3. Promoting HIV Testing in Diverse Populations
Summary
Barriers to HIV Testing
Studies have revealed that some healthcare practitioners hold certain beliefs that limit increased HIV testing efforts, including:
- Other priorities during patients visits
- Patient reluctance/refusal
- Beliefs regarding informed consent requirements
- Rapid HIV testing not available in clinic
- Language barriers
- Lack of high-risk behaviors
- Lack of reimbursement for testing
Patient beliefs and attitudes also pose challenges to increasing routine HIV testing, including:
- Lack of unawareness of their communities’ viral load
- Patients’ misplaced beliefs that they are not at risk for HIV transmission
- Married/partnered women who believe that their husbands or partners are monogamous
- Fears of learning HIV status
- Worries about the confidentiality of name-based reporting
State and local laws and regulations concerning the procedures for informed consent for HIV testing may vary in terms of how permissive or restrictive they are. In some cases, these may have the potential to limit more routine HIV testing.
Although some barriers to increasing HIV testing differ among different racial and ethnic communities—whether African American, Hispanic, Asian/Pacific Islander, or American Indian/Alaska native—certain community-related barriers are common to most of them:
- Lack of knowledge about HIV disease and how effective currently available therapies are
- Concerns about HIV-related stigma and discrimination
- Substance use issues
- Mental health issues
- Perceptions among many younger individuals that they are not at risk for HIV infection
- Lack of health insurance
- Comparatively higher rates of poverty
- Inadequate education levels
- Concerns about immigration status
- Language barriers
Strategies to Increase HIV Testing
A critical initial step to providing increased HIV testing within a healthcare organization is a practice’s internal organization, which should begin by establishing in-house policies and procedures involving all of a facility’s staff—from administrators and practitioners to support staff. Four key characteristics of such policies and procedures could include:
- Buy-in at all staff levels
- Planning for how increased testing will be implemented
- Initial and ongoing training for relevant staff
- Monitoring and evaluation of the new procedures
Working with community organizations to provide greater outreach efforts represents a key characteristic of successful testing programs. Some features of such efforts could include:
- Develop culturally appropriate programs that encourage community members to learn more about HIV and to discuss its impact among family, friends, and others
- Collaborate with community-based groups, including faith-based, to promote HIV prevention and testing services
- Utilize social marketing campaigns that are culturally and linguistically appropriate
- Offer extended hours
- Provide HIV testing in such places as:
- Emergency departments and urgent care clinics
- Sexually transmitted disease clinics
- Obstetric/gynecology clinics
- College and university clinics
- Prison clinics
- Mobile healthcare vans
