Beliefs About Who Should Be Tested for HIV Among African American Individuals Attending a Family Practice Clinic

Abstract

Despite comprising only 12% of the U.S. population, African Americans account for nearly 50% of its HIV cases. Early HIV testing and antiretroviral therapy, when indicated, can prolong or prevent the onset of life-threatening AIDS, yet many African Americans go undiagnosed. Among those with HIV, compared to whites, African Americans are 23% less likely be diagnosed. Furthermore, when tested, African Americans are more likely to be tested and diagnosed with HIV late in the course of infection—near the onset of AIDS. While 42.6% of whites receive an AIDS diagnosis within 3 years of their HIV diagnosis, 46.1% of African Americans receive an AIDS diagnosis within 3 years of their HIV diagnosis. From an individual’s perspective, beginning antiretroviral therapy before receiving an AIDS diagnosis can prolong life. From the community’s perspective, HIV testing delays result in years of missed opportunities for antiretroviral therapy, which lowers an individual’s HIV viral load to decrease infectiousness, a key step in interrupting ongoing transmission in the community. Furthermore, when people are diagnosed with HIV, they reduce their risk behaviors, which also helps prevent ongoing transmission in the community. Because HIV testing is thus a prevention intervention that may help to stem the tide of the ongoing HIV epidemic, in 2006 the Centers for Disease Control and Prevention (CDC) issued new recommendations to make HIV testing opt-out and routine for all persons ages 13–64 in health care settings. The CDC has specifically emphasized the need for improved testing in African American communities. In 2011, some 5 years after the CDC issued its new recommendations, routine HIV testing in health care settings is still far from being universal. Recent studies indicate that not only is HIV testing not being offered routinely by physicians, but when it is offered, patients are opting-out. In a 2011 national survey, 26% of African Americans reported never having been HIV tested. Of those reporting no testing, 53% indicated they were not being tested because they did not feel they were at risk for HIV. Over 1 of 4 African Americans surveyed were ‘‘not at all concerned’’ about becoming infected with HIV. While it is true that some may not be at risk for HIV infection, this lack of concern may, instead, suggest a lack of awareness of the actual prevalence of HIV in the African American community, as well as conflicts in preexisting beliefs about who is and is not at risk for HIV. Such lack of awareness and conflict between beliefs and realities are certainly potential barriers to getting tested. Given that recent research has highlighted low perception of risk as an ongoing barrier to accepting HIV testing even when it is offered routinely in health care settings, the purpose of this study, which was conducted in a family practice clinic serving predominantly African Americans, was to understand patient beliefs about who should be tested for HIV. Understanding these beliefs could help guide campaigns to educate patients about the current epidemiologic profile of the HIV epidemic and the need for routine HIV testing for all persons ages 13–64 in health care settings. Between February and March 2010, a cross-sectional survey was conducted of adult African American individuals attending a family practice clinic in the Harris County Hospital District (HCHD), Houston, Texas. HCHD provides public health care for the nation’s third most populous county; significantly, over 90% of the HIV/AIDS cases in the Houston metropolitan area are in Harris County. Mirroring national trends, African Americans account for 50% of Harris County’s HIV/AIDS cases despite making up only 18% of the county’s population. The HCHD family practice clinic at which this study was conducted serves a predominantly African American population (57%). Patients were recruited while they were in the waiting room waiting for their health care provider appointment. Patients were considered eligible if they were aged 18–64 years, self-identified as African American, and fluent in English. Baylor College of Medicine Institutional Review Board approval was obtained for this human subjects research; patients’ completion of our study’s voluntary survey was deemed an appropriate indication of