466. Racial Composition of Practice Influences HIV Testing Practices and Attitudes among Black Primary Care Physicians in the US
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1

Background: The CDC recommends routine HIV testing, but limited data exist on HIV testing practices and attitudes among Black physicians in the US. We report survey findings according to racial composition of the physician's practice.

Methods: We conducted an online survey at the 2010 National Medical Association (NMA) Annual Convention and by email to physicians from the AMA Masterfile. Eligible physicians met pre-defined criteria: Black race; practicing ≥1 year; practice comprised of ≥60% adults and ≥20% Black patients.

Results: Results are physician-reported estimates. 143/502 (28%) physicians had ≥75% and 124/502 (25%) had <40% Black patients. Respective physician (≥75 vs <40% Black patients) demographics: 45 vs 49% male; 22 vs 31% <40 years old; 36 vs 21% Family Practice; 34 vs 35% Internal Medicine; 24 vs 24% OB/GYN; 7 vs 19% Emergency Medicine. Physicians caring for more Black patients were more likely to be NMA members and have more low-socioeconomic status, HIV-infected, and Medicaid patients.

Physicians with ≥75% Black patients perceived the HIV epidemic in the Black community to be more serious and local prevalence to be higher (17 vs 10%), had more patients tested for HIV in the past year (40 vs 24%), were more comfortable discussing HIV testing, and were more likely to see patients as open to testing than those with <40% Black patients.

Testing was based on physician recommendation in 67% of cases. Physicians with ≥75% Black patients recommended testing based on sexual activity (83 vs 69%), previous incarceration (73 vs 63%) and a routine approach (64 vs 41%) more often than those with <40% Black patients. Top barriers to physicians recommending testing were: seen as accusatory by patient; patient fear of HIV stigma; competing priorities and insufficient time.

Physicians responded that brochures, media attention, and government mandates would help them test more.

Conclusion: Among patients of Black primary care physicians in the US, the annual incidence of HIV testing is 34%. Physician recommendation is a key driver of testing, but multiple barriers prevent a more routine approach. Education and NMA adoption of policies around CDC testing recommendations may encourage earlier HIV diagnosis and referral to care to improve HIV racial disparities in the US.


Subject Category: H. HIV/AIDS and other retroviruses

Valerie Stone, MD, MPH1, Wilbert Jordan, MD, MPH2, Lori DeLaitsch, MPH3, Eric Wong, PhD3, David Malebranche, MD, MPH4, Alisha Bermudez5 and Bryan Baugh, MD3, (1)Massachusetts General Hospital/Harvard Medical School, Boston, MA, (2)OASIS Clinic of King/Drew Medical Center, Los Angeles, CA, (3)Tibotec Therapeutics, Titusville, NJ, (4)Emory School of Medicine, Atlanta, GA, (5)Cheskin Added Value, Redwood Shores, CA


V. Stone, Tibotec Therapeutics: Consultant, Consulting fee

W. Jordan, Tibotec: Grant Investigator and Investigator, Grant recipient and Speaker honorarium

L. DeLaitsch, Tibotec Therapeutics/Johnson & Johnson: Employee and Shareholder, Salary and Shareholder

E. Wong, Tibotec Therapeutics /Johnson&Johnson: Employee, Salary

D. Malebranche, Tibotec Therapeutics: Consultant, Consulting fee

A. Bermudez, None

B. Baugh, Tibotec Therapeutics/Johnson & Johnson: Employee and Shareholder, Salary and Shareholder

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