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Spielberg Freya; Branson, Bernard M.; Goldbaum, Gary M.; Lockhart, David; Kurth, Ann; Celum, Connie L.; Rossini, Anthony; Critchlow, Cathy W.; Wood, Robert W.
JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2003

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 selftesting (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.

This study was supported by a grant from the University of Washington Center for AIDS Research New Investigator Award No. AI27757 and from cooperative agreement No. R18/CCR015258-01 with the Centers for Disease Control and Prevention. Time to prepare this manuscript was supported by a grant from the National Institute for Drug Abuse (K08 DA00472-01).

Address correspondence and reprint requests to Freya Spielberg, Center for AIDS and STD, PO Box 359931, 325 9th Avenue, 3EC44 Seattle, WA 98104-2499; e-mail:

Manuscript received January 18, 2002; accepted September 20, 2002.

© 2003 Lippincott Williams & Wilkins, Inc.