Anonymous versus Confidential HIV Testing: Client and Provider Decision Making under Uncertainty

Abstract

Six intensive observational studies of HIV testing sites were undertaken in order to improve understanding of confidential and anonymous testing. Three sites offered only confidential testing (a large health maintenance organization's Urgent Care clinic, the same organization's HIV clinic, and a private medical practitioner's office), one offered only anonymous testing (a free clinic), and two offered a choice of confidential or anonymous testing (a thrift shop alternate testing site and a mobile testing unit). Multiple data collection strategies were used including direct field observation, semistructured interviews with clients and providers, and document and policy analysis. Using an organizational/interactional uncertainty framework, this study found that the choice between anonymous and confidential testing is a central aspect of the HIV testing process, that some clients are unclear about the differences between anonymous and confidential testing, that alternate testing sites' providers play a significant role in encouraging confidential rather than anonymous testing in order to further their organization's resource needs and public health goals, and that testing counselors' may consider that some clients prefer anonymous testing because of fear of stigma, discrimination, or loss of privacy.

A mixed methods study of non-occupational post-exposure prophylaxis at an STI clinic in Singapore: Five-year retrospective analysis and providers' perspectives

“…Preference for anonymous HIV-testing over sequential testing at DSC Clinic is further fortified by consequences of reporting HIV status to health authorities, and pertinence of HIV stigma and discrimination locally. [ 22 , 23 ] Nevertheless, the follow-up rate has improved from a previous audit (34%)[ 6 ] conducted in 2010 and this could be attributed to a larger sample size and a higher proportion of residents, employment and student pass holders (resides in Singapore for an extended period) who were prescribed with nPEP in this study. The misconception about a treatment’s efficacy was identified by IDI participants as a barrier and this underscored the importance of counseling and education.…”

Evaluation of the Relative Effectiveness of Three HIV Testing Strategies Targeting African American Men Who Have Sex with Men (MSM) in New York City

“…Numerous explanations for not being tested have been proposed and include the belief that one is not at risk for HIV [7], a general fear of testing results [8,9], fear of stigmatization [10][11][12], misunderstanding about test result reporting [8,13], lack of HIV/AIDS-related knowledge [9], distrust in the accuracy of testing [9], mistrust of the medical system [14], and lack of culturally appropriate testing strategies [9,10,14]. As a result, a variety of strategies have been developed to identify previously undiagnosed African American MSM.…”

Provision of Test Results and Posttest Counseling at STD Clinics in 24 Health Departments: U.S., 2007

“…29 In a study assessing anonymous and confidential testing, counselors commonly urge clients to test confidentially because it gives staff members the means to contact clients regarding test results and linkage to care. 30 Furthermore, Grusky and colleagues found that some counselors tried to convert anonymous, HIV-positive clients to confidential testing if they had a preliminary HIV-positive rapid test. When clients refused to be converted, several respondents explained that they used various unofficial means to keep in touch with the clients.…”