The role of the general practitioner in the community care of people with HIV infection and AIDS: a comparative study of high- and low-prevalence areas in England

BACKGROUND: Policy for the care of people suffering from HIV and AIDS has changed over the past decade. Schemes for shared primary and secondary care have been met with varying success, and patients may be reluctant to become involved. No systematic evaluation comparing the views of primary care providers and users in areas of varying HIV prevalence has been published. AIM: To examine the role of general practice in areas of England with low and high human immunodeficiency virus (HIV) prevalence and to compare barriers to general practice care in each area. METHOD: We used focus groups, semistructured questionnaires and interviews in north London (high HIV prevalence) and Nottingham (low HIV prevalence). RESULTS: Four focus groups took place in London. A total of 411 general practitioners (GPs) in London and 405 in Nottingham replied to postal questionnaires. Overall, 121 primary care staff in 40 London practices and 26 staff in five Nottingham practices were interviewed. In all, 54 people infected with HIV were interviewed in London and 20 in Nottingham. Providers and users regarded the 24-hour availability and the familiar environment of general practice as its key assets. Lack of expertise and time were its disadvantages. Providers were concerned about inadequate communication with specialist services. Although providers were concerned about confidentiality, whether they had liberal and sympathetic attitudes was more important in deciding whether people with HIV used the service. In the low-prevalence area, general practice involvement was the result of individual initiatives, and practices were not integrated into specialist care. In the high-prevalence area, HIV care was more usual in general practice, but there was also little integration with HIV services. CONCLUSIONS: In high-prevalence districts, a strategy to make HIV care routine for all GPs may be appropriate. In low-prevalence areas, a network of selected, strategically located, relatively high-involvement practices may be more effective in meeting the primary care needs of people with HIV infection and acquired immunodeficiency syndrome (AIDS).     

Risk for HIV infection among bisexual men seeking HIV-prevention services and risks posed to their female partners.

The present study interviewed gay (n?=?473) and bisexual men (n?=?146) as part of an HIV prevention program and investigated social cognitive factors associated with HIV risk. Results indicated that HIV risk in homosexual men was associated with sexual openness and connections to gay communities, factors not associated with risk for bisexual men. Compared with men at lower risk, those who practiced high-risk sex scored lower on measures of perceived safer sex norms, safer sex self-efficacy, and social skills. Bisexual men with primary female partners often had not disclosed their bisexuality to female partners (75%), and 64% had not modified their behavior to protect female partners. Bisexual men who engage in high-risk behaviors therefore pose a risk to female partners who may be unaware of their involvement with men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of hypolipidemic drugs on the expression of genes involved in high density lipoprotein metabolism in the rat

Sexual behaviors of long-distance truck drivers in Thailand were investigated to define patterns and determinants critical to the transmission of HIV. This article reports on commercial, spousal, and other sexual partners and on condom use among 327 drivers interviewed in 1992. Forty-eight percent reported a commercial sex worker (CSW) as their first partner and 87% had contact with a CSW at some time. Median lifetime number of all partners was 29. In the 6 months prior to interview, 35% had two or more partners. Among the currently married, 23% had CSW contact within the past 6 months; 13% had contact with a nonmarital, noncommercial partner; and about 8% reported marital as well as both CSW and noncommercial relationships in the same time period. Over half the unmarried reported sexual relations in the 6 months; 25% reported contacts with both CSW and noncommercial partners. About 40% of subjects visiting CSWs used condoms inconsistently or not at all. Drivers were knowledgeable about AIDS and prevention measures, with some important misconceptions, but self-assessment of risk of HIV showed a negligible sense of their personal vulnerability.     

Determination of 60% or greater carotid stenosis: a prospective comparison of magnetic resonance angiography and duplex ultrasound with conventional angiography

BACKGROUND: Direct access to Magnetic Resonance Imaging (MRI) is becoming available to GPs in the UK, offering major benefits for the improved diagnosis and management of certain clinical conditions. Variations in usage of this service may be large, and effective locally produced guidelines are not currently available. The Department of General Practice is conducting a research programme to develop and evaluate methods to optimize MRI use by GPs. OBJECTIVES: We aimed to describe the current use of MRI by GPs in South Glamorgan; to summarize their reasons for requesting MRI; and to produce criteria to assess the appropriateness of magnetic resonance (MR) scan requests. METHODS: Using the critical incident technique, 25 GPs were interviewed about recent scans requested for patients with knee and lumbar spine complaints. A local panel of primary and secondary care doctors was convened to develop criteria for assessing MR scan requests. RESULTS: Sixty-two scan requests were discussed. Doctors' reasons for requesting MR scans were identified and classified. Reasons for requests included personal, contextual and biomedical variables. Fifteen patients (24%) were managed in primary care following MRI when otherwise they would have been referred. When referrals were made, GPs felt able to reinforce the request and occasionally to direct the patient somewhere more appropriate. The panel reviewed the interview data to produce objective criteria to assess scan requests. The criteria reflect the relative importance of non-biomedical variables in the decision to request MRI. CONCLUSION: The study identified those reasons which are important to GPs when requesting MR scans and the impact of this new technology upon patient management. Interview data have been used to inform locally developed consensus criteria, which will be made available as practice guidelines as the research programme progresses.     

Counselling for an HIV test

Doctors may feel uncomfortable with the prospect of discussing a human immunodeficiency virus (HIV) antibody test with their patient. This is in part because they do not enquire about high risk activity as part of a medical history. With increasing medical and public awareness of both the clinical manifestations and social implications of HIV infection, it is important that all doctors receive guidance on how to deal with these issues. Counselling is not the usual term used to describe obtaining informed consent. In the general medical setting, tests for hepatitis B and syphilis are routinely carried out without specific consent even though results of these tests may have profound effects on both the patient and their sexual partners. However society and ethical considerations have made HIV testing different. HIV testing will inevitably become more widespread, and thus become a more routine part of patient investigation and management.     

Campus courtship behavior and fear of human immunodeficiency virus infection by university students

Data were collected by telephone from a random sample of 762 students at the University of Northern Colorado to examine students' fear of human immunodeficiency virus (HIV) infection and their suggested approaches to prevent the spread of the disease. Of the 762 students interviewed, 177 (24.1%) believed that HIV/acquired immunodeficiency syndrome (AIDS) was a threat to socialization on campus. Fourteen percent of the female students considered HIV/AIDS to be a threat compared with 10.1% of their male counterparts. Among all interviewees, 573 (76.7%) believed HIV/AIDS was a threat to romance at the university. Statistically significant association was found between the perceived fear of HIV/AIDS and gender. With regard to actual sexual intercourse, 86.4% of the students believed that HIV/AIDS was a major threat compared with 13.6% who did not. The association between the perception about HIV/AIDS as a threat to on-campus sexual intercourse and gender was statistically significant. Of the entire sample, 69.3% suggested abstinence as an approach to avoid HIV infection. Slightly more than 24% suggested condom use. Eighteen (10.8%) students advised that sexual contact should be only with a trusted partner. More information about HIV/AIDS should be provided to all students, especially women, in institutions of higher learning. More information can reduce the fear associated with this deadly disease.     

Infant birth weight among women with or at high risk for HIV infection: The impact of clinical, behavioral, psychosocial, and demographic factors.

The purpose of these analyses was to provide a prospective examination of the impact of HIV on birth weight using clinical, behavioral, psychosocial, and demographic correlates. 319 HIV-positive and 220 HIV-negative pregnant women matched for HIV risk factors (i.e., drug use and sexual risk behaviors) were interviewed during the 3rd trimester of pregnancy and 6 weeks postpartum. Medical chart reviews were also conducted for the HIV-seropositive pregnant women to verify pregnancy-related and birth outcome data. In a logistic regression analysis, controlling for parity and gestational age, women who were HIV seropositive were 2.6 times more likely to have an infant with low birth weight. Black women and those who did not live with their partners were more than 2 times as likely to have infants with low birth weight, and those who smoked were 3.2 times more likely to have infants with low birth weight. Knowing that women with HIV, those who are Black, and those not living with a partner are at highest risk for adverse birth outcomes can help those in prenatal clinics and HIV specialty clinics to target resources and develop prevention interventions. This is particularly important for women with HIV because birth weight is associated with risk of HIV transmission from mother to child. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of HIV counseling and testing for women: Behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n?=?106) and a comparison group of never-tested women (n?=?54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles of living arrangements and grandmother social support in adolescent mothering and infant attachment.

Examined the roles of social support from adolescents' mothers and living arrangements in 197 adolescent mother–infant pairs. Major observational measures were teaching interactions, Home Observation for Measurement of the Environment (HOME) scores, and infant attachment security. Adolescents living with neither mothers nor partners had better teaching interactions but lower HOME scores compared with those living with mothers. High mother support was associated with more secure infant attachment only for those adolescents living with partners. When mother support was low, adolescents living alone had more secure infants than adolescents living with partners. Although parenting scores were related to differences in demographics and personal resources (intelligence and social skills), these did not appear to be responsible for the major findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Satisfaction in interpersonal interactions as a function of similarity in level of dysphoria.

This study compared dysphoric and nondysphoric male and female undergraduates as they conversed with dysphoric or nondysphoric undergraduates of the same sex. Subjects rated their satisfaction with the conversation after each turn. The results showed that people in homogeneous dyads (i.e., both partners were dysphoric or both partners were nondysphoric) were most satisfied with the interaction, and their satisfaction increased as the conversation proceeded. People in mixed dyads were less satisfied, perceived each other as colder, and spoke about increasingly negative topics. Thus, in accord with other research showing that similarity leads to liking, the crucial determinant of interactional satisfaction was neither the mood of the subject nor the mood of the partner, but their similarity in mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug scene roles and HIV risk

AIMS: Drug scenes (social and spatial drug-using and drug-selling environments) have complex role structures. Many drug injectors earn money or drugs as drug or syringe sellers, hit doctors (people who help others to inject) commercial sex workers, or in other roles. This paper aims to measure "role behaviors" of drug injectors; describe which drug injectors are more likely to engage in such role behaviors; and to determine whether roles are related to elements of HIV risk. DESIGN: Cross-sectional study of drug injectors. SETTING: Bushwick, a section of Brooklyn, New York, a major location for injection drug use and drug sales. PARTICIPANTS: Seven hundred and sixty-seven street-recruited drug injectors. MEASUREMENTS: Participants were interviewed about their roles, behaviors, socio-demographics and risk networks; sera were collected and assayed for HIV and hepatitis B core antibody. FINDINGS: Socio-demographic variables are related to role-holding in complex ways. Economic need is generally associated with engaging in drug-scene role behaviors. Holders of these roles are at greater behavioral and network risk for HIV and other blood-borne infections than are other drug injectors. They also engage in extensive communication with other drug users, including discussion of HIV risk reduction. CONCLUSION: Role behaviors can be measured in quantitative studies, and seem to be related to HIV risk. Role-holders may be strategic targets for risk-reduction campaigns. It seems feasible and advisable to measure drug scene role-holding in research on drug users.     

Testing for HIV and other sexually transmitted diseases: Implications for risk behavior in women.

A sample of 808 nonpregnant women residing in an area of high prevalence of sexually transmitted diseases (STDs) was studied with respect to sexual risk behaviors in the 4-month period before and after testing for a series of STDs. All women were tested for both Chlamydia trachomatis and Trichomonas vaginalis and were given the option of also taking a test for the HIV antibody. Neither the experience of receiving a negative HIV test result nor that of receiving a positive versus a negative diagnosis for STDs resulted in significant mean changes in self-reports of STD or HIV susceptibility, condom use consistency, or number of sexual partners during the 4 months following testing. However, perceived susceptibility was found to predict when women would decrease the consistency with which they used condoms as a function of HIV testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary test of the Addiction-to-Near-Death construct.

The diagnostic concept of Addiction to Near Death (ATND) is a construct with strong face validity. The purpose of this study was to empirically test the ATND construct in the context of a substance abusing population who were at high risk of contracting HIV. Interviews of female clients were conducted 30 days postdischarge from a residential therapeutic community. Clients were interviewed about their sexual activity and their condom use while they were in treatment. Results preliminarily support the ATND construct. The limitations were: data were from retrospective self-reports; the original study contained no baseline measures of sexual activity, safe-sex knowledge, condom use, HIV status; it had no male participants, no specific questions about near-death behavior, nor whether alternative safe-sex activities were practiced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes.

A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be "casual" sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information-motivation-behavioral skills model of preventive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Views of Cameroonian sex workers on a woman-controlled method of contraception and disease protection

Five hundred and twenty female Cameroonian sex workers participating in a clinical trial of the effectiveness of nonoxynol-9 (N-9) contraceptive film to prevent HIV infection were interviewed to determine their experience with this woman-controlled method. The sex workers liked the film, with over 80% stating they would continue to use it if it were shown to be effective against HIV and were to become widely available. However, they were much more likely to use condoms and films simultaneously with their clients (40%) than with their regular partners (16%). The advantages ascribed to the film were that its use was under the woman's control; it could be used without the partner's knowledge; it allowed direct contact between partners; and it provided back-up protection in case of condom breakage. Data from this small study suggest that development of an effective, woman-controlled method of pregnancy and disease protection would be welcomed by these women.     

Antenatal HIV antibody testing in Australia

OBJECTIVE: To evaluate the role of voluntary antenatal testing in HIV surveillance and prevention by examining antenatal HIV antibody testing practice and policy in Australia. DESIGN: Cross-sectional study using a self-administered questionnaire. SUBJECTS AND SETTING: Specialist obstetricians and gynaecologists and general practitioners (GPs) affiliated with the Royal Australian College of Obstetricians and Gynaecologists and Australian public hospital antenatal clinics, August-November 1992. MAIN OUTCOME MEASURES: The percentage of public hospital antenatal clinics and specialist and GP obstetricians in Australia who tested pregnant women for HIV antibody as part of their antenatal care, and the proportion of pregnant women in Australia who had an antenatal HIV antibody test in the 1991-92 financial year. RESULTS: Questionnaires concerning antenatal HIV antibody testing were completed by 90% (993/1108) of specialists, 87% (2134/2461) of GPs and 93% (215/230) of public hospitals surveyed. Of the 706 specialists and 1503 GPs who reported that they were currently engaged in obstetric care, approximately 60% (430/706) and 935/1503, respectively) offered antenatal HIV testing either to all pregnant women or to selected groups at risk. There were significant differences in testing patterns between States and Territories. For the 95 public hospitals with antenatal clinics, 81% (77) offered the HIV antibody test to all or selected groups of pregnant women; these percentages did not differ significantly between States and Territories. It was estimated that 25% of pregnant women seen by specialists, 29% seen by GPs and 9% seen in public hospital clinics were tested for HIV antibody as part of their antenatal care in 1991-92. CONCLUSIONS: In Australia approximately one in five pregnant women were tested for HIV antibody as part of their antenatal care in 1991-92. Voluntary HIV testing in pregnancy may provide unrepresentative data for measuring the prevalence of HIV infection in pregnant women.     

Self-efficacy and disclosure of HIV-positive serostatus to sex partners.

HIV-positive persons face significant challenges to disclosing their HIV serostatus, and failure to disclose can place their sex partners at risk. The current study examined HIV serostatus disclosure in 266 sexually active HIV-positive persons recruited from the community. Results showed that 41% had not disclosed their HIV serostatus to sex partners. Men who had not disclosed to partners indicated lower rates of condom use during anal intercourse and scored significantly lower on a measure of self-efficacy for condom use compared to individuals who had disclosed. Emotional distress was also greatest among persons who had not recently disclosed. Having not disclosed to sex partners was closely associated with lower self-efficacy for disclosing, with women who had not disclosed reporting the lowest disclosure self-efficacy. As people living with HIV-AIDS are encouraged to disclose their HIV status, interventions are needed to facilitate disclosure decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Forms of inhibition in animal and human learning.

Forms of inhibition were identified in human predictive learning that are qualitatively similar to those identified by P. C. Holland (see record 1985-19327-001) in rats. When P (positive) signaled the outcome and PN (N?=?negative) signaled the absence of the outcome, participants learned the discrimination, but the negative cue did not suppress responding to a transfer cue. Postlearning reversal training, in which N was followed by the outcome, did not abolish the original discrimination. These 2 results imply a configural form of inhibition. Negative transfer, which indicated a 2nd, elemental form of inhibition, was observed when neither PN nor N were reinforced during the discrimination stage. Under these conditions, negative transfer and the original discrimination were both abolished by individually pairing N with the outcome. Empirical parallels and differences with the animal conditioning literature are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)