Background
Methods
Participants
Procedure
Analyses
Results
Number of HIV physicians | |
---|---|
State | |
- New South Wales | 9 |
- Victoria | 6 |
- Queensland | 3 |
- Canberra | 1 |
- Tasmania | 1 |
Work hours | |
- Full-time | 11 |
- Part-time | 9 |
Specialty | |
- High HIV case-load General practitioner | 7 |
- Sexual health physician | 7 |
- Infectious disease physician or immunologist | 6 |
Gender | |
- Male | 12 |
- Female | 8 |
Physicians’ understanding of anal cancer
…a devastating infection (F, Sexual health, 15 YiHP)…potentially very nasty (M, General Practice, 28 YiHP)…the last 25 years the rates have almost doubled I guess in Australia and similar patterns have been seen around the world (M, Infectious Disease, 15 YiHP)
…I suspect the numbers have increased a bit over the last five or 10 years but they haven’t gone up like everyone was predicting where we were going to see an avalanche (M, General Practice, 28 YiHP).
…you’ve got a cancer that’s 100 times more common [in HIV-positive MSM compared with the general population] then we should be trying to do something about it (M, Infectious Disease, 27 YiHP)
Views on anal cytology
…still done on the basis of belief rather than evidence (M, Immunologist, 30 YiHP)
…just about all gay men with HIV will have abnormal cells and the natural history of those abnormal cells is still not understood enough really so we don’t know what to do once we’ve found those abnormal cells (M, General Practice, 22 YiHP)
…one of the problems is that the current guidelines that we have in Australia don’t recommend any form of anal cancer screening (M, General Practice, 23 YiHP).…screening tests require a much higher level of evidence than even treatment studies (M, Sexual Health, 34 YiHP)
Views on DARE
…probably best practice (M, Immunologist, 30 YiHP)…reasonable thing to do (F, Infectious Disease, 23 YiHP)…correct means by which we should be screening… should be embraced (M, General Practice, 30 YiHP)…sensible, cheap and easy thing to do (F, Immunologist, 5 YiHP),…it’s going to pick up lumps that may well be early cancers and I guess that’s where the efforts should be made, really (M, General practice, 22 YiHP)
…I do it very rarely unless someone has symptoms (M, Infectious Disease, 5 YiHP)
Systems factors | Lack of opportunity |
Unclear referral pathway | |
Differences in HIV care practices | |
No financial incentives | |
Health provider factors | Lack of evidence |
Difficulty discussing with patients | |
Lack of confidence in DARE | |
Patient factors | DARE discomfort |
Low anal cancer risk awareness |
…now we’re getting people to self-collect all of the specimens at sexual health screens which I think is terrible because it means that often nobody looks (M, General practice, 23 YiHP)
…often when you're time poor and there’s other more pressing issues that the patient wants to discuss… [DARE] may be something that gets missed (M, Sexual health, 15 YiHP)
…it’s just one more thing that needs to be done in too little amount of time (M, GP, 30 YiHP)…it’s only once a year. Your average consultation now with a HIV patient is nowhere near as cluttered as it was 10 years ago… so it [DARE] wouldn’t be that big an intrusion. It would add a minute or two to the consultation (M, Sexual health, 34 YiHP)
…where does that responsibility - who does it lie with? I guess for some people they potentially would fall through the cracks in the system in that we’d say it was the GPs and the GP would say it was ours (F, Sexual health, 25 YiHP)
…being a sexual health physician we don’t mind looking at bums at all… That could be quite different in a hospital outpatient environment for instance… ID clinics, as you know, have always avoided going anywhere near the genitalia (M, Sexual health, 34 YiHP)
…GPs won’t do it because there’s no money in it… if you’ve got to spend two or three minutes getting somebody undressed and doing an exam and then explaining their result then that’s time that the GPs won’t want to spend (M, Immunologist, 24 YiHP)
…everybody would need to be convinced that the evidence was strong enough (M, Immunologist, 24 YiHP)
…I must admit it’s not easy for me to bring that one up (F, General practice, 19 YiHP)…feel awkward in raising the issue (M, Immunologist, 24 YiHP)
…people don’t like to think and talk about it [anal cancer]… you have to wait until patients become symptomatic and not embarrassed to talk about it or show you before it can get diagnosed (F, Immunologist, 5 YiHP)…A lot of patients feel it’s a bit of an invasion (M, General practice, 30 YiHP)…there have been a few patients where they’ve said ‘oh look I haven’t prepared for that sort of examination’… the patient had some fears about not being clean (M, General practice, 29 YiHP)
…there’s kind of a relationship builds up which is - it kind of almost an intimate friendship to some extent… almost it’s like being an aunt or an older sister… and you don’t let aunts and older sisters examine your backside comfortably (F, Infectious disease, 23 YiHP)
…I think the vast majority wouldn’t know that [anal cancer is] something that they’re particularly at risk of (M, General practice, 22 YiHP)
Attitude towards early cancer detection using self- and partner-examination
…often patients do present because they’ve felt a lump (M, General Practice, 29 YiHP)…quite a lot of patients I’ve looked after are quite adept at examining their perianal region (F, Infectious Disease, 23 YiHP)
…it definitely gives the patient some responsibility for their own health which I think is definitely worth it (F, Sexual Health, 15 YiHP)…it’s probably a bit like breast cancer screening… that if they find a lump that’s a good thing if they tell us about that before we find it in them (M, Infectious Disease, 5 YiHP)
…I don’t think the majority would to do it regularly and actually report back findings… There’s been campaigns to get men to do testicular self-examination. By and large not even that happens (M, Immunologist, 30 YiHP)…[The anus is] not the easiest place to self-examine (M, Sexual Health, 22 YiHP)…they don’t know what they’re feeling and they haven’t had the chance to be trained (M, Immunologist, 24 YiHP)
…plenty of boys do, as part of foreplay, stick their fingers in each other’s butts and are probably fairly familiar with what they feel (M, General Practice, 30 YiHP)
…putting the responsibility on to the partner for the screening. I don’t think that’s appropriate’ (F, Sexual Health, 14 YiHP).
…it’s not very romantic to have your partner do it too often I think. Well you’d need a very good friend at least’ (M, Sexual Health, 22 YiHP)