Barriers to universal prenatal HIV testing in 4 US locations in 1997.
OBJECTIVE
We determined rates of prenatal HIV testing and investigated barriers to testing.


METHODS
We surveyed 1362 representative parturient women from 7 hospitals in 4 locations of the United States.


RESULTS
Overall, 89.9% of women reported being offered HIV testing and 69.6% reported being tested. Proportions of women not offered testing differed by location (range = 5.2%-16.3%), as did proportions not tested (range = 12.2%-54.4%). Among women who perceived that their clinicians had not recommended testing, 41.7% were tested, compared with 92.8% of women who perceived a strong recommendation (P < .05). Private insurance for prenatal care was also associated with not being tested. Women gave multiple reasons for not being tested, most commonly not being at risk, having been tested recently, and the test's not being offered or recommended, cited by 55.3%, 39.1% and 11.1% of women, respectively.


CONCLUSIONS
Although most parturient women were offered a prenatal HIV test and got tested, testing proportions did not reach national goals and differed significantly by location and payment status. Concern about testing consequences was not a major barrier. Perception of clinicians' recommendations strongly influenced testing. Changing provider practices will be essential to implementing universal prenatal HIV testing.
Royce
R A
RA
Department of Epidemiology, University of North Carolina at Chapel Hill, USA. rroyce@rti.org
Walter
E B
EB
Fernandez
M I
MI
Wilson
T E
TE
Ickovics
J R
JR
Simonds
R J
RJ
D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003237:Connecticut; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D015999:Multivariate Analysis; D009518:New York; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D012306:Risk; D015144:Southeastern United States