STD and HIV Counseling Practices of British Columbia Primary Care Physicians

Abstract

This study evaluated British Columbian primary care physicians' use of sexually transmitted disease (STD) and HIV counseling guidelines. The authors sought to assess barriers to integrated HIV and STD testing and counseling, with the objective of developing and revising practice guidelines to meet the needs of primary care physicians in diverse settings. The BC College of Physicians and Surgeons membership of general practice/family medicine practitioners was stratified by practitioner location; 1200 physicians were randomly selected to receive a mailed self-administered questionnaire. Four hundred seven completed questionnaires were returned. Female physicians reported better adherence to practice guidelines on many items than their male counterparts. A minority of primary care physicians routinely integrated HIV and STD testing and counseling. Physicians in nonurban areas were more likely to report that they lacked sufficient information on HIV and STD risk and prevention. Although male primary care physicians in British Columbia were more likely to provide care for people with HIV infection, female physicians were more likely to undertake ongoing screening for sexual risk behavior and sexually transmitted infections (STIs) among their HIV-positive patients. Clinical practice guidelines are theoretically equally available to all physicians, but they are not universally used. Physicians may not receive adequate training in sexual health during their medical education; continuing education opportunities may be limited to physicians outside of urban centres. Accessible and relevant continuing medical education in novel formats are needed to address the gap between ideal and actual practice in HIV and STD prevention, treatment, and care in Canada.

Consultations for sexually transmitted infections in the general practice in the Netherlands: an opportunity to improve STI/HIV testing

“…On the one hand, practical tools, such as sufficient (financial) incentives and support, could be a possible motivation for more proactive testing practices, that is, of chlamydia tests as was shown in an intervention setting in England21 while productivity goals could discourage such practices 22. Increasing clinician experience with patients attending the GP for an STI-related consultation and use of standardised (online) protocol sheets may help improve the quality of care,23 24 as well as accessible and relevant continuing medical education 25. Raising awareness and increasing collaboration improved STI services in a US study 26.…”

HIV Prevention Services Received at Health Care and HIV Test Providers by Young Men who Have Sex with Men: An Examination of Racial Disparities

“…51 However, several studies, including ours, have found that providers of health care and HIV testing services miss opportunities to provide services that might help MSM avoid infection. 31,[58][59][60][61][62][63] Of those who reported using a regular source of health care, depending on race/ethnicity, one third to one half of participants reported that no one at their source of care had ever discussed whether they should test for HIV. Of those who had tested HIV-negative in the past year, nearly half reported that they did not receive any counseling with their test, including half of those who subsequently acquired HIV and could have benefited from counseling.…”

Gaps between knowing and doing: Understanding and assessing the barriers to optimal health care

“…65 Many professionals believed they were performing to a standard; however, such performance was not found on testing. 66 Health care professional/physician barriers Sixty-two studies identified professional characteristics or factors such as maturity of practice, 67-70 legal concerns, 71 boundaries, 72,73 or peer influence as barriers to implementation of guidelines and evidence.…”