To assess primary care physicians' attitudes, knowledge, and practices with respect to the human immunodeficiency virus (HIV) in older patients, a prospective survey of a representative cohort of primary care physicians was conducted in Dallas County, Texas, a large metropolitan area. Three hundred thirty primary care physicians participated in the survey. Questions were asked regarding physician demographics, practice characteristics, and knowledge and practices with respect to HIV and the acquired immunodeficiency syndrome (AIDS) in patients older than 50 years. The responses of the following groups were compared: family practitioners vs internists, physicians younger than 40 years vs those aged 40 years and older, those who saw 5 or less vs more than 5 patients with HIV or AIDS per year, and those in private vs nonprivate practice. Most respondents (85.5%) reported having seen 10 or fewer patients with HIV or AIDS in the previous year. Most physicians (69.7%) reported that patients older than 50 years rarely or never asked questions concerning HIV or AIDS. Most physicians rarely or never discussed HIV or AIDS with patients older than 50 years (60.8%) and rarely or never discussed risk factor reduction (67.5%). Physicians were more likely to rarely or never ask patients older than 50 years compared with those younger than 30 years about HIV risk factors (40.0% vs 6.8%, P<.001). Physicians incorrectly rank ordered the most prevalent risk factors in patients older than 50 years. The correct order is (1) male-male sex, (2) intravenous drug use, (3) blood transfusion, and (4) heterosexual sex. Physicians aged 40 years and older were more likely to correctly identify the most prevalent risk factor (P=.03). Family practitioners were more likely to rarely or never ask older patients about risk factors for HIV (54.9% vs 28.9%, P=.007). Primary care physicians have inadequate knowledge concerning HIV and AIDS risk factors in older patients and insufficiently discuss HIV and AIDS with older patients. Physicians should counsel patients of all ages about HIV and AIDS. Arch Fam Med. 1997;6:289-294.
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