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Lin Ding, PhD; Bruce E. Landon, MD, MBA; Ira B. Wilson, MD, MSc; Mitchell D. Wong, MD, PhD; Martin F. Shapiro, MD, PhD; Paul D. Cleary, PhD

Arch Intern Med. 2005;165:618-623.

Background  We evaluated physicians’ training, experience, and practice characteristics and examined associations between their attitudes toward human immunodeficiency virus (HIV)–infected persons who are injection drug users (IDUs) and quality of care.

Methods  Cross-sectional surveys were conducted among a probability sample of noninstitutionalized HIV-infected individuals in the United States and their main HIV care physicians. Physician and practice characteristics, training, HIV knowledge, experience, attitudes toward HIV-infected IDUs, stress levels, and satisfaction with practice were assessed. The main quality-of-care measures were patient exposure to highly active antiretroviral therapy, reported problems, satisfaction with care, unmet needs, and perceived access to care.

Results  Nationally, 23.2% of HIV-infected patients had physicians with negative attitudes toward IDUs. Seeing more IDUs, having higher HIV treatment knowledge scores, and treating fewer patients per week were independently associated with more positive attitudes toward IDUs. Injection drug users who were cared for by physicians with negative attitudes had a significantly lower adjusted rate of exposure to highly active antiretroviral therapy by December 1996 (13.5%) than non-IDUs who were cared for by such physicians (36.1%) or IDUs who were cared for by physicians with positive attitudes (32.3%). Physician attitudes were not associated with other problems with care, satisfaction with care, unmet needs, or perceived access to care.

Conclusions  Negative attitudes may lead to less than optimal care for IDUs and other marginalized populations. Providing education or experience-based exercises or ensuring that clinicians have adequate time to deal with complex problems might result in better attitudes and higher quality of care.

Author Affiliations: Department of Health Care Policy (Drs Ding, Landon, and Cleary) and Division of General Medicine, Beth Israel Deaconess Medical Center (Dr Landon), Harvard Medical School, and Institute for Clinical Research and Health Policy Studies, Tufts–New England Medical Center (Dr Wilson), Boston, Mass; Department of Medicine and Health Services, University of California, Los Angeles (Drs Wong and Shapiro); and RAND Health, Santa Monica, Calif (Dr Shapiro).

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