Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South

Abstract

Although CDC guidelines call for universal, "opt-out" HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of "opt-out" HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (N=250) and qualitative data from providers (N=10) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of "opt-out" HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.

<p>A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction</p>

“…[26][27][28][29][30][31][32][33] HIVST is particularly relevant for stigmatized populations as it provides individuals with increased privacy and greater control over their testing needs. 34 The option to test privately at times and locations of choice creates the opportunity to reduce stigma, a significant barrier for MSM, [35][36][37][38][39] BMSM, 36,[39][40][41][42] sex workers, 43,44 prisoners, 45,46 and transgender women. 37,39,47 There is also evidence that HIVST may be acceptable for partner-testing by MSM 48 and transgender women 49 including transgender female sex workers.…”

“… 23 However, given barriers to care experienced by key populations including stigma, lack of access, and outreach that does not fully meet the needs of vulnerable and oppressed key populations, HIVST is an important option for empowering potential users to learn their HIV status in ways most responsive to their needs. 41 , 42 Additionally, HIVST can decrease harm to participants, either directly, such as by reducing potential for intimate partner violence, or indirectly, by reducing stigma. HIVST, therefore, is consistent with the harm reduction model of care because it (1) aims to improve health outcomes by decreasing harm but not necessarily eliminating it and (2) is patient-centered and prioritizes the need, context, and autonomy of the patient.…”

Utilizing Alternative Testing Technology for Human Immunodeficiency Virus (HIV) in the COVID era

“…There are two CDC-approved forms of HIV testing: traditional in-person testing at a designated clinic or at a primary care appointment, and novel at-home testing. Traditional barriers to in-person testing include access to testing services, the cost of test, and wait time [ 6 , 9 – 12 ]. These barriers were considered in the Federal Drug Administration (FDA) decision to approve the OraQuick® In-Home HIV Test in 2012.…”

Awareness and Attitudes Toward HIV Self-Testing in Northern Thailand

“…Previous studies have identi ed many barriers to HIV testing at the patient, health care provider, and institutional levels. These barriers include perception of HIV risk, fear and stigma related to HIV, accessibility to HIV services, and human and nancial resources for delivering HIV services (3)(4)(5)(6)(7)(8)(9).…”