title: Public attitudes towards opt-out testing for HIV in primary care: a qualitative study.
abstract: BACKGROUND; The rate of new HIV infections in the UK continues to rise, with one-quarter of cases undiagnosed. Opt-out HIV testing - in which tests are routinely offered to all patients, with the offer to decline - have proved effective in antenatal care. Pilot studies of HIV opt-out testing at GP registration and acute medical admission to hospital have described service-level issues and the clinician's perspective, but not the views of the general public.
  
  
  OBJECTIVE
  To further understand the public's perspective on opt-out testing for HIV in England.
  
  
  METHODS
  Focus groups (n = 9) with a total of 54 participants in Brighton, England, where HIV prevalence is high.
  
  
  METHODS
  Quota sampling on sexual orientation, age, sex, and testing experience was applied to groups with high and low HIV prevalences, and analysed using framework analysis.
  
  
  RESULTS
  Opt-out testing for HIV was acceptable. Testing on GP registration was regarded as a more appropriate setting than acute medical admission. Participants from groups in which HIV has a higher prevalence felt HIV testing required consideration that may not be possible during acute hospital admission. However, there was concern that screening would still be targeted at groups in which HIV prevalence is higher, based on clinicians' judgement of patients' behaviours, sexuality, or ethnicity.
  
  
  CONCLUSIONS
  The opt-out method of testing for HIV must be routinely offered to all who are eligible, to increase test uptake and to prevent communities feeling targeted. Any pressure to test is likely to be poorly received. Inaccurate concerns about medical records being shared with financial services are a disincentive to test. Primary care should be an active setting for opt-out HIV testing.
authors.affiliation: Brighton and Sussex Medical School, Brighton.
authors.forename: Simon
authors.initials: S
authors.lastname: Glew
authors.forename: Alex
authors.initials: A
authors.lastname: Pollard
authors.forename: Leila
authors.initials: L
authors.lastname: Hughes
authors.forename: Carrie
authors.initials: C
authors.lastname: Llewellyn
mesh_terms: D003153:Community Health Services; D004739:England; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission; D015438:Health Behavior; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007258:Informed Consent; D008297:Male; D008403:Mass Screening; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011320:Primary Health Care; D011639:Public Opinion; D036301:Qualitative Research; D063127:Secondary Health Care; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data
keywords: HIV; general practice; policy; qualitative research