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.

Keywords: Barriers; Delivery of health care; HIV; Health knowledge, attitudes, practice; Screening.

Figure 1

Patient Rated Significance of Barriers to HIV Testing *Patients were asked to rate the importance of each barrier to HIV testing, with higher scores indicating a more hindering barrier.

Figure 2

Perceived Barriers to HIV Testing as Ranked by Providers *Providers were asked to rank patient barriers to HIV testing on a scale from one to eight, with lower scores indicating the most hindering barrier.