Is experience with human immunodeficiency virus disease related to clinical practice? A survey of rural primary care physicians.

BACKGROUND: Human immunodeficiency virus (HIV) disease is spreading to the rural United States, and medical care is increasingly provided by local primary care physicians. A volume-outcome relationship might exist in HIV care. However, little is known about the HIV experience and practices of rural primary care physicians. OBJECTIVES: To estimate the HIV experience of rural primary care physicians, and to determine whether experience is associated with use of newer management strategies, confidence in care, and consultation needs. DESIGN: Telephone survey of a random sample of primary care physicians. SETTING: Primary care sites in nonmetropolitan California. PARTICIPANTS: One hundred twenty eligible primary care physicians in nonmetropolitan California, with 102 respondents (85.0%). MAIN OUTCOME MEASURES: Physicians' HIV experience, use of protease inhibitors and viral load tests, familiarity with vertical HIV transmission prophylaxis, confidence in HIV care, and consultation needs. RESULTS: Most physicians were low-volume providers of HIV care and had limited knowledge of newer management strategies. Experience with protease inhibitors and viral load tests was significantly related to number of recent patients with HIV; 25.0% of those with 1 to 3 patients but 75.0% of those with 4 or more patients had prescribed protease inhibitors (P = .01), whereas 20.8% of those with 1 to 3 patients but 83.3% of those with 4 or more patients had used a viral load test (P = .001). Only 59.8% of all respondents, but 100.0% of those with 4 or more patients, were familiar with vertical HIV transmission prophylaxis (P = .001). After adjustment for other characteristics, HIV experience remained significantly associated with use of newer management strategies (P = .01) and familiarity with vertical HIV transmission prophylaxis (P = .007). Physicians' confidence in HIV care increased with experience (P = .006), and consultation needs decreased (P = .006). CONCLUSIONS: Primary care physicians in rural California lacked in-depth experience with HIV disease. Experience was significantly associated with use of newer HIV management strategies, confidence, and consultation needs. Treating 4 or more patients with HIV or acquired immunodeficiency syndrome may be the threshold above which primary care physicians rapidly adopt new strategies and have confidence in their care.

The relationship of assumption and knowledge of the homosexual orientation to the abridgment of civil liberties.

This article is concerned with the relationship of assumption or knowledge of departure from the heterosexual orientation to the abridgment of civil liberties. The methodology for obtaining data on sexual orientation is described. The definitions for assumption and knowledge of sexual orientation is described. The definitions for assumption and knowledge of sexual orientation are provided. The results indicated that: (a) the most frequently violated civil liberties were equality and procedural due process; (b) there was more assumption than knowledge of sexual orientation; (c) patterns of violations of civil liberties were similar whether sexual orientation was known or assumed; and (d) there was much more use of avoidance than any other mode of resolution, both when the sexual orientation was known and when it was assumed.

The effects of social sex-role stereotypes and sexual orientation on psychotherapeutic outcomes.

This paper examines the relationship of biological sex, social sex-role stereotypes, and sexual orientation of client and the therapist to psychotherapeutic outcomes. It was hypothesized that analogus biological sex, departures in social sex-role, and sexual orientation of client and therapist would have positive effects on psychotherapeutic outcomes. Twenty-four clients and 16 therapist, including five client-therapist pairs, were interviewed on how issues of social sex-role stereotyping and sexual orientation arose and were dealt with in therapy. The results indicated (a) a trend toward more positive outcomes when client and therapist were of the same sex, and (b) that similarity of sexual orientation of client and therapist is related to positive psychotherapeutic outcomes. The results for deparature from social sex-role stereotypes were inconclusive.