Background:  Increasing the frequency of discussing HIV transmission risk reduction was a recommendation in the HIV prevention guidelines published by CDC/HRSA/HIVMA in 2003. Just before publication of those guidelines, the CDC-funded ARTAS provider survey examined frequency with which physicians discussed prevention and care topics with their HIV patients. 

Methods:  We solicited 417 physicians seeing HIV patients in Atlanta, Georgia; Baltimore, Maryland; Miami, Florida; and Los Angeles, California.  In 127 clinical practices, 317 physicians (76%) responded to the mailed questionnaire about the frequency of discussing HIV risk reduction, adherence to HIV ART, opportunistic infection prophylaxis, and psychosocial issues with patients. Questions used a 4-point Likert scale. Logistic regression was used to determine the effects of physician and practice characteristics on frequency of discussing 8 prevention and care topics. Generalized estimating equations were used to control for the clustering of physicians within clinics.

Results:  HIV transmission risk reduction was discussed with patients less than 40% of the time. In contrast, adherence to ART was discussed 85% of the time and opportunistic infection prophylaxis 65% of the time. White physicians were less likely than Hispanic or Asian physicians to discuss risk reduction (29% vs 53%, p = 0.0002). White physicians were as likely as Hispanic or Asian physicians to discuss ART adherence (83% vs 84%, p = 0.82) and opportunistic infection prophylaxis (62% vs 70%, p = 0.23).  In all, 66% of physicians strongly agreed or agreed with the statement, “I feel I have sufficient time to provide care and information needed to my HIV-positive patients.” In multivariable analysis, a lower frequency of discussion of HIV transmission risk reduction was found for physicians who:  perceived that they did not have enough time to provide care and information to patients (p = 0.002), had more patients (p = 0.05), were male (p = 0.05), and were of white race (vs Hispanic or Asian) (p = 0.0005).

Conclusions:  Although two-thirds of physicians surveyed reported they had enough time to provide care and information to HIV patients, risk reduction topics were discussed much less often than biomedical topics—although more frequently by female and Hispanic and Asian physicians. This infrequent discussion of prevention with HIV-infected patients represents a missed opportunity, and encouragement of clinical practices to include discussion of prevention as standard of care is needed.