Prevention of HIV Infection in Primary Care: Current Practices, Future Possibilities
- Harvey J. Makadon, MD; and
- Jonathan G. Silin, EdD
- From Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts; Bank Street College of Education, New York, New York; and the Center for AIDS Prevention Studies, University of California, San Francisco, California. Acknowledgments: The authors thank William Taylor, MD; Jeff Stryker; Mark Smith, MD; Thomas Coates, PhD; Janet Walzer, MEd; Pamela DeCarlo; and Christine Veiga for support in preparing this manuscript. Grant Support: By grant 93-2321 from the Kaiser Family Foundation. Requests for Reprints: Harvey J. Makadon, MD, Division of General Medicine and Primary Care, Beth Israel Hospital, LY 330, 330 Brookline Avenue, Boston, MA 02215. Current Author Addresses: Dr. Makadon: Division of General Medicine and Primary Care, Beth Israel Hospital LY 330, 330 Brookline Avenue, Boston, MA 02215.
Abstract
More than a decade has passed since the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome [AIDS] epidemic began; our failure to develop an effective vaccine and adequate medical treatments indicates that future research and practice must work to prevent the spread of HIV. We review the literature on the current HIV-prevention practices of primary care physicians and highlight opportunities for clinical prevention. Prevention is hindered in four ways: 1) by narrow conceptions of medical care and of the role of the physician; 2) by physicians' discomfort with discussing human sexuality and illicit drug use and their attitudes toward persons with HIV or AIDS; 3) by constraints on time and resources; and 4) by the ambiguity of HIV prevention messages. We suggest strategies to overcome these barriers, including modifications in public policy, health care delivery systems, and medical education. These strategies support a nonhierarchical physician–patient relationship, with attention to culture and values, that will help physicians to identify and work with persons at increased risk for HIV infection.
- Copyright ©2004 by the American College of Physicians
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