The Assessment of Men’s Risk of STI and HIV in the General Practice Setting
Background: General practitioners (GPs) conduct the majority of STI/HIV (sexually transmitted infections/human immunodeficiency virus) testing in men. Given the overall low prevalence of STI in general practice, GPs undertake targeted risk assessment and testing of their patients. Little, however, is known about the extent of STI and HIV risk assessment in general practice, the consistency of questioning or the extent to which GPs identify patients with risk behaviours. Aim: To explore STI and HIV testing strategies for men by general practitioners (family medicine doctors). Methodology: This study employs a cross-sectional survey of GP testing patterns adjoining a qualitative, multiple-case study, drawing on semi-structured interviews with seventeen GPs from the Wellington region. The testing behaviour of two cohorts of GPs is studied – those who frequently test for STI/HIV and those who infrequently test – stratified by practice size, the location and GP gender. Results: This study provides new insights into the risk assessment and testing behaviour of GPs in relation to STI and HIV and men. Several salient findings are highlighted. Amongst them include, first, GPs dictate the quality of sexual health services, including the intensity of case findings through risk assessment and testing. Second, a wide variation and range in testing exists. Third, GPs undertake logical and rational risk assessment based on epidemiology and prevalence, a logic which works to differentiate testing behaviour for very rare conditions such as HIV and more common STI (in this study HIV and other STIs are differentiated for clarity). Fourth, a GP’s interaction with men influences his/her risk assessment and testing behaviour. Last, successful sexual health consults require time within a consult, appropriate lead-ins to that discussion, and asking the right question at the right time. Because of the sensitive nature of sexual health consults, asking the right question at the right time, however, may be difficult to achieve consistently and successfully. Conclusion: It is evident that GPs play a significant role in men’s sexual health by achieving the goals of assessing STI and HIV risk and testing for them. However, it appears that a GP’s encounter with males in regard to sexual health issues is variable, which may undermine their ability to instil quality risk assessment and testing behaviours. Better understanding of GP approaches to risk assessment and how testing occurs provides valuable insights into how general practice can further develop sexual health consults for men. Additionally, such an understanding can suggest how GPs can more effectively liaise with specialist sexual health, given the different contexts in which primary and secondary care operates.
Advisor: Dowell, Tony; Gray, Lesley
Degree Name: Master of Primary Health Care
Degree Discipline: Department of Primary Health Care and General Practice
Publisher: University of Otago
Keywords: Men; GPs; STI; HIV; Assessment; Testing; Behaviour; Risk; Primary; Health; Care; Sexual; Strategy; Qualitative; Quantitiative; Family; Medicine
Research Type: Thesis