Evaluating the Accessibility of HIV Testing Organizations

Using the Lifeworld Approach to Improve HIV Testing

Major guidelines for HIV recommend that testing should be provided in a way that is adapted to the lifeworld of groups at risk. However, precise definitions as to what adaption to the lifeworld means are missing. Therefore, this research project evaluated how the lifeworld approach can be operationalized in regard to HIV testing and how voluntary counseling and testing services can use this approach to improve efficacy. A survey for VCT providers in Germany showed a limited number of factors influencing the adaption to the lifeworld of groups at risk. The opening hours, the number of languages used in public relations, and the comfort of the waiting zone are important for all clients. For men who have sex with men, information material for use in social networks and peer volunteers are relevant. Intravenous drug users are concerned with participation, (low) costs, and counseling. For migrants, continuing staff training and anonymity are important.

Attitude toward rapid HIV testing in a dental school clinic

Detection of HIV infection provides an opportunity for transmission reduction and lifesaving treatment strategies. This study examined patients' willingness to take a routine, rapid oral HIV test if offered at a dental school clinic. For fifteen days in 2011, an anonymous survey containing demographic information and willingness to be tested questions was offered to all patients awaiting treatment. A total of 383 of 443 people approached, answered the questionnaire (40.2% Hispanic, 27.2% Caucasian, and 19.3% African American) with 58.8% indicating that they had been previously tested for HIV (as compared to the California mean of 39.2%). Patients were highly likely to participate (84.0% of Hispanics, 63.6% of Caucasians, 80.0% of African Americans and 66.7% of Asians) in a free HIV rapid test when given the opportunity. Of respondents never tested before, 62.6% reported a willingness to be tested in this study. HIV screening in a dental clinic during routine visits may allow new undiagnosed cases to be detected with subsequent referral into medical treatment.

HIV testing sites' communication about adolescent confidentiality: potential barriers and facilitators to testing

PURPOSE

This study sought to evaluate HIV testing locations in New York City in terms of staff communication of confidentiality policies for adolescent clients.

METHOD

Using the New York State Directory of HIV Counseling and Testing Resources as a sampling frame, this study made telephone contact with 164 public HIV testing locations in New York City and used a semistructured interview to ask questions about confidentiality, parental permission, and parent access to test results.

RESULTS

At 48% of locations, either HIV testing was not offered or we were unable to reach a staff member to ask questions about testing options and confidentiality. At the remaining sites, information provided regarding confidentiality, parental consent, and privacy of test results was correct only 69% to 85% of the time. Additionally, 23% of sites successfully contacted offered testing exclusively between 9:00 a.m. and 3:00 p.m. weekdays, when most adolescents are in school.

CONCLUSIONS

Our findings point to a need for increased training and quality control at the clinical level to ensure that consumers in need of HIV testing are provided with accurate information and accessible services. Furthermore, these results highlight the need for more "patient-centric" sites with enhanced accessibility for potential clients, particularly youth.

Sisters empowered, sisters aware: three strategies to recruit African American women for HIV testing

African American women account for 66% of new HIV infections among U.S. women, and many are not aware of their status. The authors compared three strategies (targeted outreach, alternate venues, and social networks) to recruit African American women for HIV testing in Houston, New York City, Baltimore, and Dayton. A quasi-experimental design (N = 4,942) was used to compare HIV-positivity rates and to identify risk factors for previously undiagnosed infection. A total of 2.1% of the women were newly diagnosed with HIV. The proportion newly identified as HIV-positive did not differ significantly among the three strategies (2.4% for social networks, 1.7% for both targeted outreach and alternate venues). However, the social networks strategy recruited women with greater risk behaviors and other characteristics associated with newly identified HIV infection and thus may be effective at reaching some high-risk women before they become infected. A combination of recruitment strategies may be warranted to reach various subgroups of African American women at risk for HIV.

Self-reported HIV antibody testing among Latino urban day laborers

OBJECTIVE

To identify the characteristics of male Latino urban day laborers who self-report having tested for human immunodeficiency virus (HIV).

METHODS

A cross-sectional survey was conducted with 356 Latino day laborers, aged 18 to 40 years, who had been sexually active in the previous 12 months, from 6 day labor sites in the City of Los Angeles.

RESULTS

Most of the men were single, mainly from Mexico and Guatemala, and had been employed as a day laborer for fewer than 3 years; 38% had an annual income of $4000 or less. Ninety-two percent of the men reported having sex with women only, and 8% reported a history of having sex with men and women. Forty-six percent had received an HIV test in the previous 12 months and 1 person tested positive. In univariate logistic regression analyses, day laborers who were aged 26 years or older, had more than 3 years in the United States, had more than 1 year but fewer than 5 years employed as a day laborer, and had annual incomes greater than $4000 were significantly more likely to self-report HIV testing in the previous 12 months. In a multivariate logistic regression analysis, only higher annual income was found to be significantly associated with self-reported HIV testing.

DISCUSSION

Interventions that target lower-income Latino day laborers are needed to promote early HIV detection. HIV detection offers individual benefits through treatment, with decreased morbidity and mortality, as well as public health benefits through decreased rates of HIV transmission in the community.

Distance to public test sites and HIV testing

This article examines how proximity to the nearest publicly funded test site affects HIV testing. Using a sample of 5,361 Los Angeles County adults, multinomial logit models estimated simultaneously the likelihood of (1) obtaining an HIV test in the prior 2 years, and (2) testing in a private physician's office, a publicly funded medical clinic, or in a nonmedical setting, such as a bar or bathhouse. Low-income Los Angeles residents rely on publicly funded sites for HIV testing. When public sites are more distant, poor individuals are less likely to use them and less likely to get tested. Distance from public sites does not affect HIV testing among the nonpoor. To encourage HIV testing among the groups where HIV is growing fastest, public health agencies must keep the time and money costs of HIV testing low.

HIV/AIDS: testing and risk behaviors among British Columbia's rural Aboriginal population

OBJECTIVES

Over the last decade, there has been growing concern in the public health sector over the spread of Human Immunodeficiency Virus (HIV) in Canada's Aboriginal population. However, there continues to be a general lack of HIV awareness and its risk factors in Aboriginal communities.

STUDY DESIGN AND METHODS

This study investigated HIV testing patterns, perceptions and risk factors within 7 community organizations through the use of face-to-face interviews. The objectives of this research project were to 1) describe the prevalence of HIV testing; 2) describe issues concerning confidentiality related to the HIV testing; 3) identify the prevalence of risk factors for HIV transmission; and, 4) build research capacity in the Aboriginal community.

RESULTS

Two hundred and nineteen Aboriginal persons participated in interviews. Off-reserve residents (pOR: 0.48, 95% CI: 0.29 - 0.80) were significantly more likely to use illicit drugs than reserve residents. Sixty percent of participants had reported undergoing HIV testing at some point. Two-spirited participants (pOR: 16.1, 95% CI: 2.13-121.06), those who previously tested for a Sexually Transmitted Disease (pOR: 2.94, 95% CI: 1.73-4.98), those currently using cocaine (pOR: 3.88, 95% CI: 1.25 - 12.0), and those who reported to "never", or "some of the time" use clean needles (pOR: 11.0, 95% CI: 1.36- 88.66) were significantly more likely to undergoing HIV testing. On-reserve residents (pOR: 0.55, 95% CI: 0.35-0.87) and respondents older than 40 years of age (pOR: 0.40, 95% CI: 0.19 - 0.86) were less likely to undergo HIV testing.

CONCLUSIONS

Participants with HIV risk factors are more likely to be tested for HIV in rural areas and confidentiality issues were not a barrier to testing for most participants. Off-reserve residents were more likely to undergo HIV testing, the reasons for which require additional research. Finally, public health units are often under-utilized as locations to seek testing.

Anonymous versus confidential HIV testing: client and provider decision making under uncertainty

Six intensive observational studies of HIV testing sites were undertaken in order to improve understanding of confidential and anonymous testing. Three sites offered only confidential testing (a large health maintenance organization's Urgent Care clinic, the same organization's HIV clinic, and a private medical practitioner's office), one offered only anonymous testing (a free clinic), and two offered a choice of confidential or anonymous testing (a thrift shop alternate testing site and a mobile testing unit). Multiple data collection strategies were used including direct field observation, semistructured interviews with clients and providers, and document and policy analysis. Using an organizational/interactional uncertainty framework, this study found that the choice between anonymous and confidential testing is a central aspect of the HIV testing process, that some clients are unclear about the differences between anonymous and confidential testing, that alternate testing sites' providers play a significant role in encouraging confidential rather than anonymous testing in order to further their organization's resource needs and public health goals, and that testing counselors' may consider that some clients prefer anonymous testing because of fear of stigma, discrimination, or loss of privacy.