Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men

J Acquir Immune Defic Syndr. 2003 Mar 1;32(3):318-27. doi: 10.1097/00126334-200303010-00012.


Objective: To determine strategies to overcome barriers to HIV testing among persons at risk.

Methods: We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic.

Results: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing.

Conclusions: Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Counseling
  • Female
  • Focus Groups
  • Guidelines as Topic
  • HIV Infections / diagnosis
  • HIV Infections / prevention & control*
  • Health Care Surveys*
  • Health Knowledge, Attitudes, Practice
  • Homosexuality, Male
  • Humans
  • Male
  • Middle Aged
  • Needle-Exchange Programs
  • Patient Acceptance of Health Care*
  • Sexually Transmitted Diseases, Viral / diagnosis*
  • Washington