'The last resort would be to go to the GP'. Understanding the perceptions and use of general practitioner services among people with HIV/AIDS

In England and Wales, departments of Genito-Urinary Medicine have led the c linical response to HIV infection and AIDS (HIV/AIDS). They provide an open -access self-referral service on a basis of strict confidentiality. People with HIV/AIDS have been found to be reluctant to involve their general prac titioner (GP) in their care. Previous research has not investigated their d ecisions about service use in the context of their broader strategies for c oping with the multiple psychological and social challenges, which are pose d by HIV/AIDS as a chronic, stigmatised condition. We report a depth-interv iew study of twenty people with HIV/AIDS in a low-prevalence non-metropolit an urban area of England. Their health care choices were products of comple x judgements. Five concerns predominated: expertise, security, rights to ca re, confidentiality and the maintenance of normality. Transfer to GP care s ignified a transition from essential wellness to essential illness and repr esented a loss of biographical continuity. Their other concerns express pro blems of information management, which are universal features of stigmatisi ng conditions. These may be heightened in the case of locally provided serv ices, where any leakage of discrediting information is likely to impact dir ectly on everyday life. These concerns should be understood and respected i n policy initiatives to develop services. (C) 1999 Elsevier Science Ltd. Al l rights reserved.