Do physicians provide counseling with HIV and STD testing at physician offices or hospital outpatient departments?

To estimate the frequency of HIV/sexually transmitted disease (STD) counseling among patients tested for HIV or STD infection at physician offices and hospital outpatient departments and to describe the factors associated with HIV/STD counseling in private settings in the USA. Cross-sectional study of patients served by physicians in private settings in the USA. We analyzed 1997-1998 data from two representative national surveys of ambulatory care visits in private settings by persons aged 18-64 years. During 1997-1998, 12.7 million ambulatory care visits included HIV or STD testing. HIV/STD counseling was documented in 35% of all visits and in 28% of visits by pregnant women at the time HIV or STD tests were done. Counseling was less common when only HIV tests (21%) or STD tests (37%) alone were carried out than when both HIV and STD tests (50%) were performed. Counseling was more common (65%) if the patient's reason for visit was related to HIV, STD, or genitourinary complaints than if the visit was for other reasons. Private physicians often counseled about HIV/STD when testing patients with symptoms. The proportion of other visits in which counseling accompanied HIV or STD tests was variable. This suggests the need for a better understanding of the reasons why clinicians in private settings decide whether to counsel patients about HIV and STD when they order testing, barriers to offering counseling, and interventions to increase counseling when appropriate.