title: Reasons for HIV antibody test refusal in a heterosexual sexually transmitted disease clinic population.
abstract: OBJECTIVE
  To evaluate acceptance of confidential HIV antibody testing and reasons for test refusal among heterosexual clients of Los Angeles County sexually transmitted disease (STD) clinics.
  
  
  METHODS
  From January 1993 through June 1994, all blood specimens routinely collected for syphilis serology were tested blindly for HIV antibody at seven STD clinics. Patients were counseled and offered a confidential HIV test. Rate of refusal of confidential testing and primary reason for test refusal were examined by demographic group and HIV serostatus, as determined in the blinded survey, for all heterosexual clients.
  
  
  RESULTS
  Of 20,125 persons offered confidential testing, 35.6% refused the test. Test refusal was higher among men (38.7%) than women [31.1%; adjusted odds ratio (OR), 1.4; 95% confidence interval (CI), 1.3-1.4] and among blacks (38.6%) than whites (28.6%; adjusted OR, 1.7; 95% CI, 1.5-2.0). The most common reason for refusal was 'already know my HIV status' (40.6%), followed by 'don't want to know' (23.9%), and 'not at risk' (19.4%). Confidentiality concerns were cited as the primary reason for refusal by 2.2%. Among the 180 (0.9%) persons who tested positive in the blinded survey, 99 (55.0%) refused the confidential test. Of the 44 seropositive persons who refused the confidential test because they "already knew their HIV status', 29 (65.9%) reported their previous test to be negative.
  
  
  CONCLUSIONS
  Efforts are needed to increase acceptance of confidential HIV testing in this heterosexual population and should (1) include a client-centered counseling approach that facilitates accurate self-assessment of risk and addresses the misperception that a prior negative test result implies an absence of risk, and (2) highlight the potential benefits of early intervention medical and psychosocial services.
authors.affiliation: HIV Epidemiology Program, Los Angeles County Department of Health Services, California 90005, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Simon
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.forename: W L
authors.initials: WL
authors.lastname: Ford
authors.forename: F
authors.initials: F
authors.lastname: Cheng
authors.forename: P R
authors.initials: PR
authors.lastname: Kerndt
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000523:psychology*; D000328:Adult; D005260:Female; D015483:HIV Antibodies / Q000032:analysis*; D016655:HIV Core Protein p24 / Q000276:immunology; D015699:HIV Envelope Protein gp120 / Q000276:immunology; D019302:HIV Envelope Protein gp160 / Q000276:immunology; D015700:HIV Envelope Protein gp41 / Q000276:immunology; D006801:Humans; D008297:Male; D008403:Mass Screening; D012749:Sexually Transmitted Diseases / Q000523:psychology*; D013587:Syphilis / Q000150:complications* / Q000523:psychology; D016312:Treatment Refusal / Q000523:psychology*
chemical_list: D015483:HIV Antibodies; D016655:HIV Core Protein p24; D015699:HIV Envelope Protein gp120; D019302:HIV Envelope Protein gp160; D015700:HIV Envelope Protein gp41