Papers

Concerns about AIDS in general practice

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7026.285 (Published 03 February 1996) Cite this as: BMJ 1996;312:285
  1. Marian A W Moons, research fellowa,
  2. Loe Peters, coordinator of consumer researcha,
  3. Aad I M Bartelds, coordinator of Dutch Sentinel Practice Networka,
  4. Jan J Kerssens, senior research fellowa
  1. a Netherlands Institute of Primary Health Care, PO Box 1568, 3500BN Utrecht, Netherlands
  1. Correspondence to: Dr Peters.
  • Accepted 1 November 1995

General practitioners are regarded as well placed to help prevent the transmission of HIV infection.1 2 3 In 1988 a study was started in the Netherlands to get more information on concerns about AIDS among the non-infected population and on the general practitioner's role in providing advice and health education about AIDS. In this paper we present the results after five years (April 1988-April 1993).

Subjects, methods, and results

Since April 1988 general practitioners participating in the Dutch sentinel practice network recorded all face to face consultations with non-infected patients in which the subject of AIDS was brought up, either by the patient or by the general practitioner. When the subject of AIDS was a substantial part of the consultation, the general practitioners filled in a questionnaire giving information on the contents of this HIV related consultation and on the patient. If an arrangement for HIV testing was made the result of the test was recorded on a separate form.

The Dutch sentinel practice network (45 general practices, 62 practitioners) is a national network that can be regarded as representative of Dutch general practice. It covers about 1% of the Dutch population.4 5 The participating general practitioners collect data on different topics every year. In the process of data collection several checks are built in to ensure a representative and valid database.

A total of 1082 HIV related consultations were recorded, of which 890 (82%) were first HIV related consultations. To make allowances for differences in the size of the practice populations, the number of HIV related consultations was calculated per 10000 patients. For trend analysis the numbers of HIV related consultations (per 10000 patients) were aggregated per three month period according to degree of urbanisation and geographical area. Changes in the size of the total patient population over time and the effect of seasonal variation were accounted for. A stepwise linear regression analysis was applied. For associations a χ2 test was used. All statistics were tested with (alpha) of 0.05.

In the five years of the study an average of 17 HIV related consultations per 10000 patients a year (range 0 to 57 per 10000) were recorded in Dutch general practice. A time trend analysis (fig 1) showed a significant increase in the number of HIV related consultations over time: from 14.4 (95% confidence interval 14.1 to 14.7) to 24.6 (24.3 to 24.9) per 10000. The decrease in the number of these consultations in rural areas (from 5.7 (95% confidence interval 5.3 to 6.1) to 3.0 (2.6 to 3.3) per 10000) was in contrast with this growing trend. A time trend analysis of only first HIV related consultations showed similar trends as the analysis of all HIV related consultations.

Fig 1
Fig 1

Number of HIV related consultations per 10000 patients by degree of urbanisation (quarterly data points and trend lines)

The possibility of HIV testing (67%: 723/1082) was by far the most important topic of conversation. Time trend analysis showed that HIV testing became even more important over the five years (rising from 57% to 75%). For 85% (626/723) of the tests requested an arrangement for testing was made, the “need for reassurance” being the commonest reason (76%: 478/626). In 1% (5/573) of the tests actually performed the result was HIV positive.

Only in 6% (21/335) of the consultations in which concerns about physical complaints in relation to HIV (32%: 335/1082) were discussed did the general practitioner share his or her patient's anxiety. Men and women differed strikingly in their concerns about the possible hazards of sexual contacts. Women (32%: 166/527) more often than men (18%: 99/555) were worried about regular sexual contacts (χ2=27.28, df=1, P<0.001). General practitioners took the initiative to talk about HIV infection in only 4% of the contacts recorded. The initiative was taken more frequently in combination with the general practitioner observing potentially HIV related physical complaints: 29% (14/48) versus 3% (29/1034) (χ2=48.17, df=1, P<0.001).

Comment

The data show that the number of HIV related consultations in Dutch general practice is rather low. However, the increase observed in the number of these consultations during the study period and the differences in the numbers of consultations recorded between practices are remarkable. General practitioners can play an important role in reassuring their concerned patients providing that they can translate the general information about AIDS/HIV to the needs of the individual patients.

Footnotes

  • Funding Ministry of Welfare, Health and Culture, after nomination by the Dutch programme committee for AIDS research.

  • Conflict of interest None.

References

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