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Why don't physicians test for HIV? A review of the US literature

Burke, Ryan Ca,b; Sepkowitz, Kent Aa; Bernstein, Kyle Ta,c; Karpati, Adam Ma; Myers, Julie Ea; Tsoi, Benjamin Wa; Begier, Elizabeth Ma

doi: 10.1097/QAD.0b013e32823f91ff
Epidemiology and Social

Objective: In its 2006 HIV testing guidelines, the Centers for Disease Control and Prevention (CDC) recommended routine testing in all US medical settings. Given that many physicians do not routinely test for HIV, the objective of this study was to summarize our current understanding of why US physicians do not offer HIV testing.

Design: A comprehensive review of the published and unpublished literature on HIV testing barriers was conducted.

Methods: A literature search was conducted in Pubmed using defined search terms. Other sources included Google, recent conference abstracts, and experts in the field. Studies were divided into three categories: prenatal; emergency department; and other medical settings. These categories were chosen because of differences in physician training, practice environment, and patient populations. Barriers identified in these sources were summarized separately for the three practice settings and compared.

Results: Forty-one barriers were identified from 17 reports. Twenty-four barriers were named in the prenatal setting, 20 in the emergency department setting, and 23 in other medical settings. Eight barriers were identified in all three categories: insufficient time; burdensome consent process; lack of knowledge/training; lack of patient acceptance; pretest counselling requirements; competing priorities; and inadequate reimbursement.

Conclusion: US physicians experience many policy-based, logistical, and educational barriers to HIV testing. Although some barriers are exclusive to the practice setting studied, substantial overlap was found across practice settings. Some or all of these barriers must be addressed before the CDC recommendation for routine HIV testing can be realized in all US medical settings.

From the aNew York City Department of Health and Mental Hygiene, New York, New York, USA

bCouncil of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Atlanta, Georgia, USA

cNew York University School of Medicine, Department of Emergency Medicine, New York, New York, USA.

Received 5 January, 2007

Revised 11 April, 2007

Accepted 12 April, 2007

Correspondence to Ryan C. Burke, MPH, New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 346 Broadway, Room 706, CN44, New York, NY 10013, USA. Tel: +1 212 442 3447; fax: +1 212 788 2520; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.