title: Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings.
abstract: We examined the relationship between provider fatalism, a belief that behavior change among HIV-infected patients is unlikely, and HIV-prevention counseling in 16 publicly funded clinics. HIV-seropositive patients (N = 618) completed surveys assessing prevention counseling in the past 6 months. Additionally, 144 interviews were conducted with providers, administrators, and patients to examine beliefs about prevention counseling. We summed the number of fatalistic comments made by providers and administrators in each clinic, and assigned these counts as clinic-level fatalism scores to survey participants. Patients in high fatalism clinics were less likely to report prevention counseling than patients in low fatalism clinics. This difference remained significant even after controlling for clinic characteristics or patients' sexual risk and health status. However, clients in high fatalism clinics were more likely to be White, gay, educated, and older. Provider fatalism is a barrier that must be addressed when implementing HIV-prevention counseling in primary care settings.
authors.affiliation: Center for AIDS Prevention Studies, University of California, San Francisco, California 94105, USA. Wayne.Steward@ucsf.edu
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Steward
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Koester
authors.forename: Janet J
authors.initials: JJ
authors.lastname: Myers
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Morin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001727:Bisexuality; D003376:Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D006282:Health Personnel; D006716:Homosexuality; D006801:Humans; D008019:Life Style; D008297:Male; D011320:Primary Health Care / Q000379:methods*; D012725:Sexual Behavior; D011795:Surveys and Questionnaires