HIV clinician fatalism hinders "prevention for positives" counseling

By Jeff Sheehy

UCSF researchers have found that some physicians express a sense of fatalism about HIV prevention and this belief—that changes in sexual risk behavior by their HIV-positive patients are unlikely—is hindering the provision of prevention counseling services in publicly-funded clinics.

“This research suggests that attitudinal barriers among providers will need to be addressed in order for the new ‘prevention with positives’ initiative from the Centers for Disease Control and Prevention to achieve fully its goal of reducing sexual risk behaviors by HIV-positive patients,” said the study’s lead author, Wayne T. Steward, PhD, MPH, postdoctoral fellow at the UCSF Center for AIDS Prevention Studies.

Steward presented the findings at the XV International AIDS Conference in Bangkok, Thailand on July 15.

The study assessed receipt of prevention counseling by surveying 618 HIV positive patients as they left primary care appointments in one of 16 publicly funded clinics in nine states. In addition, qualitative interviews were conducted with service providers and administrators from the clinics to assess their attitudes, as well as the barriers to providing HIV prevention counseling.

In interview transcripts, each statement reflecting a belief that behavior change among HIV-positive patients was unlikely was coded as “fatalism.” An example is this quote from one provider, “I think it’s like almost hopeless to try and change people’s sexual behavior. I shouldn’t say that, but you know, that’s basically what my feeling is.”

The number of fatalistic statements was added up and each clinic was assigned a score.  Patients in clinics with high provider fatalism were less likely to report receiving prevention counseling in the last six months than patients in clinics with low provider fatalism.

“We also found that patients in clinics with high provider fatalism were more likely to be gay men than patients in clinics with low provider fatalism,” said study co-author, Stephen F. Morin, PhD, director of the UCSF AIDS Policy Research Center.

Study co-authors are Kimberly A. Koester, MA, Director of Qualitative Research, and Janet J. Myers, PhD, MPH, co-director, at the UCSF AIDS Policy Research Center.

Funding for this research was provided by a grant from the Health Resources and Services Administration.

The AIDS Policy Research Center and the Center for AIDS Prevention Studies are components of the UCSF AIDS Research Institute (ARI). UCSF ARI houses hundreds of scientists and dozens of programs throughout UCSF and affiliated labs and institutions, making ARI one of the largest AIDS research entities in the world.