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• Re: Why do people decline HIV testing?
  Helen L Munro
  Published on: 13 May 2016
• Why do people decline HIV testing?
  Manjula Pammi
  Published on: 13 May 2016
• STI symptoms and less offer of HIV test , possible explanation
  Malaki O Ramogi
  Published on: 13 May 2016

• Published on: 13 May 2016

  Re: Why do people decline HIV testing?

  • Helen L Munro, Senior Scientist
  • Other Contributors:
    • Catherine M. Lowndes, David G. Daniels, Ann K. Sullivan and Angela J. Robinson

  Dear Editor,

  In response to M O Ramogi on 21st August 2008, it is important to point out that since only patients attending with a new episode were included in the study, those experiencing chronic/recurrent infections or attending solely for treatment were excluded. Therefore the inclusion of patients for who HIV testing is less applicable is unlikely to be the explanation for the association between symptoms of an STI...

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  Dear Editor,

  In response to M O Ramogi on 21st August 2008, it is important to point out that since only patients attending with a new episode were included in the study, those experiencing chronic/recurrent infections or attending solely for treatment were excluded. Therefore the inclusion of patients for who HIV testing is less applicable is unlikely to be the explanation for the association between symptoms of an STI and a decrease in the likelihood of being offered an HIV test.

  With regard to point of care testing (POCT), while anxiety may play a part in the demand from patients for POCT there is evidence that POCT does attract a higher risk population and may lead to an increase in the number of new HIV diagnoses(1). In a study conducted in Amsterdam average HIV prevalence among MSM receiving one-hour testing with result was 5.2% compared with 3.8% among the control group: those testing with a standard one-week wait. Similar results were found for heterosexuals. In another study among a high risk population utilising a rapid community outreach HIV testing clinic in London, 54% said they would not have tested if a rapid test had not been available(2). Also in London, a recent questionnaire based study found that 51% of high risk patients who declined HIV testing said they would be more likely to test if POCT was available(3).

  In response to M Pammi et al on 16th September 2008, one third of patients reporting a dislike of needles as the reason for declining an HIV test is considerably higher than found in our study. The second most common reason is having “checked recently”. Whether this is truly reflective of differences in testing among heterosexuals compared with men who have sex with men, or specific to the locality where the study was done, is an interesting point. About two thirds of the patients in the Pammi study gave at least one response that would allow them to be divided into those who should be tested at the current visit and those who don’t need to be, with those who have recently tested in the latter group. But what to do about those claiming a dislike for needles? Since all respondents in clinics C and D reported one or more reasons for not testing, is it possible that a dislike of needles is a secondary reason, one not associated with the sensitive issue of actual or perceived risk of HIV exposure? Was there consistency between needle phobia and having tested before, i.e. none of those reporting needle phobia had tested previously? It would also be interesting to know whether those stating that they have had a recent check have indeed done so within the last 3 months and if they know their status. Of note is the variation even between the two clinics in the proportion who perceived themselves at risk for HIV (the proportion was more than 3-fold higher in clinic U), and in the proportion who were in the window period and who had tested recently (both also higher in clinic U). Does this reflect a difference in the sexual orientation or the sexual behaviour of the two samples, or merely highlight difficulty in ascertaining valid reasons for not testing? Patients’ reasons for not HIV testing are likely to be an unreliable measure on which to base HIV testing policy recommendations.

  With regard to testing within the window period, it is important to note that not testing due to the window in our study was clinician as well as patient driven, which may help explain the higher proportion. In addition, consideration of the window period due to repeat risk may be more relevant to MSM populations than heterosexuals.

  References

  1. C L J Van Loon, W M E Koevoets. Rapid HIV testing in a one-hour procedure motivates MSM in the Netherlands to take the test. Oral Abstract session: The XV International AIDS Conference: Abstract no. TuOrC1197.

  2. R Grimes, P Weatherburn, R Mugezi, A Wilkinson, A K Sullivan. Know4sure: who comes to a rapid HIV testing outreach clinic and why? Sexually Transmitted Infections 2006;82(Supplement 2 ): P69.

  3. S F Forsyth, E A Agogo, L Lau, E Jungmann, S Man, S G Edwards, A J Robinson. Would offering rapid point-of-care testing or non-invasive methods improve uptake of HIV testing among high-risk genitourinary medicine clinic attendees? A patient perspective. Int J STD AIDS 2008;19: 550-552.

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  Conflict of Interest:
  None declared.

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• Published on: 13 May 2016

  Why do people decline HIV testing?

  • Manjula Pammi, Specialist Registrar, Nottingham University Hospitals NHS Trust
  • Other Contributors:
    • Dr EM Carlin, Nottingham University Hospital and Sherwood Forest Hospitals NHS Trust

  Dear Editor,

  Although the uptake of the HIV test has increased significantly in recent years, following the introduction of opt-out screening programmes, there is still a substantial number of the HIV population that is still undiagnosed.1 Therefore, we read with interest the National study of HIV testing in men who have sex with men attending genitourinary clinics in the United Kingdom by H L Munro et el.2 This st...

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  Dear Editor,

  Although the uptake of the HIV test has increased significantly in recent years, following the introduction of opt-out screening programmes, there is still a substantial number of the HIV population that is still undiagnosed.1 Therefore, we read with interest the National study of HIV testing in men who have sex with men attending genitourinary clinics in the United Kingdom by H L Munro et el.2 This study focussed on men who have sex with men (MSM) and identified that the most common reason for declining an HIV test was a potential exposure within the three month window period.

  We report on a different group of patients, predominantly heterosexual (97%), in whom we conducted a questionnaire survey on the reasons for declining an HIV test. Our study was conducted in two genitourinary medicine clinics over a 10 week period. One clinic was in based in a University City (Nottingham, Clinic U) and one clinic was based in an urban/semi rural area (Sutton-in-Ashfield, Clinic D). All patients attending the clinics who declined an HIV test were asked to complete a self-administered questionnaire.

  During the study period, 3172 and 1050 new or re-book patients attended Clinic U and Clinic D, respectively, of which 417 (13%) and 211 (20%) declined HIV testing. A total of 231 and 156 questionnaires were filled in by Clinic U and Clinic D respectively. Individuals gave one or more reasons for declining the test(see Table 1).

  In our study the reasons for declining HIV testing in different conurbations and populations appear to be similar in many aspects, for example needle-dislike, regular partner, blood donor. However, variations were seen in relation to result-perception, result-concerns and recent test history, which indicates the importance of local factors. Unlike Munro et al.2, we identified only 3-6% of individuals who declined an HIV test for reasons related to the window period. This indicates that the reasons for declining an HIV may also differ according to sexual orientation.

  The uptake of HIV testing is a major objective of national strategies across the United Kingdom, with the aim of reducing the undiagnosed disease burden. It would appear that different approaches to encouraging HIV testing may be required to enable this, taking into account the patient’s sexual orientation and local factors.

  References

  1. www.hpa.org.uk

  2. Munro HL, Lowndes CM, Daniels D et al. National study of HIV testing in men who have sex with men attending genitourinary clinics in the United Kingdom. Sex Transm Dis 2008; 84: 265-70.

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  Conflict of Interest:
  None declared.

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• Published on: 13 May 2016

  STI symptoms and less offer of HIV test , possible explanation

  • Malaki O Ramogi, Spr Genitourinary Medicine

  Dear Editor,

  An interesting finding in this study was the association between having STI symptoms and less chance of being offered HIV test as compared with the patients with no STI symptoms. However the study fails to describe what symptoms these patients might have had. One explanation could be that these patients had chronic recurrent symptoms like genital herpes, chronic non specific urethritis or genital warts an...

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  Dear Editor,

  An interesting finding in this study was the association between having STI symptoms and less chance of being offered HIV test as compared with the patients with no STI symptoms. However the study fails to describe what symptoms these patients might have had. One explanation could be that these patients had chronic recurrent symptoms like genital herpes, chronic non specific urethritis or genital warts and they were attending clinic for treatments only. It's possible that they did not have new risk factors to warrant any repeat HIV testing.

  Secondly regarding whether HIV POC test would be of cost benefit use in GUM setting,its mainly low HIV risk patients with HIV anxiety who are likely to opt for POCT HIV testing in preference of standard HIV testing. Hence while it may increase uptake of HIV test in a certain group of patients attending GUM clinic, there is little evidence to prove that this will lead to increase in new HIV diagnosis in GUM clinic setting.

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  Conflict of Interest:
  None declared.

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