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BMC Public Health. 2012; 12: 3.
Published online Jan 3, 2012. doi:  10.1186/1471-2458-12-3
PMCID: PMC3267671
Understanding patient acceptance and refusal of HIV testing in the emergency department
Katerina A Christopoulos,corresponding author1,2 Sheri D Weiser,1,2 Kimberly A Koester,2 Janet J Myers,2 Douglas AE White,3 Beth Kaplan,4 and Stephen F Morin2
1San Francisco General Hospital HIV/AIDS Division, University of California San Francisco, San Francisco, CA, USA
2Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
3Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA. USA
4Department of Emergency Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
corresponding authorCorresponding author.
Katerina A Christopoulos: christopoulosk/at/php.ucsf.edu; Sheri D Weiser: sheri.weiser/at/ucsf.edu; Kimberly A Koester: kimberly.koester/at/ucsf.edu; Janet J Myers: janet.myers/at/ucsf.edu; Douglas AE White: daewhite/at/gmail.com; Beth Kaplan: Beth.Kaplan/at/emergency.ucsf.edu; Stephen F Morin: steve.morin/at/ucsf.edu
Received October 21, 2011; Accepted January 3, 2012.
Abstract
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.
Keywords: Emergency department, HIV testing, HIV test refusal, HIV test acceptance
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