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

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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.

Resumen

Aunque las pautas de la CDC recomiendan pruebas de VIH universales y de “exclusión voluntaria”, las barreras a dichas pruebas continúan existiendo en todo Estados Unidos, siendo el sur rural particularmente vulnerable a la infección por VIH y a un menor conocimiento de las condiciones vigentes. Por lo tanto, los objetivos de este estudio fueron evaluar la aceptación de las pruebas de VIH de “exclusión voluntaria” y las barreras que existen a dichas pruebas en el entorno de atención de la salud primaria en el sur. Un diseño de triangulación concurrente guio la recopilación de datos cuantitativos de pacientes (N = 250) y datos cualitativos de proveedores (N = 10) en tres clínicas de salud primaria en Alabama. Descubrimos que el 30% de los pacientes nunca habían sido evaluados para detectar el VIH, y que la barrera más alta entre los pacientes es la percepción de los costos, el acceso a la atención especializada y el no sentirse en riesgo. Existen diferencias significativas en la percepción de las barreras entre los pacientes y los proveedores. Tanto una mayor interacción entre proveedores y pacientes, así como la implementación rutinaria de las pruebas de VIH de “exclusión voluntaria” revelarían y mitigarían de manera efectiva las barreras a las pruebas, aumentando así el conocimiento de las condiciones vigentes.

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Acknowledgements

This research was supported by the University of Alabama at Birmingham (UAB) Center For AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, NIDCR and OAR; and the National Institutes of Health (NIH), National Institute on Minority Health and Health Disparities (NIMHD), Gulf States Health Policy grant (U54MD008602).

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Authors and Affiliations

  1. School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 573H Nursing Building, Birmingham, AL, 35294, USA

    Jenni M. Wise, Corilyn Ott, Andres Azuero, David E. Vance & Mirjam-Colette Kempf

  2. Division of Infections Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Corilyn Ott & Mirjam-Colette Kempf

  3. Department of Behavior Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Robin Gaines Lanzi, Susan Davies & Mirjam-Colette Kempf

  4. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Mirjam-Colette Kempf

  5. School of Nursing, Troy University, Troy, AL, USA

    Andrea Gardner

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Correspondence to Mirjam-Colette Kempf.

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Wise, J.M., Ott, C., Azuero, A. et al. Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South. AIDS Behav 23, 1062–1072 (2019). https://doi.org/10.1007/s10461-018-02385-5

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