Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing

Abstract

Late diagnosis of HIV is associated with increased morbidity, mortality, and health care costs. Despite the availability of HIV testing, persons continue to test late in the course of HIV infection. We used the HIV/AIDS case registry of San Francisco Department of Public Health to identify and recruit 41 persons who developed AIDS within 12 months of their HIV diagnosis to participate in a qualitative and quantitative interview regarding late diagnosis of HIV. Thirty-one of the participants were diagnosed with HIV because of symptomatic disease and 50% of the participants were diagnosed with HIV and AIDS concurrently. Half of the subjects had not been tested for HIV prior to diagnosis. Fear was the most frequently cited barrier to testing. Other barriers included being unaware of improved HIV treatment, free/low cost care, and risk for HIV. Recommendations for health care providers to increase early diagnosis of HIV include routine ascertainment of HIV risk behaviors and testing histories, stronger recommendations for patients to be tested, and incorporating testing into routine medical care. Public health messages to increase testing include publicizing that (1) effective, tolerable, and low cost/free care for HIV is readily available, (2) early diagnosis of HIV improves health outcomes, (3) HIV can be transmitted to persons who engage in unprotected oral and insertive anal sex and unprotected receptive anal intercourse without ejaculation and from HIV-infected persons whose infection is well-controlled with antiretroviral therapy, (4) persons who may be infected based upon these behaviors should be tested following exposure, (5) HIV testing information will be kept private, and (6) encouraging friends and family to get HIV tested is beneficial.

Effectiveness of the U.S. National HIV Testing Day Campaigns in Promoting HIV Testing: Evidence from CDC-Funded HIV Testing Sites, 2010

“…Schwarcz et al reported that fear was the most frequently cited barrier to testing, as was being unaware of improved HIV treatment and risk for HIV. 13 Mass media campaigns, often included as part of the NHTD activities, can help address these barriers. Studies that evaluated the effects of mass media campaigns have shown significant Public Health Reports / September-October 2014 / Volume 129 improvements in information-seeking for HIV testing among African American women, 14 hotline calls about and receipt of HIV testing among adolescents, 15 and recall of HIV testing-related campaign material and HIV testing at partner clinics among Latinos.…”

Predictors of Health-Seeking Behavior: HIV Test Experiences among Youth Aged 15-24 Years in Cameroon and Gabon

“…The HIV-negative people get updated information on the primary prevention from the pre-and post-test counseling and the HIV-positive people get the opportunity of accessing to the psychosocial support, linkage to care and treatment [2]. On the other hand, delay in diagnosis of HIV infection is the most substantial obstacle to accelerate HIV treatment and prevention and increases morbidity, mortality, and health care costs [9]. The main objectives of the Joint United Nations Program on HIV/AIDS (UNAIDS) are to make voluntary HIV testing services 90% accessible to help 90% of people living with HIV to know their status, especially young people and those living in a high HIV prevalent settings [10,11].…”

All Black People Are Not Alike: Differences in HIV Testing Patterns, Knowledge, and Experience of Stigma Between U.S.-Born and Non–U.S.-Born Blacks in Massachusetts

“…15,16 Barriers to HIV testing fall within several well-described categories: individual level concerns including fear of results, internal and external stigma attached to testing, anxiety waiting for results, lack of recognition of risk status, and low HIV knowledge; provider level barriers such as lack of funding, limited awareness of testing guidelines, and discomfort; and system related barriers such as limited availability of rapid testing. [17][18][19][20] Although data regarding black non-U.S.-born individuals and HIV testing is limited, data from Europe indicate that black immigrants (primarily from sub-Saharan Africa) experience many of the same barriers as native born individuals, including fear of positive test results and its related personal and social consequences, lack of preventive health behavior, and denial of HIV risk. HIVrelated stigma, language barriers, and low HIV knowledge are also common.…”