Opt-out testing for stigmatized diseases: a social psychological approach to understanding the potential effect of recommendations for routine HIV testing

Health Psychol. 2009 Nov;28(6):675-81. doi: 10.1037/a0016395.


Objective: Little research has studied experimentally whether an opt-out policy will increase testing rates or whether this strategy is especially effective in the case of stigmatized diseases such as HIV.

Design and main outcome measures: In Study 1, a 2 x 2 factorial design asked participants to make moral judgments about a person's decision to test for stigmatized diseases under an opt-in versus an opt-out policy. In Study 2, a 2 x 2 factorial design measuring testing rates explored whether opt-out methods reduce stigma and increase testing for stigmatized diseases.

Results: Study 1 results suggest that getting tested draws suspicion regarding moral conduct in an opt-in system, whereas not getting tested draws suspicion in an opt-out system. Study 2 results suggest that an opt-out policy may increase testing rates for stigmatized diseases and lessen the effects of stigma in people's reluctance to test.

Discussion: A social psychological approach to health services can be used to show how testing policies can influence both the stigmatization associated with testing and participation rates. An understanding of how testing policies may affect patient decision making and behavior is imperative for creating effective testing policies.

MeSH terms

  • Adolescent
  • Adult
  • Centers for Disease Control and Prevention, U.S.
  • Decision Making
  • Female
  • HIV Seropositivity / diagnosis*
  • Humans
  • Judgment
  • Male
  • Mass Screening / statistics & numerical data*
  • Organizational Policy
  • Patient Acceptance of Health Care / psychology*
  • Stereotyping*
  • United States
  • Young Adult