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1.
Public Health Rep ; 127(3): 318-29, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22547863

RESUMO

OBJECTIVES: CDC 2006 recommendations for new HIV testing methods in U.S. health-care settings (opt-out approach, general medical consent, and optional prevention counseling) have been the subject of a public ethical debate. Ethical concerns might limit their implementation and affect expanded HIV screening efforts. We compared clinicians' and patients' perspectives on the ethical concerns raised about, justifications provided in support of, and preferences for the 2006 CDC-recommended HIV testing methods for the U.S. health-care setting, in contrast with the 2001 CDC-recommended HIV testing methods (opt-in approach, specific written consent, and mandatory prevention counseling). METHODS: We conducted a non-inferiority trial and survey of 249 clinicians and random samples of 1,013 of their patients at three emergency departments and three ambulatory care clinics at university-affiliated hospitals in Rhode Island from June to December 2007. RESULTS: Clinicians found the 2006 CDC HIV testing methods to be more ethically concerning than the 2001 testing methods (i.e., ethically inferior), while patients had few ethical concerns. In regard to ethical justifications cited for the 2006 CDC HIV testing methods, clinicians were more supportive of the ethical justifications cited for using an opt-out approach and general medical consent, while patients were more supportive of the justifications for optional HIV prevention counseling. Clinicians showed a relatively greater preference for the opt-out approach and use of general medical consent, while patients had a relatively greater preference for optional HIV prevention counseling. CONCLUSIONS: Clinicians and their patients hold divergent ethical perspectives on CDC's 2006 HIV testing methods. The results indicate an opportunity to review not only these but also future HIV testing recommendations, as well as how they are presented for implementation.


Assuntos
Sorodiagnóstico da AIDS/ética , Atitude do Pessoal de Saúde , Centers for Disease Control and Prevention, U.S./normas , Infecções por HIV/diagnóstico , Preferência do Paciente , Adolescente , Adulto , Aconselhamento/ética , Feminino , HIV , Humanos , Consentimento Livre e Esclarecido/ética , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Rhode Island , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
2.
J Natl Med Assoc ; 103(5): 432-8, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21809793

RESUMO

PURPOSE: Human immunodeficiency virus (HIV) is a preventable disease that can have improved outcomes with early diagnosis and treatment. The CDC recommends that HIV testing be incorporated into clinical settings as part of routine medical care. METHODS: Individual, open-ended interviews were conducted with primary care providers and administrators to obtain their views regarding the meaning of routine HIV testing and the barriers and facilitators to implementing routine HIV testing in their respective practices. RESULTS: Most respondents supported routine HIV testing, although their definitions of routine varied. Barriers for providers included time and financial constraints to appropriately conduct HIV counseling and testing and inadequate HIV education and training. Facilitators for implementing routine HIV testing included patients' feelings of empowerment and reduced HIV stigma. CONCLUSIONS: The implementation of routine HIV testing in primary care practices appears to be an acceptable public health intervention. Next steps should include efforts to standardize the definition of routine HIV testing and working with primary care settings to better understand and reduce barriers to routine testing.


Assuntos
Infecções por HIV/diagnóstico , Atenção Primária à Saúde , Aconselhamento , Testes Diagnósticos de Rotina/normas , Feminino , Educação em Saúde , Promoção da Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Programas de Rastreamento , Mississippi , Motivação , Rhode Island
3.
J Natl Med Assoc ; 100(5): 553-8, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18507208

RESUMO

Rates of sexually transmitted infections (STIs) in women in U.S. corrections facilities are higher than rates in community samples. Research that combines behavioral correlates of STI with STI history by race/ethnicity has not been done in incarcerated women. The purpose of this study was to compare by race/ethnicity self-reported sexual risk behaviors with self-reported history of STI in an incarcerated sample. An interviewer administered a questionnaire to 428 incarcerated women. Blacks were more likely to report consistent condom use in the three months prior to incarceration (47% vs. 28%, p < 0.05), and Hispanics were less likely to report sex work than were whites (16% vs. 39%, p < 0.05). Whites were more likely than blacks to report having had an unplanned pregnancy (88% vs. 67%, p < 0.05). Despite having lower self-reported risk on several measures, Blacks were more likely to report history of STI (65% vs. 40%, p < 0.05). The correctional setting is an opportune place to better understand and address the complex issue of sexual health disparities.


Assuntos
Disparidades nos Níveis de Saúde , Prisioneiros/estatística & dados numéricos , Prisões/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Saúde da Mulher , Adulto , Negro ou Afro-Americano , Etnicidade , Feminino , Inquéritos Epidemiológicos , Humanos , Rhode Island/epidemiologia , Medição de Risco , Fatores de Risco , Assunção de Riscos , Estados Unidos/epidemiologia , População Branca
5.
J Natl Med Assoc ; 98(12): 1912-6, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17225833

RESUMO

PURPOSE: Routine HIV testing on college campuses has the potential to increase students' awareness of their HIV status. Testing targeted only at persons reporting HIV risk behaviors will not identify infected persons who may deny or be unaware of their risk. Thus, this study sought to investigate the acceptability of rapid HIV testing among African-American college students in a nontraditional setting on a historically black college/university (HBCU) campus. METHODS: A cross-sectional survey on risk behaviors, barriers to testing, and HIV testing history was administered to 161 African-American college students at an HBCU. All approached students (both those participating and not) were offered free HIV rapid testing. RESULTS: Eighty-one African-American college students consented to be tested for HIV and all tested negative. Results of the questionnaire indicated that African-American college students engage in risky sexual behaviors (such as unprotected sex) yet perceive themselves as at little or no risk. College students who reported past HIV testing often did so in conjunction with routine exams, such as annual pap smears, rather than specifically seeking HIV testing. CONCLUSIONS: Routine HIV testing on college campuses may be an important public health initiative in reducing the spread of HIV. Specifically, this strategy may provide a model for student access to HIV testing, particularly males and other students who may be less likely to seek HIV testing at traditional medical settings. These data supports expansion of routine testing programs directed at African-American college students.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Negro ou Afro-Americano , Infecções por HIV/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Serviços de Saúde para Estudantes , Estados Unidos
6.
J Natl Med Assoc ; 97(1): 46-52, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15719871

RESUMO

PURPOSE: To determine attitudes of patients towards routine HIV testing in the primary care setting. METHODS: Cross-sectional survey on the risk factors, beliefs, attitudes and knowledge of HIV/AIDS administered to 101 individuals present in urban primary care clinics in Providence, RI. RESULTS: Previous HIV testing was done most frequently for those respondents requiring prenatal services and for those who were curious about their HIV status. Patients' perceptions of their personal risk for HIV infection and their self-identified risk factors were frequently discordant. Patients wanted to be tested routinely for HIV by their primary care providers, even when they did not feel that they were at high risk for HIV acquisition. CONCLUSIONS: Patients in this study clearly indicated their desire to be tested for HIV routinely by their primary care providers. Routine HIV testing is a reasonable option to identify HIV infections in the primary care setting, as it is nondiscriminatory, allows increased awareness of actual risk for infection, and provides an opportunity for earlier detection of HIV.


Assuntos
Sorodiagnóstico da AIDS/psicologia , Atitude Frente a Saúde , Etnicidade/psicologia , Atenção Primária à Saúde , Adulto , Negro ou Afro-Americano/psicologia , Estudos Transversais , Coleta de Dados , Feminino , Hispânico ou Latino/psicologia , Humanos , Masculino , Fatores de Risco , População Branca/psicologia
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