STD/HIV prevention practices among primary care clinicians: risk assessment, prevention counseling, and testing

To describe current practices of primary care (PC) clinicians for STD/HIV control services: risk assessment, prevention counseling, and offering tests.

We identified clinical strategies through qualitative interviews. We then surveyed by mail a random sample of Washington State family physicians, general internists, obstetrician-gynecologists, nurse practitioners, and certified nurse midwives. We identified characteristics of clinicians and their practices associated with each strategy and universal provision of each service.

We report on 519 clinicians (80% adjusted response rate). Clinicians provided services to selected patients they considered high risk. Universal practices were less common: risk assessment (56%), prevention counseling (60%), STD tests (30%), and HIV tests (19%). Universal services were more common among nurses, those recently trained, and those seeing more STD patients.

Different types of PC clinicians use widely differing clinical strategies and many use selective rather than universal approaches to STD/HIV control services. Further research is needed to develop tailored interventions to improve provision of these services.