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Attitudinal and Structural Barriers to Care

Barbara Gerbert, PhD; Bryan T. Maguire, PhD; Thomas Bleecker, PhD; Thomas J. Coates, PhD; Stephen J. McPhee, MD

JAMA. 1991;266(20):2837-2842.

Abstract
Objective.
—To explore the extent to which primary care physicians are providing health care for people with human immunodeficiency virus (HIV) infection and to document barriers to HIV care giving.

Design.
—National random-sample mailed survey.

Participants.
—Population-based random sample of 2004 US general internists, family physicians, and general practitioners in 1990. Response rate was 59%.

Main Outcome Measures.
—HIV treatment experience, willingness to treat HIV-infected patients, negative attitudes toward homosexuals and intravenous drug users, fear of contagion of the acquired immunodeficiency syndrome (AIDS), perceived lack of information about AIDS, and time demands of HIV care.

Results.
—Most physicians (75%) had treated one or more patients with HIV infection. A majority (68%) believed that they had a responsibility to treat people with HIV infection, yet half (50%) indicated that they would not, if given a choice. Over 80% of respondents believed that they lacked information about AIDS and that caring for people with AIDS is time consuming. Further, 35% of respondents agreed that they "would feel nervous among a group of homosexuals" and 55% expressed discomfort about having intravenous drug users in their practice. Physicians who had treated 10 or more HIV-infected patients expressed less negativity toward members of these stigmatized groups who are likely to be HIV infected.

Conclusions.
—These data suggest that many primary care physicians are responding professionally to the AIDS epidemic but that attitudinal barriers may be hindering some physicians from providing treatment to HIV-infected patients.

(JAMA. 1991;266:2837-2842)

Author Affiliations
From the School of Dentistry (Drs Gerbert and Bleecker), Center for AIDS Prevention Studies (Drs Gerbert, Bleecker, and Coates), and School of Medicine (Drs Coates and McPhee), University of California, San Francisco; and Department of Psychology, University of Wales, Bangor (Dr Maguire).

Footnotes
Reprint requests to Division of Behavioral Sciences, University of California School of Dentistry, 707 Parnassus, D1012, San Francisco, CA 94143-0754 (Dr Gerbert).

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