Decision making in HIV testing among a group with low HIV risk

An investigation of the practice of unsafe sex yet repeated HIV testing

RATIONALE

A purportedly heterogeneous group of people, who come to take tests at the Human Immunodeficiency Virus (HIV) Test-ing Clinic, includes young males and females who lead a normative lifestyle with no unique characteristics. Within this population, we have observed one distinct subgroup of predominantly male individuals, who return from time to time to take the HIV tests. They tend to partake in many occasional sexual encounters with numerous partners, and despite their obvious knowledge of the risks involved, they attest to not using condoms during sexual intercourse. The aim of this preliminary study was to investigate the patterns of their risky behavior in conjunction with their test taking conduct.

METHODS

Ten self-referred volunteering subjects were recruited.

EXCLUSION CRITERIA

HIV-positive, drug and/or alcohol abusers, mentally ill, men who have sex with men (MSM) and minors. The study was carried-out using semi-structured interviews (40-90 min each). The interviews were recorded, transcribed and content analyzed.

FINDINGS

Data analysis showed several possible explanations for risky sexual behavior, such as applying of a variety of risk management mechanisms, refraining from impulse control behaviors, and self-destruction motives. The reasons for undergoing HIV testing were most frequently related to specific events, high-risk in nature, and not part of a routine behavioral practice.

CONCLUSIONS

Our findings might suggest that within this population group, the prevailing primary preventive interventions would not satisfy the purpose of decreasing levels and frequency of risk-taking behaviors. In the opinion of the authors, there are two strategies that could be employed, simultaneously or separately. An indirect approach entails the increase and enhancement in utilizing widely spread media, e.g., feature films and television programs, to convey issues related to curbing risk-behavior. Direct emphasis should be put on secondary preventive measures, by encouraging frequent test-taking conduct, preferably accompanied by counseling, in order to decrease the risk of further transmitting the virus.

Desired elements of HIV testing services: test recipient perspectives

Thematic analysis of transcripts from interviews with a purposive sample of 39 voluntary human immunodeficiency virus (HIV) test recipients in Ontario (selected on the basis of HIV serostatus, risk behaviors, region of residence, gender, and testing format) was used to identify elements of HIV testing services of concern to test recipients. Colleague review was used to ensure dependability of findings, and emergent themes were compared with the existing literature on patient satisfaction. Data analysis identified a comprehensive set of 28 service elements, including components related to access and availability (convenience, physical accessibility, familiarity), structure of the service (privacy, and characteristics of the venue, session, and test provider), technical and medical aspects of the testing process (including blood-taking, file maintenance, obtaining informed consent, waiting period, and manner of result provision), and both cognitive and socioemotional aspects of the interpersonal process (including decision-making support, personalized risk information, receipt of appropriate emotional support, and service referrals). Results suggest that information on, and training in, counseling skills for both physician and nonphysician test counselors is important in the provision of quality testing services. Results also suggest that test recipients would appreciate choice in testing service options, and within the test session, individualized information, and counseling.

Moving from apprehension to action: HIV counseling and testing preferences in three at-risk populations

This study sought to identify factors influencing HIV testing decisions among clients at a sexually transmitted disease clinic, gay men, and injection drug users. Focus group and intensive interview data were collected from 100 individuals. The AIDS Risk Reduction Model was adapted to describe factors that affect test decisions. Testing barriers and facilitators were grouped as factors affected by "Individual" beliefs, "System" policies and programs, "Testing" technology, and "Counseling" options. Individual factors (fear of death and change), system factors (anonymous test availability, convenience), and counseling and testing factors (rapid results, counseling alternatives) interact to determine whether an individual does not test ("apprehension") or does test ("action"), and ultimately, tests routinely ("integration"). In conclusion, traditional HIV testing presents barriers to some populations at risk for HIV. These findings suggest several strategies to improve HIV test acceptance: acknowledge fears, address system barriers, utilize available test technologies, and expand counseling options.