HIV and the Primary Care Provider

Addressing Confidentiality, Stigma, Culture, and Patient Education

Jan 31, 2009

Providers often face issues of confidentiality, stigmas, cultural difference, and patient education when treating HIV-positive patients.

Primary care providers play a major role in caring for individuals with HIV/AIDS. There are number of things that these providers can do to help ensure that they are providing their HIV-positive patients with the best care possible. Providers need to be aware that HIV patients face a number of special challenges that can affect the interactions between doctor and patient. These special considerations include concerns over confidentiality, stigma, cultural differences, and lack of HIV education.

Addressing Concerns Over Patient Confidentiality

The provider should reassure the patient that all discussions and information will be kept confidential. In accordance with the Health Insurance Portability and Accountability Act (HIPAA), providers should actively work protect patient confidentiality. All personnel working in settings where HIV patients are seen should be instructed not to leave files laying around or leave records up on a computer screen.

HIV Stigma and Discrimination Concerns

Individuals living with HIV/AIDS still face stigma and discrimination from a variety of sources. Often times patients fear that health care provides will treat them differently because of their HIV status. Providers should, for the most part, treat the patient the way they would any other patient. This means not wearing examination gloves, except when called for by the type of test or examination.

Addressing Patient Cultural Concerns

Minorities are disproportionately affected by HIV. This situation is further complicated by the fact that many minorities often have disproportionate rates of poverty, homelessness, and lack of insurance. Cultural background also affects individual beliefs about health and well-being. Providers should explore a patient’s beliefs in order to better understand how the patient views health behaviors, medical treatment, and HIV. Understanding these beliefs can help providers develop a treatment plan that is agreeable to both the patient and the provider.

HIV Patient Education

Despite the availability of HIV knowledge, many HIV-positive patients lack a general understanding of how HIV is transmitted, the meaning of test results, and the benefits of treatment. Patient education should make up a large portion of the time a provider spends with the patient, especially in the time immediately following diagnosis. This education can be done by a physician, nurse, social worker, case manager, or other trained caregiver.

Topics that should be covered with the patient include an understanding of how HIV is transmitted and how they can protect others, the benefits of antiretroviral treatment (ART) and the importance of consistently taking the medication, and the interpretation of CD4 and viral load tests. Understanding HIV can help patients take a more active role in their treatment and regain control over their lives.

Bartlett, John G. et al. A Guide to Primary Care of People with HIV/AIDS. 2004. Rockville: Department of Health and Human Services.

The copyright of the article HIV and the Primary Care Provider in Aids/HIV Treatment is owned by Jamie Robertson. Permission to republish HIV and the Primary Care Provider in print or online must be granted by the author in writing.