Karen Vernon

Missed opportunities: prevention with HIV-infected patients in clinical care settings.

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. Method: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.

Why HIV Infections Have Increased Among Men Who Have Sex with Men and What to Do About It: Findings from California Focus Groups

A resurgence of sexual risk taking, STDs, and HIV incidence has been reported among men who have sex with men (MSM) in several countries. We asked 113 MSM in 12 focus groups conducted in five California cities to identify factors leading to increased risk taking and assess prevention messages to reduce risk in this population. Participants perceived that HIV risk taking has increased because (1) HIV is not the threat it once was due to more effective therapies, (2) MSM communicate less about HIV, and social support for being safe has decreased, and (3) community norms have shifted such that unsafe sex is more acceptable. The prevention messages ranked most likely to motivate risk reduction encouraged individuals to seek social support from friends. Themes ranked least likely to succeed were those that described the negative consequences of HIV or reinforced existing safer sex messages.

Implementation of HIV Prevention Interventions with People Living with HIV/AIDS in Clinical Settings: Challenges and Lessons Learned

Integrating HIV prevention into the clinical care of people living with HIV has emerged as a priority in the US As part of a cross-site evaluation this study examined the processes by which 15 clinic-based projects implemented interventions funded under the Health Resources and Services Administrations (HRSA) HIV Prevention with Positives (PwP) in Clinical Settings Initiative. We conducted 61 in-depth interviews with researchers and interventionists across the 15 projects. Intervention implementation was feasible assuming several key components were in place: (1) internal leadership to overcome resistance and foster interest and motivation among clinical providers and staff; (2) adequate attention to creating seamless flow between clinic practice and intervention; and (3) ongoing training that met clinician and staff needs as prevention interventions become a regular part of care. Interventions well matched to the clinical environment and the patient populations were feasible and acceptable to health care providers, prevention interventionists, and clinic staff.

I don't know when it might pop up: understanding repeat HIV testing and perceptions of HIV among drug users.

PURPOSE The study sought to understand the HIV testing patterns of low-income drug users. METHODS Sixty-seven low-income drug users were recruited from street outreach venues in three San Francisco Bay Area counties. Participants were interviewed using an open-ended questionnaire eliciting information on HIV testing histories, sexual behavior, and drug use. Transcripts from interviews were coded and analyzed using methods consistent with the grounded theory approach of qualitative research. RESULTS Participants identified four themes related to HIV testing: (1) anticipating positive results, (2) belief in a 10-year window period during which the virus is undetectable, (3) regular HIV testing as part of self-care, and (4) the HIV test as a means of control. These themes did not relate to personal risk behavior but rather to the community experience of HIV in small, dense populations of low-income drug users with high rates of HIV infection. IMPLICATIONS Participants used HIV testing like regular mammograms or blood pressure checks, as if it were a screening procedure for a chronic illness. This is a reasonable response given the context of HIV within their communities. HIV testing in this population should not be limited.