FACTORS ASSOCIATED WITH REQUESTING AND REFUSING HUMAN-IMMUNODEFICIENCY-VIRUS ANTIBODY TESTING

Objective: To ascertain factors associated with having a test for human immunodeficiency virus (HIV) antibody. Design: All attenders at a sexually transmitted diseases (STD) clinic who were at risk of HIV infection and had not been tested previously were included in the study and classified as requesting a test or being offered a test. Setting: The study was conducted at a central city STD clinic. Participants: Of all patients in 1990, 1835 men and 849 women were excluded because of previous HIV tests and 259 men and 120 women were not tested because of their low risk, leaving a target population of 2249 men and 1153 women. Main outcomes: Among men tested the results in 1.2% (9/771) of those requesting a test and in 0.6% (7/1177) of those not requesting a test were positive. There were no positive results among the women tested. Results: Among men, accepting testing was related to intravenous drug use (odds ratio [OR] = 3.49), not having a steady partner (OR = 1.40), and having an STD (OR = 0.57) or a history of STD (OR = 0.67). Among women, accepting testing was related to not having a steady partner (OR = 1.73), being an STD contact (OR = 0.43), having vaginal discharge and/or dysuria (OR = 0.51), and having a history of STD (OR = 0.61), and was unrelated to having an STD. In both men and women accepting testing was unrelated to having multiple sex partners. Conclusions: The findings are consistent with a failure to associate the risk of HIV infection with risks associated with other STDs. This has implications for health education programs as well as approaches to testing by doctors. Those requesting a test accounted for only 56% (9/16) of infections detected.