic-based "Prevention with Positives" programs are discussed.

Editors’ note: If HIV care providers do not feel they can discuss sexual behaviour with their patients because they believe it won’t result in behaviour change, then this becomes a self-fulfilling prophesy. Barriers to positive prevention need to be considered and intentions reinforced in discussions between patients and care providers. The latter may need training and skills building to overcome their fear of damaging the therapeutic relationship, a fear which may be based in reality.