HIV prevention with positives and disclosure of HIV status: practice and views of Thai healthcare providers.

OBJECTIVE: The present study provides information from health care providers about sexual practices of and preventive and disclosure counseling for People Living with HIVand AIDS (PLWHA). MATERIAL AND METHOD: A survey of health care providers attending HIV prevention workshops was undertaken using self-administered and anonymous questionnaires. RESULTS: Of 678 respondents, 72% were nurses. Ninety-six percent agreed that they had duty to provide prevention services and measures. However, less than half (46%) had enough time for counseling. Asking health providers to estimate different aspects of sexual practice in their patients, the highest chosen band estimation was 'unsafe sex' (21-40%), 'partner disclosure' (41-60%) and 'abstinence' (0-10%). When patients did not disclose their HIV status to partner most health care providers kept HIV serostatus of patient confidential from their sexual partners. The main reasons for not notifying were patients 'rights and fear of adverse effects on patients. Some (9%) did notify the patient's partner directly or indirectly. The main notification reasons were for preventing HIV transmission and recognizing the partner's right to be informed. Seventy percent agreed that a law should require disclosure of HIV status to husband, wife, or intimate partner. CONCLUSION: Health care providers supported the 'Prevention with Positives' strategy. HIVstatus disclosure is a continuing ethical dilemma since there are conflicts of principle between confidentiality of patients and right to healthy life of their partner Improved or new interventions are needed to prevent HIV transmission with consideration of both rights of PLWHA and of HIV risk reduction for sexual partner.

Sexual practice among Thai HIV-infected patients: prevalence and risk factors for unprotected sex.

Positive prevention which focuses on prevention of HIV transmission from those already infected to those uninfected is an important issue for HIV prevention. A self-administered questionnaire on sexual practice survey of HIV-infected patients attending HIV clinics was undertaken. Of the 1160 patients, 53% knew their HIV status after being ill and 59% believed that they got infection from their regular sexual partner. In 3 months prior to the survey, 18% reported unprotected sex. Unprotected sex significantly decreased in people having adequate condoms but increased in those who believed that their sexual partners were already infected. Effect of disclosure of HIV status on unprotected sex depended on whether patients were men or women. Non-disclosure HIV-positive men claimed to have less unprotected sex than their counterpart, HIV-positive women. Factors related to unprotected sex should be addressed and sexual health must be integrated and promoted in HIV health care.