Understanding patient acceptance and refusal of HIV testing in the emergency department.
BACKGROUND
Despite high rates of patient satisfaction with emergency department (ED) HIV testing, acceptance varies widely. It is thought that patients who decline may be at higher risk for HIV infection, thus we sought to better understand patient acceptance and refusal of ED HIV testing.


METHODS
In-depth interviews with fifty ED patients (28 accepters and 22 decliners of HIV testing) in three ED HIV testing programs that serve vulnerable urban populations in northern California.


RESULTS
Many factors influenced the decision to accept ED HIV testing, including curiosity, reassurance of negative status, convenience, and opportunity. Similarly, a number of factors influenced the decision to decline HIV testing, including having been tested recently, the perception of being at low risk for HIV infection due to monogamy, abstinence or condom use, and wanting to focus on the medical reason for the ED visit. Both accepters and decliners viewed ED HIV testing favorably and nearly all participants felt comfortable with the testing experience, including the absence of counseling. While many participants who declined an ED HIV test had logical reasons, some participants also made clear that they would prefer not to know their HIV status rather than face psychosocial consequences such as loss of trust in a relationship or disclosure of status in hospital or public health records.


CONCLUSIONS
Testing for HIV in the ED as for any other health problem reduces barriers to testing for some but not all patients. Patients who decline ED HIV testing may have rational reasons, but there are some patients who avoid HIV testing because of psychosocial ramifications. While ED HIV testing is generally acceptable, more targeted approaches to testing are necessary for this subgroup.
San Francisco General Hospital HIV/AIDS Division, University of California San Francisco, San Francisco, CA, USA. christopoulosk@php.ucsf.edu
Katerina A
KA
Christopoulos
Sheri D
SD
Weiser
Kimberly A
KA
Koester
Janet J
JJ
Myers
Douglas A E
DA
White
Beth
B
Kaplan
Stephen F
SF
Morin
D000293:Adolescent; D000328:Adult; D002140:California; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D019037:Urban Health Services / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult