Family physician involvement
Family physicians can contribute to the country’s HIV prevention efforts by implementing the steps listed in the Table. This new approach places more emphasis on finding those infected with HIV and initiating actions beneficial to them and their partners while reducing risk of transmission.
Explore acceptability of needle exchange programs. Another intervention proven effective, but more controversial, is needle exchange programs for illicit drug users. The evidence to date is that needle exchange programs prevent transmission of HIV and other blood borne pathogens and do not encourage use of illicit drugs.5 Because these programs have proven as controversial as they are effective, they have not been widely adopted. If the community political climate is receptive, family physicians could also advocate for these programs.
Implement routine testing. As family physicians move to make HIV testing routine, several issues must be considered. Though HIV testing methods are quite accurate, an initial positive test in a person with a very low pretest probability is more likely to be a false positive than a true positive. Risks, however, are not always apparent or admitted to by patients. Positive tests should be repeated and confirmed. Newly approved rapid HIV tests allow for results within a half-hour, but positive test results must be confirmed by western blot or immunofluorescence assay.15
Report cases promptly. In 31 states, HIV infection is a reportable disease. This may cause concern among patients and lead physicians to under report. This practice is discouraged for several reasons. Accurate tracking of the HIV epidemic is critical to measure the effectiveness of preventive interventions and to enable quick implementation of needed changes in public health practice. Federal funds to support treatment for those with HIV/AIDS depend on the number of persons with documented HIV infection; under-reporting causes the community to lose treatment funds. Finally, public health departments have a long established record of maintaining confidentiality of infectious disease reports and, in most jurisdictions, have more confidentiality legal protections than do physician offices.
HIV remains a significant public health problem in the US. As the epidemic evolves, new public health efforts will be needed. Full control of the epidemic might not be achieved until a more effective intervention, such as a vaccine, is available. However, interventions have proven effective and more widespread use would reduce the community burden of the disease.
TABLE
Practice based initiatives that could contribute to HIV reduction in the community
| Make HIV testing a routine part of general medical care. |
| Make HIV testing a routine part of pregnancy care. Test as early as possible in pregnancy and retest those at high risk in the third trimester. |
| Refer those who are HIV-positive to the local public health department for case management. |
| Work collaboratively with the public health department to insure that people with HIV infection receive medical care and social services. |
| Reinforce the message to those infected about how to avoid transmitting the infection to others. |
| Counsel uninfected patients who practice high-risk behaviors about how to reduce their risks of infection, using patient centered methods. |
| Promptly diagnose and treat other sexually transmitted infections. |
Correspondence
1825 E. Roosevelt, Phoenix, AZ 85006. E-mail: dougcampos@mail.maricopa.gov.