Approximately 17% of American doctors, responsible for treating just under a quarter of HIV patients, have a negative attitude towards HIV-positive individuals who inject drugs, according to a study published in the March 28th edition of the Archives of Internal Medicine. Lack of knowledge about HIV treatment and a heavy workload were identified as risk factors for negative physician attitudes. However, the investigators found that, on the whole, this did not affect the quality of care HIV-positive injecting drug users received, even though they established that individuals who did not inject drugs were twice as likely as injecting drug users to be treated with HAART.
In the US, 34% of all cases of AIDS involve injecting drug users. Many HIV-positive injecting drug users do not receive optimal HIV treatment, possibly because they do not adhere to their medication properly, or because of interactions between HAART and illicit drugs. Earlier studies have also found the a doctor’s experience of treating injecting drug users and their attitudes can have an impact on the quality of care they provide.
Investigators hypothesised that experience of treating injecting drug users would be associated with a more positive attitude towards them, and that physician attitudes would be linked to the quality of care provided to HIV-positive injecting drug users.
Cross-sectional data from both doctors and their patients were obtained from the HIV Cost and Services Utilization Study (HCSUS). A total of 373 doctors, who treated 1820 HIV-positive patients participated in the study. Data were collected in 1996, at the very beginning of the HAART era.
Doctors were asked to provide details of their demographics, experience, the total number of HIV-positive patients they treated, the proportion of their patients from different risk groups, and if they were an HIV specialist. The questionnaire also assessed knowledge of HIV treatment and the level of a doctor’s stress.
Attitudes towards the treatment of HIV-positive injecting drug users were assessed by the strength of agreement or disagreement with two questions. The first enquired “if treating IV drug users seems futile” and the second “when given the choice, I would not treat intravenous drug users with HIV infection.”
Quality-of-care was assessed using five measures including the percentage of patients exposed to HAART, patient satisfaction, and the unmet needs of patients.
Results
The doctors who returned the questionnaires were overwhelmingly white (79%) and male (72%) and had been practicing medicine for a mean of 17 years.
Doctors said that just under a quarter (24%) of their patients had a history of injecting drug use. A total of 70% of doctors said that they cared for 50 or more HIV-positive patients. Overall, doctors had a good knowledge of HIV (mean score eight on an eleven point scale).
A total of 17% of doctors agreed or strongly agreed with the statements designed to assess negative attitudes towards injecting drug users. These doctors treated 24% of HIV-positive patients.
Factors significantly associated with a negative attitude towards HIV-positive injecting drug users included being male (p = 0.01), and having a lower percentage of patients who are injecting drug users (p
Injecting drug users treated by doctors with a negative attitude towards injecting drug users were significantly less likely to be treated with HAART than those with a positive attitude (14% versus 33%, p = 0.01), but for other measures assessing quality of care there were no significant differences between doctors with negative and positive attitudes.
“About 17% of physicians surveyed, who treated 23.2% of HIV-infected patients nationally, had negative attitudes towards HIV-infected patients who injected drugs”, write the investigators. However, they are encouraged that this did not affect overall standard of care.
Ding L et al. Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users. Arch Int Med 165: 618 - 623, 2005.