HIV-related disease: family physicians' multiple opportunities for preventive intervention

The spread of the human immunodeficiency virus (HIV) and the increasing number of persons with acquired immunodeficiency syndrome (AIDS) are major health problems. HIV risk factors are well documented, and HIV disease is recognized as a chronic illness with a predictable course.

Since September 1987 the East Central AIDS Education and Training Center for Health Professionals has served Michigan, Ohio, Kentucky, and Tennessee. Activities include (1) educating and training primary health care providers on prevention and treatment of AIDS, (2) training selected individuals to train others, (3) providing guidance in multidisciplinary management of HIV disease, (4) disseminating updates about HIV and AIDS, and (5) serving as a support system through referral activities.

Too many primary physicians, including family physicians, are uncomfortable with patients who are at risk for becoming infected with HIV or who are HIV-infected. Long-term concern and attention that might normally be offered to other patients with different chronic or fatal diseases are sometimes avoided. Patients also present barriers to care, making it difficult for family physicians to provide appropriate care.

Understanding the natural history of HIV infection is integral to family physicians' important roles in preventing and dealing with HIV. One role is screening at-risk persons; this function usually has associated opportunities for education. A second role is mainstreaming HIV-related illnesses; if family physicians treat HIV-positive persons, then AIDS is not "someone else's problem." A third role is leadership; as family physicians overcome fear and prejudice, they become role models. Each role is consistent with long-held traditions of family practice.