Training Needs for HIV Risk Assessment with Older Adults: Results from a Family Medicine Resident Survey

Special Article - Family Practice

J Fam Med. 2015;2(3): 1029.

Training Needs for HIV Risk Assessment with Older Adults: Results from a Family Medicine Resident Survey

Gleason-Comstock J¹*, Streater A², Kivell L² and Xu J¹

¹Department of Family Medicine & Public Health Sciences, Wayne State University, Detroit Michigan, USA

²Center for Urban Studies, Wayne State University, Detroit, Michigan, USA

*Corresponding author: Gleason-Comstock J,Department of Family Medicine & Public Health Sciences, Wayne State University, USA

Received: April 18, 2015; Accepted: May 25, 2015; Published: May 29, 2015


Introduction: Older Americans are more likely than young Americans to be diagnosed with HIV infection late in the course of their disease, which can lead to poorer prognoses.

Objective: This survey of Family Medicine and transitional year residents at an urban university-affiliated hospital sought to determine the knowledge and practices of the residents in assessing HIV risk with their older patients.

Methods: A convenience sample of thirty-two residents participated in a needs assessment survey. Residents were asked about their experience with HIV risk assessment, diagnosis and treatment of HIV infection as well as training needs from their own experience and what they thought would be helpful for practicing primary care physicians.

Results: Although older patients may have many of the same sexual and drug use risk factors as younger patients, residents were less likely to ask their older patients, particularly older female patients, about sexual orientation, number of sexual partners and safer sex practices than their younger patients. Similarly, but to a much lesser extent, they were less likely to ask older patients than younger patients about intravenous drug use.

Discussion: Our results suggest HIV risk assessment is often overlooked in older adults by resident physicians. There is a critical need to raise the awareness of this bias, and to educate primary care physicians to assess, screen and test their older patients of HIV infection as they would for younger patients to prevent the disease and/or diagnose and treat the disease early to improve their prognosis.

Keywords: HIV prevention; Primary care; Family medicine; Continuing medical education


In 2010, Americans aged 55 years and older accounted for 5% of new infections, and in 2011 they were 26% of the estimated 1.2 million people living with HIV/AIDS [1]. From 2009-2013, rates for new HIV infections remained stable for persons aged 50-59 years and increased for persons age 60 and older [2]. US Preventive Services Task Force (USPSTF) Risk Assessment behavioral risk factors for HIV infection include: having unprotected vaginal or anal intercourse, having sexual partners who are HIV-infected, bisexual or injection drug users, or exchanging sex for drugs or money. The USPSTF “recognizes the categories are not mutually exclusive, the degree of sexual risk is on a continuum and individuals may not be aware of their sexual partners‘ risk factors for HIV infection,” and recommends routine HIV screening in persons 15 to 65 years of age, regardless of risk, as well as persons at increased risk for HIV under age 15 and over age 65 [3]. Early diagnosis and treatment is important in the control of the HIV/AIDs prognosis and its spread; however, half of people 50 and over with the disease are diagnosed late compared with one-third of those aged 30-34. Accordingly, the period of survival is shortened and there may be more health, psychological, and social consequences for older people [4,5].

More than half of older Americans are sexually active [6]. Older persons are less likely to see themselves at risk for HIV even if they had a sexual encounter outside a long- term relationship [7]. Gender may also affect HIV incidence and prognosis in older populations. Women are not likely to talk with their physicians about risk, but overwhelmingly prefer that primary care physicians (PCPs) initiate conversations about sexual health [8,9]. With the increasing risk of acquiring HIV among people aged 50 and older, undergraduate and graduate medical education programs need to be aware of the HIV risk of older people and develop curricula to aid in prevention and earlier diagnosis [8,10,11].

Primary care physicians, who regularly see older adults in their offices, have a major role in HIV prevention, screening, diagnosis and treatment. The American Academy of Family Physicians (AAFP) has adopted a clinical policy to improve HIV screening, diagnosis, education, counseling, and referral of people aged 13-64 years [12]. How residents and medical students perceive their HIV prevention role is not well understood, but studies over the past decades show that most primary care residents believe they are inadequately prepared to work with HIV patients [13,14]. The Liaison Committee on Medical Education (LCME) Section II Educational Program for the MD Degree notes the curriculum of a medical education must include behavioral and socioeconomic subjects in addition to basic science and clinical disciplines, but states that the coverage of the individual topics depends on the medical education programs‘ educational goals and objectives. Human sexuality/sexual functioning is noted as a content area which can be included as a subject in required courses [15]. Nonetheless, the Institute of Medicine (IOM) states physiciansin- training should learn the importance of taking a thorough sexual history and performing routine HIV testing during medical school and continuing through residency [16]. As part of the effort to address the HIV training needs of family physicians, a survey was conducted determine the knowledge and practices regarding assessing HIV risk, sexual history taking and HIV prevention and diagnosis in a Family Medicine residency program.

Materials and Methods


The survey was conducted at a suburban location of an urban university-affiliated community hospital in a metropolitan area. Permission was received from the Chair of Family Medicine & Public Health Sciences, in coordination with the Family Medicine Residency Director, to conduct the survey at a mandatory monthly meeting. The study protocol was approved by the university‘s institutional review board. A convenience sample of 32 residents in Family Medicine and transitional year was invited to participate in the study during the September meeting of the 2010-2011 academic year. Participants were advised that completion of the survey was voluntary and two participants opted out. The Investigators administered the survey and received it at the end of the meeting.


The survey instrument was an HIV/AIDS needs assessment derived from a prior survey of internal medicine residents [17]. Questions for family practice physicians were validated and pretested in a presentation with participants at a statewide university family medicine research conference [18]. All survey items were closeended and the survey took an average of ten minutes to complete. In addition to several background questions (i.e., gender, age, residency year, and medical specialty area), the residents were asked about their current experiences with HIV/AIDS patients, their risk assessment and HIV testing practices, and their perception of risk (i.e., no risk to high risk) for three patient age groups: 13-20, 21-49, and 50 years and over. They also identified their past training on HIV topics, preferred methods of receiving HIV educational information, and the specific topics for which they thought practicing PCPs should be trained. The list of 13 topics was chosen from the HIV/AIDS clinician training content offered though the AIDS Education and Training Centers [19]. Examples of survey items are presented in Table 1.