HIV-1 infection in gynecology: Gynecologist's barriers to care for HIV-infected women

Background: Decreasing Vertical transmission Fates of HIV due to highly active antiretroviral therapy regimens faciliate the choice for childbearing in HIV positive women. Recent trends in epidemiology of HIV show increasing incidence of HIV-related gynecologic diseases. These facts implicate the question about the role of gynecologists in primary care of HIV-infected women and furthermore about the use of health services by HIV-infected women. Materials and methods: 143 of the total of 298 office-based gynecologists practicing in Vienna (41 %) completed a questionnaire to assess their knowledge, attitudes, and practice with respect to HIV-infection and AIDS. In addition, personal interviews with 30 HIV-positive women were conducted. Results: Although about 75 % of the gynecologists are willing to care for HIV-positive women in their private practice, only about a third of them already care and 17.9% refuse to care for these patients. More than two thirds of the gynecologists refuse to care for intravenous drug users and patients with manifestations of AIDS. Barriers to care are the fear to be confronted with the psychosocial problems of patients, the fear to need more time to care for these patients and the fear of a lack in knowledge about HIV/AIDS. HIV-positive women are highly satisfied with care, although the majority of the women reported about a lack of confidentiality and therefore did not inform their gynecologist about their HIV-infection. Conclusions: The physician-patient relationship of gynecologists and HIV-positive women is characterized by gynecologist's barriers to care on the one hand, on the other hand HIV-positive women report about a lack of confidentiality, which often is associated with a delay in seeking medical care. Discussion: A strategy to overcome gynecologist's barriers in care for HIV-positive women is medical education. The improvement of the physician-patient relationship will enhance the effects of HIV/STD risk assessment as well as the quality of care.