Patient attitudes and knowledge about HIV infection and AIDS

Journal of Family Practice, April, 1991 by Ronald Epstein

Background. Family physicians are caring for an increasing number of those with human immunodeficiency virus (HIV) infection, those at risk, and those concerned about HIV disease.

Methods. A questionnaire survey of attitudes and knowledge about HIV infection was conducted in 430 patients in three family practices in Monroe County, NY.

Results. The majority of those surveyed had worried about catching HIV and had spoken with friends or relatives about HIV. Approximately 7.5% had had the HIV test. Approximately half of all the respondents expressed a desire to discuss HIV-related issues with their family doctor; however, less than 8% had actually done so. The majority of the respondents believed their family doctor was competent to answer questions about HIV disease. Furthermore, the majority were well informed about the modes of transmission of HIV. Many of the respondents were unsure of the lack of risk from casual contact, however, and whether acquired immune deficiency syndrome (AIDS) is incurable at the present time.

Conclusions. Family physicians need to take a more active role in educating and counseling patients about HIV disease.

Key words. Acquired immunodeficiency syndrome, patient education, HIV. J Fam Pract 1991; 32:373-377.

As the epidemic of human immunodeficiency virus (HIV) infection spreads outside of the major cities to smaller communities, [1,2] family physicians will be at the forefront in the prevention, diagnosis, early intervention, and long-term management of HIV disease.[3-7] At present, the most effective strategy for control of the epidemic depends on education and counseling to reduce high-risk behaviors.[8] Family physicians are potential sources of such information and counseling. It is not known to what extent patients have discussed HIV-related issues with their family physicians, however, or whether patients desire more HIV-related discussion. The general level of knowledge of patients outside the major population centers has not been assessed, and it is not known which knowledge deficits need to be addressed. These are important factors in planning educational interventions for physicians in primary care settings.

This study was conducted to evaluate the degree of concern about HIV infection, the desire to discuss HIV-related issues, the sources of information about HIV, and the level of knowledge about HIV in a family practice population in Rochester. NY, and surrounding areas of Monroe Country. Rochester is typical of other small cities that are experiencing a second wave of the HIV epidemic following the first wave, which occurred in large cities such as New York, San Francisco, and Miami. We assessed how many patients had actually discussed an HIV-related topic with their family physicians and how many had been tested for the presence of antibody to HIV. We were particularly interested in teenagers' responses since they have been identified as a group who may be poorly informed about HIV disease and may be at particular risk of acquiring HIV disease through drug use and unprotected sexual contact.[9,10]

Methods

The study was conducted during October and November 1988, in Monroe County, NY (population 950,000). In 1988, Monroe County had a reported cumulative AIDS incidence of 20 cases per 100,000 residents, defining the county as an area of high risk for HIV infection.[11] Three family practices were approached and agreed to participate: an inner-city, hospital-affiliated private practice in Rochester, NY, serving a predominantly black and Hispanic working-class and poor population; an urban Rochester residency training practice serving a predominantly white lower-middle-class population; and a rural-suburban private practice 20 miles outside of Rochester serving a mixture of an upper-middle-class white suburban population and a middle-class-to-poor rural farming population.

Each practice received questionnaires in approximate proportion to the number of patients seen per week. The principal investigator met with the physicians, nurses, and administrative staff of each practice to describe the method of distributing and collecting the questionnaires. The staff was instructed to distribute the questionnaires consecutively over a period of 10 days to patients age 14 years and older, regardless of the presenting complaint. Each patient was asked to complete the questionnaire while in the examination room awaiting the doctor. The completed questionnaire was placed in a plain envelope that was collected by the secretary at the end of the visit. Patients were told that completion of the questionnaire had no connection with the doctor visit and that the information provides would be kept strictly confidential.

The questionnaire, which was originally developed for a study carried out in the United Kingdom and Eire, consisted of multiple response questions and open-ended comments designed to asses seven areas: HIV-related concerns; desire to discuss HIV-related issues with a family physician; whether respondents had actually discussed any of those topics with their family physicians; perceived competence of family physicians to discuss HIV-related issues; sources of information about HIV; and knowledge of HIV as determined by an 8-item scale. It was by coincidence, not by design, that the Surgeon General distributed an information booklet containing answers to these questions on HIV to all households during the month before the questionnaire was distributed.