LETTERS TO THE EDITOR

Pharmacy Education about HIV and Condoms Most Americans know that condoms can reduce the risk of HIV infection but many do not know which types of condoms are most effective. Because pharmacies are by far the most significant retailer of condoms, which are critical for safer sex and HIV prevention, they offer an important potential source of education about their use and effectiveness. Condoms probably can prevent transmission of HIV,1,2 but naturalmembrane condoms may be less effective than latex condoms because of their permeability and inconsistent quality. Petroleum-based lubricants can weaken latex condoms, but nonoxynol-9, a condom lubricant and spermicide, appears to inactivate HIV.2 It is important to educate sexually active individuals about these differences. We randomly selected 14 independent and 10 chain pharmacies in the Boston, Massachusetts area and conducted a pilot study to evaluate whether they provided accurate information about HIV infection and condom use. At each study pharmacy, we asked the pharmacist or assistant questions regarding HIV prevention and the use of condoms and recorded information about the way condoms were displayed and the availability of information about HIV infection. All of the pharmacists said that condoms could help prevent the transmission of AIDS: only 63 percent (15) said that latex were better than naturalmembrane condoms; 29 percent (7) said that there was no difference; and one said natural-membrane condoms were stronger, Twenty-two knew that nonoxynol-9 was a spermicide, but a majority (19) said that spermicides could not reduce the risk of transmitting AIDS, and none spontaneously mentioned the potential anti-HIV effects of nonoxynol-9. Twenty pharmacists displayed condoms openly, but none provided literature on HIV infection, AIDS, or safer sex. When asked about written information, 10 pharmacists referred to the package insert and 13 said they had none. Seven pharmacists could not refer the interviewer to additional sources of information and three again mentioned the packet insert. Three pharmacists suggested talking to a doctor. Other pharmacies could be better sources of information. However, given AJPH November 1990, Vol. 80, No. 11

that the medical community in Boston is attuned to HIV-related issues, we think that many pharmacies in other regions of the country, as well as in Boston, would fail to provide accurate information. Pharmacists are a respected source of health information, and the inability of many to answer basic questions about condom use and to provide written information was disconcerting. We suggest that pharmacists take a much more active role in developing and disseminating information about HIV infection and prevention. REFERENCES 1. Ranki A, Valle S, Krohn M, et al: Long latency precedes overt seroconversion in sexually transmitted human-immunodeficiency-virus infection. Lancet 1987; 2:589-593. 2. Feldblum PJ, Fortney JA: Condoms, spermicides, and the transmission of human immunodeficiency virus: A review of the literature. Am J Public Health 1988; 78:52-54. Paul D. Cleary, PhD Allan M. Brandt, PhD Larry 0. Gostin, JD Kenneth Mayer, PhD Faculty, Harvard Medical School, Department of Health Care Policy, Boston, MA 02115 Terri Ronna Michele Costanzo Pre-med students at Harvard

© 1990 American Journal of Public Health

Decline in NHSC Physicians Threatens Patient Care The National Health Service Corps (NHSC) was created in 1970 (Public Law 91-623). According to its Congressional mandate its purpose was to provide "health manpower resources to those areas, populations, and facilities of greatest need, whether urban or rural, which cannot otherwise recruit and retain health care providers." I The NHSC Scholarship Program began in 1972 to provide a source of physicians for the NHSC. Medical students accepted into this program incurred a year-for-year service obligation (minimum of two years) at a health care site in a Health Manpower Shortage Area for each year of scholarship received. The Scholarship Program experienced a rapid increase and then decline in funding largely as a result of predictions of physician over-supply and a subsequent diffusion effect.2 As a result ofthe decline in students awarded scholarships, the field strength of the NHSC experienced a similar decline. End of year field strength for the

NHSC reached a high of 3,304 in 1986. The 1990 field strength estimate is 900 and, if there is no increase in the supply of NHSC physicions, will drop to 200 doctors by 1992.3,4 To study the effect this decline in the physician pipeline will have on access to care for patients at sites to which NHSC physicians are assigned, we surveyed all NHSC physicians completing their obligated service in 1989 (n=8 10). Of the respondents (n=401), only 33 percent indicated they were planning to stay in the NHSC after completing their obligations, 74 percent believed that the decreased number of NHSC doctors in the pipeline would threaten the existence of their site, and 51 percent reported there would be no access to clinic sites or doctors within a 25-30 mile drive if their site closed. Hospital emergency rooms and inaccessible private practices were listed as the two primary sources of care to which patients would have to turn if the NHSC site closed. Although the response rate (50 percent) was low, and we were not able to compare survey respondents to non-respondents, we feel our results indicate that little diffusion effect has occurred in communities with NHSC physicians and that access to care for patients at NHSC sites will be seriously impaired by the decline in the physician

pipeline.

Given these findings, we recommend several policy changes: * Funding for the NHSC should be increased; these resources provide program support money, staff salaries, supplies, and other resources at sites with NHSC

physicians.

* The NHSC Scholarship Program should be re-expanded as a source of physicians for the NHSC. * Efforts to increase NHSC physician retention should be renewed and concerns of physician employees in the NHSC should be addressed to prevent the "revolving-door" pattern of physician service which has characterized the NHSC in the past. The NHSC has played a pivotal role in the provision of health care services to indigent and uninsured people in the US. Re-authorization of the NHSC and its scholarship program will ensure access to care for those in health manpower shortage areas who depend on practice sites staffed by NHSC phy-

sicians.

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Pharmacy education about HIV and condoms.

LETTERS TO THE EDITOR Pharmacy Education about HIV and Condoms Most Americans know that condoms can reduce the risk of HIV infection but many do not...
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