PSYCHOSOCIAL BARRIERS TO PHYSICIAN CARE OF AIDS PATIENTS

IN SPITE OF EDUCATIONAL EFFORTS DIRECTED TOWARD HEALTH PROFESSIONALS BY HOSPITALS, MEDICAL JOURNALS, AND PROFESSIONAL ASSOCIATIONS, THE PROBLEM OF THEIR RELUCTANCE OR REFUSAL TO TREAT PATIENTS WITH AIDS REMAINS. RECENT SURVEYS INDICATE THAT AS MANY AS 24 PERCENT OF PHYSICIANS DO NOT BELIEVE IT IS UNETHICAL TO DENY CARE. RESEARCH HAS DIRECTLY DEMONSTRATED PREJUDICIAL ATTITUDES AMONG PHYSICIANSIN FOUR LARGE METROPOLITAN AREAS TOWARD PATIENTS WITH AIDS, AND RECENT ASSESSMENTS OF PROFESSIONALS IN NEW YORK CITY REVEALED FOUR INSTITUTIONAL BARRIERS TO EFFECTIVE CARE: (1) REALISTIC OR UNREALISTIC FEAR OF CONTAGION, (2) CONFRONTATION WITH MORTALITY, (3) FEELINGS OF HELPLESSNESS AND HOPELESSNESS, AND (4) FEELINGS OF REVULSION TOWARD THE PATIENTS' LIFESTYLES. PHASE I RESEARCH WILL DEVELOP A VIDEO-BASED INTERVENTION PROGRAM TO EXAMINE THESE UNDERLYING PSYCHOSOCIAL CONFLICTS; IT WILL HELP PHYSICIANS REACH A DECISION TO TREAT PATIENTS WITH AIDS AND PATIENTS WHO ARE SEROPOSITIVE BY PROVIDING BEHAVIORAL AND VERBAL MODELS WITH WHOM THE PHYSICIANS CAN IDENTIFY. PHASE II EFFORTS WILL BROADEN THE INTERVENTION BY DEVELOPING A VIDEO-BASED CORE CURRICULUM FOR HOSPITALS TOUSE IN EDUCATING HEALTH PROFESSIONALS AT ALL LEVELS OF CARE.