[HIV infection: survey among practicing physicians in Bern].

With increasing numbers of HIV-infected patients, practitioners will play a crucial role in the prevention of HIV infection and in the care of infected persons. To assess the need for accurate education programs we investigated by questionnaire the current practice, attitudes and knowledge of 1057 practitioners (general, internists, surgeons, dermatologists, gynecologists), on care, prevention and treatment of HIV infection and HIV-related problems in the Canton of Berne (population 1 million), Switzerland. 65% of the practitioners provided completely evaluable responses. More than 90% had already prescribed HIV tests by the end of 1989. A majority rejected routinely performed tests (e.g. for all pregnant women, for all patients before surgery). Only about 50% considered a patient's informed consent mandatory before each test. Primary prevention by sexual history-taking was only rarely done in current practice. All recommendations from the Swiss "Stop Aids" campaign were supported, and even experimental measures such as allowing i.v. drug use in street corner agencies or controlled distribution of heroin were supported by the majority. Mandatory testing of risk groups was favored by about 50% but almost nobody wanted to establish name records of persons with risk behaviour. By the end of 1989 about one third of practitioners regularly cared for HIV-infected persons. Most practitioners would prefer to care independently for asymptomatic HIV-infected persons, but would favor a specialist support when caring for symptomatic patients. Lack of medical skills and knowledge was the main reason for their reluctance in caring for patients. Skilled and experienced practitioners were more prone to care for additional patients and were more active in prevention. Knowledge about HIV transmission, HIV-related complications and treatment was good among general practitioners and internists. However, there was some confusion about the indications for active vaccination in Aids patients. The readiness of Bern practitioners to care for HIV-infected persons is already large and could be increased by improving their medical knowledge. However, it is unlikely that more medical information alone will improve their prevention activities. It appears that education programs aimed at improving the prevention activities of practitioners are best designed and performed by their skilled and experienced colleagues.