Abstract
BackgroundHIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. The objective of this study is to identify community-based strategies to increase testing among African Americans in both urban and rural areas.MethodsThis study conducted focus group discussions (FGDs) informed by community-based participatory research principles to examine African American’s concerns and ideas around HIV testing and HIV self-testing. Participants included highly affected (i.e., PLWH, MSM, PWID, low-income, teens and young adults) populations from African American communities in North Carolina, aged 15 years and older. We digitally transcribed and analyzed qualitative data using MAXQDA and axial coding to identify emergent themes.ResultsFifty-two men and women between 15 to 60 years old living in urban (n=41) and rural (n=11) areas of North Carolina participated in focus group discussions. HIV testing barriers differed by HIV testing setting: facility-based, community-based, and HIV self-testing. In community-based settings, barriers included confidentiality concerns. In facility-based settings (e.g., clinics), barriers included negative treatment by healthcare workers. With HIV self-testing, barriers included improper use of self-testing kits and lack of post-test support. HIV testing facilitators included partnering with community leaders, decentralizing testing beyond facility-based sites, and protecting confidentiality.ConclusionsFindings suggest that HIV testing concerns among African Americans vary by HIV testing setting. African Americans may be willing to test for HIV at community events in public locations if client confidentiality is preserved and use HIV self-testing kits in private if post-test social support and services are provided. These community-identified facilitators may improve African American testing rates and uptake of HIV self-testing kits.
Highlights
Human immunodeficiency virus (HIV) testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV
Findings suggest that HIV testing concerns among African Americans vary by HIV testing setting
African Americans may be willing to test for HIV at community events in public locations if client confidentiality is preserved and use HIV self-testing kits in private if post-test social support and services are provided
Summary
HIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. A major difficulty in reaching African Americans for testing continues to be the overlapping social stigmas attached to being a racial/ethnic minority, lowincome, and/or labeled as promiscuous [5]. While these trends have been noted among African Americans living in urban areas, there is less data among African Americans living in rural areas, who make up 8.4% of all rural residents in the United States and 20.4% of rural residents in North Carolina [9,10,11]. This study uses community-based participatory research principles to guide an examination of African Americans’ barriers and facilitators to HIV testing and HIV self-testing (HIVST) in urban and rural areas in North Carolina
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