Physicians' transmission prevention assessment and counseling practices with their HIV positive patients

Physicians can help prevent transmission of HIV by assessing HIV positive p atients for risky sexual and needle-sharing behaviors, and by providing ris k reduction counseling. From 1995 to 1997, we gathered data on the HIV tran smission prevention assessment and counseling practices of 44 San Francisco Bay area physicians in face-to-face, semistructured interviews. A refined coding scheme and constant comparative analytic method were used. Although physicians varied in their responses to coded items, two styles of engageme nt, at the extremes, emerged from the data: "consultant" and "collaborator. " Consultants conducted transmission prevention assessment and counseling d uring initial visits or upon medical cues (e.g., presence of sexually trans mitted disesases) and viewed themselves primarily as information sources, w hereas collaborators regularly conducted transmission prevention counseling and viewed themselves as actively helping patients reduce transmission ris k. Physicians who fell between the two styles generally did not conduct reg ular counseling themselves, but many used referrals to health educators. Th e findings suggest that consultant and collaborator styles may influence pa tients differently, and offer insight into the role that physicians can pla y in transmission prevention with HIV positive patients.