There are physicians from many medical specialties--primary care physicians such as family practitioners, internists, and specialists in infectious diseases, pulmonary medicine, and cancer medicine--who care for people infected with HIV or those suffering from AIDS. Physicians who treat AIDS patients often perform a wide variety of services besides providing care to AIDS patients. Many are also AIDS activists and may be involved in developing policies, planning for care needs, and dealing with the media.

One challenge in the training of physicians to treat AIDS patients is that AIDS care requires skills and training in the multitude of conditions known to be part of HIV/AIDS. However, the amount of experience--rather than the kind of training--may be a better predictor of the quality of care the physician is able to deliver.

Mari M. Kitahata et al., in ''Physicians' Experience with the Acquired Immunodeficiency Syndrome as a Factor in Patients' Survival'' (New England Journal of Medicine, vol. 334, no. 11, March 14, 1996), claim that AIDS patients treated by primary care physicians with no previous experience dealing with the disease died more than a year earlier than those whose doctors had treated at least five AIDS patients. The study also shows that patients had a 43% decrease in relative risk of death at any given time when treated by a physician who had treated other AIDS patients. The difference, according to Kitahata et al., was that the more experienced physicians consulted more frequently with specialists and reported more visits with their AIDS patients. Since 1996 Kitahata et al.'s findings have been verified by further research, such as William E. Cunningham et al.'s ''The Effect of Hospital Experience on Mortality among Patients Hospitalized with Acquired Immunodeficiency Syndrome in California'' (American Journal of Medicine, vol. 107, no. 2, August 1999) and Mari M. Kitahata et al.'s ''Primary Care Delivery Is Associated with Greater Physician Experience and Improved Survival among Persons with AIDS'' (Journal of General Internal Medicine, vol. 18, no. 2, February 2003).

There is also a continuing debate about the types of physicians who should treat patients with complex chronic medical conditions such as HIV infection. In ''Physician Specialization and the Quality of Care for Human Immunodeficiency Virus Infection'' (Archives of Internal Medicine, vol. 165, no. 10, May 23, 2005), Bruce E. Landon et al. describe the results of their research to assess the relationship between specialty training and expertise and the quality of care delivered to patients with HIV infection. The investigators looked at 5,247 patients of 177 physicians who responded to a survey. Forty-two percent of the physicians were infectious diseases specialists and 58% were general medicine physicians (primary care physicians who are often called generalists). Nearly two-thirds of the generalists (63% of the generalists and 37% overall) considered themselves expert in HIV care. An analysis of the data Landon et al. collected reveals that infectious diseases physicians and generalists who considered themselves expert in HIV-care had performed similarly. In contrast, nonexpert generalists delivered lower-quality care. Landon et al. posit that their findings reconfirm the premise that ''generalists with appropriate experience and expertise in HIV care can provide high-quality care to patients with this complex chronic illness.''

The AIDS epidemic began at a time when many newly graduated physicians were not choosing primary care specialties such as internal medicine, the most fitting for the ongoing care required by HIV-infected patients. Some observers feared that new physicians would avoid practicing in geographic areas where there were large proportions of HIV/AIDS patients.

Fortunately, the Centers for Disease Control and Prevention (CDC) finds that most primary care doctors believe that they have an obligation to care for HIV-infected patients and are interested in further professional training to help increase their skill and comfort in caring for HIV/ AIDS patients. Among physicians who report they do not provide care to AIDS patients, the majority cite a lack of experience with HIV and note that providers with more expertise are readily available in their communities.

The effect of HIV/AIDS on nurses can be more difficult to assess than its effect on doctors. Nurses often have different viewpoints than some physicians about their professional obligations to patients with HIV. As hospital employees, nurses seldom have the option of choosing whether to treat a particular patient (nor do patients have much choice of nurses). Nurses, however, report that caring for HIV/AIDS patients can take an enormous emotional toll because they are often the primary source of continuous physical and emotional care for these patients, who generally require more intensive care and services than other patients.

Nurses, physicians, and other health-care professionals must cope with more than simply their fears of contracting the disease from HIV/AIDS patients and keeping abreast of advances in the treatment of the disease. They also face a wide range of emotional issues when caring for these patients, from feelings of failure when treatment is unsuccessful to grief when witnessing the untimely deaths of patients. Support groups and counselors help many health professionals, especially hospice workers, to share and understand these feelings so they are better able to care for HIV/AIDS patients and their families.

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