title: Missed opportunities: prevention with HIV-infected patients in clinical care settings.
abstract: OBJECTIVE
  To assess current practices related to prevention with HIV-positive patients in Ryan White-funded primary care settings and the barriers to providing such services.
  
  
  METHODS
  Exit surveys about HIV prevention services were conducted with 618 HIV-infected patients at 16 primary HIV care clinics receiving Ryan White CARE Act funding. To place the exit survey findings in context, qualitative in-depth interviews were conducted with 16 clinic administrators, 32 primary care providers, 32 support service providers, and 64 patients.
  
  
  RESULTS
  One quarter of patients reported having had a general discussion of "safer sex and ways to prevent transmission to others" during that day's primary care visit. However, only 6% reported discussing specific sexual activities. HIV prevention counseling was less common than counseling for adherence to antiretroviral therapy, emotional issues, and diet and nutrition (P < 0.001). Patients in clinics with established procedures for HIV prevention counseling were significantly more likely to report receiving such services (odds ratio = 2.17). Qualitative interviews identified barriers to providing prevention services as lack of time, training, funding for staffing, and providers' understanding of their roles and responsibility.
  
  
  CONCLUSIONS
  HIV prevention counseling is not routine in most clinics, and the low frequency of such services represents missed opportunities for HIV prevention.
authors.affiliation: University of California, San Francisco, 94105, USA. smorin@psg.ucsf.edu
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Morin
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Koester
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Steward
authors.forename: Andre
authors.initials: A
authors.lastname: Maiorana
authors.forename: Marisa
authors.initials: M
authors.lastname: McLaughlin
authors.forename: Janet J
authors.initials: JJ
authors.lastname: Myers
authors.forename: Karen
authors.initials: K
authors.lastname: Vernon
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Chesney
mesh_terms: D000293:Adolescent; D000328:Adult; D018562:Disease Transmission, Infectious; D005260:Female; D005376:Financial Management; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D019538:Health Care Surveys; D006282:Health Personnel; D006801:Humans; D007318:Inservice Training / Q000592:standards; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards; D018802:Patient-Centered Care / Q000191:economics / Q000592:standards; D011320:Primary Health Care / Q000592:standards; D013997:Time Factors; D014481:United States