title: Factors that affect HIV testing and counseling services among heterosexuals in Canada and the United Kingdom: an integrated review.
abstract: OBJECTIVE
  To examine factors that affect the utilization of HIV testing and counseling (HTC) services among heterosexual populations in Canada and the U.K.
  
  
  METHODS
  We conducted an integrated review of published and unpublished literature (1996-September 2010) using Scopus, OVID-EMBASE, CSA illumina, CINHAL, PROQuest, Web of Science, and Google.
  
  
  RESULTS
  Twenty-seven studies met the inclusion criteria. We identified and categorized the key factors into three broad categories depending on their source. Personal-related factors included socio-demographic characteristics, risk perception, illness, HIV-related stigma, level of HIV and testing knowledge, and culture. Provider-related factors included provider-recommended HIV testing, provision of culturally and linguistically appropriate services, and doctor-patient relationship. System-related factors included integrating HIV testing with other health care services, anonymity of testing services, suitability of testing venues, technical aspects of HIV testing, and funding for immigrant health services.
  
  
  CONCLUSIONS
  The findings from our review indicate that HTC behaviors of heterosexuals in the Canada and the U.K. are likely influenced by several unchangeable (socio-demographic characteristics) and amenable factors. There is need to step-up research to confirm whether these associations are causal using stronger research designs. PRACTICAL IMPLICATION: We have made several recommendations that could be used to improve existing services in Canada.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. skaai@uwaterloo.ca
authors.forename: Susan
authors.initials: S
authors.lastname: Kaai
authors.forename: Sandra
authors.initials: S
authors.lastname: Bullock
authors.forename: Ann N
authors.initials: AN
authors.lastname: Burchell
authors.forename: Carol
authors.initials: C
authors.lastname: Major
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D002170:Canada; D003376:Counseling; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D020010:Heterosexuality; D006801:Humans; D008403:Mass Screening; D012959:Socioeconomic Factors; D006113:United Kingdom