title: Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men.
abstract: OBJECTIVE
  To determine strategies to overcome barriers to HIV testing among persons at risk.
  
  
  METHODS
  We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic.
  
  
  RESULTS
  Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing.
  
  
  CONCLUSIONS
  Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.
authors.affiliation: University of Washington, Seattle, WA, USA. freya@u.washington.edu
authors.forename: Freya
authors.initials: F
authors.lastname: Spielberg
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Branson
authors.forename: Gary M
authors.initials: GM
authors.lastname: Goldbaum
authors.forename: David
authors.initials: D
authors.lastname: Lockhart
authors.forename: Ann
authors.initials: A
authors.lastname: Kurth
authors.forename: Connie L
authors.initials: CL
authors.lastname: Celum
authors.forename: Anthony
authors.initials: A
authors.lastname: Rossini
authors.forename: Cathy W
authors.initials: CW
authors.lastname: Critchlow
authors.forename: Robert W
authors.initials: RW
authors.lastname: Wood
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003376:Counseling; D005260:Female; D017144:Focus Groups; D017408:Guidelines as Topic; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D010342:Patient Acceptance of Health Care; D015229:Sexually Transmitted Diseases, Viral / Q000175:diagnosis*; D014861:Washington