Human immunodeficiency virus infection in patients older than 50 years. A survey of primary care physicians' beliefs, practices, and knowledge
D. J. Skiest and P. Keiser
Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, USA. skiest@utsw.swmed.edu
To assess primary care physicians' attitudes, knowledge, and practices with
respect to the human immunodeficiency virus (HIV) in older patients, a
prospective survey of a representative cohort of primary care physicians
was conducted in Dallas County, Texas, a large metropolitan area. Three
hundred thirty primary care physicians participated in the survey.
Questions were asked regarding physician demographics, practice
characteristics, and knowledge and practices with respect to HIV and the
acquired immunodeficiency syndrome (AIDS) in patients older than 50 years.
The responses of the following groups were compared: family practitioners
vs internists, physicians younger than 40 years vs those aged 40 years and
older, those who saw 5 or less vs more than 5 patients with HIV or AIDS per
year, and those in private vs nonprivate practice. Most respondents (85.5%)
reported having seen 10 or fewer patients with HIV or AIDS in the previous
year. Most physicians (69.7%) reported that patients older than 50 years
rarely or never asked questions concerning HIV or AIDS. Most physicians
rarely or never discussed HIV or AIDS with patients older than 50 years
(60.8%) and rarely or never discussed risk factor reduction (67.5%).
Physicians were more likely to rarely or never ask patients older than 50
years compared with those younger than 30 years about HIV risk factors
(40.0% vs 6.8%, P < .001). Physicians incorrectly rank ordered the most
prevalent risk factors in patients older than 50 years. The correct order
is (1) male-male sex, (2) intravenous drug use, (3) blood transfusion, and
(4) heterosexual sex. Physicians aged 40 years and older were more likely
to correctly identify the most prevalent risk factor (P = .03). Family
practitioners were more likely to rarely or never ask older patients about
risk factors for HIV (54.9% vs 28.9%, P = .007). Primary care physicians
have inadequate knowledge concerning HIV and AIDS risk factors in older
patients and insufficiently discuss HIV and AIDS with older patients.
Physicians should counsel patients of all ages about HIV and AIDS.
