HIV medical care provider practices for reducing high-risk sexual behavior: results of a qualitative study.

A first step in ensuring that HIV-infected persons practice the safer sexual behaviors that reduce disease transmission is to make certain that they receive accurate information about the relationship between sexual risk behaviors and HIV transmission. Health care providers can play a pivotal role in preventing secondary transmission of HIV; federal agencies and professional guidelines encourage providers to counsel HIV-infected patients about safer sex practices and transmission risks, particularly since the health care encounter may be the only time that HIV-infected persons receive information about prevention and risk reduction interventions. Yet research indicates that these opportunities are often missed. Prior to implementing a prevention demonstration project in an urban HIV and STD clinic, we conducted a qualitative investigation with providers, including physicians, nurse practitioners, physician assistants, and nurses. The purpose of this investigation was to examine the current status of prevention education and counseling efforts at the clinic, examine the barriers and facilitators to providing prevention counseling, and identify key areas where providers believed that they needed additional training.

Patterns of Internet use by persons with spinal cord injuries and relationship to health-related quality of life.

OBJECTIVES: To examine patterns of computer and Internet use among persons with spinal cord injuries (SCI) and to assess the relationship between Internet use and health-related quality of life (HRQOL). DESIGN: Cross-sectional survey design. SETTING: National Model Spinal Cord Injury Systems. PARTICIPANTS: People with SCI enrolled in a national database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patterns of Internet use and relationship to HRQOL indicators: self-perceived health status, health status compared with 1 year ago, severity of depression, social integration score, occupation score, contacts with friends, business contacts, and satisfaction with life. RESULTS: Most subjects owned computers, had Internet access, and used the Internet regularly-primarily for email, disability and health information, and shopping. Bivariate analysis revealed significant differences in Internet access based on sociodemographics, particularly among subjects with less education and among African Americans and Hispanics. In initial univariate analysis, most HRQOL indicators were significantly better for Internet users; once sociodemographic factors were included, 4 indicators remained significant. CONCLUSIONS: Complex factors contribute to Internet access among people with SCI, with more barriers among specific subgroups. A significant HRQOL benefit from Internet use is suggested. Targeted interventions and studies of usage patterns are recommended.