Nona Caspers

Physicians and AIDS: Sexual risk assessment of patients and willingness to treat HIV-infected patients

ConclusionThis review of the literature has summarized two challenges presented to physicians as we move into the second decade of the AIDS epidemic: 1) the low proportions of physicians playing their role in assessing patients’ sexual risk for HIV infection and providing relevant risk reduction counseling and education, and 2) the reluctance of physicians to provide care to those with HIV disease due to homophobia, IVDU aversion, and fear of contagion. In view of the growing number of HIV-infected patients and patients living with AIDS, physicians and medical educators alike must confront these challenges.

The mysteries and demands of HIV care: qualitative analyses of HIV specialists' views on their expertise.

To deepen our understanding of the mysteries and demands associated with HIV care and to inform the debate about HIV specialization, we conducted in-depth interviews with a purposive sample of 20 identified HIV specialists in the San Francisco Bay Area. Participants were from several medical specialties and reported a median of 50% of their time spent in HIV patient care. Through constant comparison, a template of open codes was constructed to identify themes that emerged from the data. Data were analyzed according to the conventions of qualitative research and revealed six interrelated themes: (1) coping with uncertainty and rapid change: being ‘comfortable with mystery’; (2) the powerful role of experience; (3) the dual faces of knowledge: ‘knowing the patient’ and ‘knowing the facts’; (4) the dual faces of passion: challenge and calling; (5) stress and burnout; and (6) the relationship between academia and ‘the trenches’. The themes underscore the dual dimensions of HIV care: providers must interweave the ‘half-baked’ science about drug therapies, side effects and drug interactions with the psychosocial and lifestyle factors of the patient. They also provide insight into quantitative findings linking greater HIV experience with better patient outcomes and suggest that providers need skills associated with generalist and specialist training, a phenomenon that argues for a ‘special’ specialty for HIV care.