PREVENTION OF HIV-INFECTION IN PRIMARY-CARE - CURRENT PRACTICES, FUTURE POSSIBILITIES

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 trea tments indicates that future research and practice must work to preven t the spread of HIV. We review the literature on the current HIV-preve ntion practices of primary care physicians and highlight opportunities for clinical prevention. Prevention is hindered in four ways: 1) by n arrow 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 c onstraints on time and resources; and 4) by the ambiguity of HIV preve ntion messages. We suggest strategies to overcome these barriers, incl uding modifications in public policy, health care delivery systems, an d medical education. These strategies support a nonhierarchical physic ian-patient relationship, with attention to culture and values, that w ill help physicians to identify and work with persons at increased ris k for HIV infection.