Factors impacting HIV testing: a review – perspectives from Australia, Canada, and the UK

Abstract

With the current global focus on strengthening HIV prevention through greater testing and treatment uptake, it is increasingly salient to identify and address barriers to testing. A review of the published, peer-reviewed literature and national reports from Australia, Canada, and the UK (2003-2013) on barriers to HIV testing was conducted to provide new information relevant to Australia and to complement earlier reviews from Canada and the UK. A systematic database search using keywords and a set of inclusion criteria yielded 36 studies (Australia = 13; Canada = 6; and the UK = 17). In addition 17 unpublished reports were included in the review. Our study uses a novel, comprehensive framework to describe barriers to HIV testing, and thus contributes to moving beyond the traditional patient-provider-system categorization. Within that framework, barriers are categorized as either intrapersonal (reported in 15 studies), interpersonal (21), or extrapersonal (16) and conceptualized within wider sociocultural and structural contexts. People's abilities and motivations to test (intrapersonal factors) are influenced by a host of interconnected factors spanning relationship (interpersonal) and broader socioeconomic, political and cultural (extrapersonal) factors. We suggest that the relative effects of interventions targeting barriers to HIV testing at the intrapersonal and interpersonal levels are limited by the extent to which the social determinants of health are addressed. The framework may also lend itself to thinking about the enabling factors for HIV testing, and future research may investigate the application of that framework for strategizing the most effective response. Future studies should also capture the lived experiences of barriers to HIV testing experienced by patients, especially in populations which are hard to reach based on social and geographic distance. Context-specific studies to evaluate the feasibility and effectiveness of various interventions proposed in the literature to address barriers to HIV testing are needed.

Criminalization of HIV Exposure: A Review of Empirical Studies in the United States

“…Yet seeking or accepting an HIV test is an exceptionally complex behavior which is influenced by a variety of factors not related to the criminalization of HIV exposure (50, 51). The complexity of the behavior and the number of factors that likely influence it may account for why studies that examined the influence of the criminalization of HIV exposure on the HIV testing behaviors of persons at risk for HIV infection found little evidence to suggest that concerns about the criminalization of HIV exposure deter testing.…”

Increasing HIV testing among hard-to-reach groups: examination of RAPID, a community-based testing service in Queensland, Australia

“…Over the last decade, some countries have seen an increase in HIV testing rates [6], but within Australia rates have remained relatively constant with less than two-thirds of gay men meeting current minimum recommendations to test every 12 months [7]. Beyond gay communities, rates of HIV testing among groups that have traditionally been hard-to-reach with conventional venepuncture testing [8], including young people and people from culturally and linguistically diverse backgrounds, are largely unknown [9]. …”

“…Many barriers undermine the uptake of HIV testing at both the individual (e.g., fear, stigma, perceptions of risk, embarrassment in talking with health professionals) and health service level (e.g., testing location, wait time for results, cost) [8, 10–13]. In response, researchers and service providers have introduced and evaluated innovative approaches and strategies designed to facilitate access to testing.…”

“…In response, researchers and service providers have introduced and evaluated innovative approaches and strategies designed to facilitate access to testing. These include the adoption of rapid HIV testing (RHT) technology, use of community and outreach settings for testing, use of peer services, and establishing testing services that do not require the disclosure of sexual history [8, 10, 14]. The following paper reports on the implementation of ‘RAPID’, a novel RHT program developed in Queensland, Australia that has employed a mix of the above-mentioned strategies to increase access to HIV testing.…”

Low HIV testing rate and its correlates among men who inject drugs in Iran

“…Despite available free HIV testing services for PWID, socio-cultural and structural barriers to scaling up HIV testing continue to exist and mitigate their likelihood of getting tested. Anticipation of HIV stigma, fear of being tested positive followed by its impact on PWID's relationships, loss of privacy, and low perceived risk have been reported as some of these barriers across various settings (Bolsewicz, Vallely, Debattista, Whittaker, & Fitzgerald, 2015;Tobin, Tang, Gilbert, & Latkin, 2004).…”