3. Promoting HIV Testing in Diverse Populations
Population-Specific Barriers
Factors That Impede HIV Testing Among African-Americans
Although HIV disease disproportionately affects the African American community
[link to earlier epidemiology
section when available], a significant percentage of this population is unaware of their
HIV status. Cultural and socioeconomic factors, in addition to disparities in access to testing facilities impede testing among African Americans. [Daniels and Wimberly Daniels 2004] list the following factors that afect responses to offers for HIV
testing:
- Lack of knowledge about HIV disease and the highly effective nature of currently available therapies
- Fear of learning of an HIV-positive status
- Concerns about HIV-related stigma and discrimination
- Financial challenges that extend beyond any costs that may be involved in testing (eg, costs of medications and clinical care, fear of job loss)
- Cultural attitudes
- Mistrust of healthcare providers
- Substance use issues
- Mental health issues
Other investigators have identified additional factors that act as barriers to inhibit wider HIV testing among African American communities.
- Many persons of color on the younger and older ends of the age spectrum do not perceive themselves at risk for HIV infection and therefore do not seek testing.
- A study of young male African American college students found that only 2 of the 53 MSM surveyed believed that they were at risk of infection. [Fitzpatrick 2004]
- Concerns about the range of affects involved in being HIV-positive also serve as a deterrent to testing. A study of low-income African American women attending an urgent care clinic in the urban South revealed that those women who felt that being HIV-positive would complicate their lives were the least likely to accept repeated testing. [Crosby 2004]
- Many African Americans, particularly those who belong to the middle class, do not want to be seen walking into testing centers, and their primary-care providers fail to take the initiative by encouraging and providing testing.
- As a related concern, Sullivan and colleagues reported that as many as 27% of those tested did not return to learn the results of their tests. [Sullivan 2004]
Issues arising from distrust between members of minority population groups and healthcare service providers and institutions can give rise to serious barriers to access to healthcare services and health outcomes among members of those groups. Whetten and colleagues examined the associations between trust of healthcare providers and the government and access to healthcare services and outcomes among a largely African American population visiting HIV treatment centers in 5 states in the South. [Whetten 2006]
The investigators reported that patients who indicated trust in healthcare providers had more HIV-related outpatient visits, fewer emergency department visits, increased use of antiretrovirals, and improved physical and mental health. Trusting the government was also associated with fewer emergency department visits and better mental and physical health. Some of the most challenging findings of this study include:
- More than 25% of participants believed that the government created HIV to kill minorities.
- More than 50% believed that a significant amount of information about HIV is withheld from the public.
- 10% did not trust their healthcare provider to give them the best care possible.
