AIDS and Behavior

, Volume 23, Issue 4, pp 1062–1072 | Cite as

Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South

  • Jenni M. Wise
  • Corilyn Ott
  • Andres Azuero
  • Robin Gaines Lanzi
  • Susan Davies
  • Andrea Gardner
  • David E. Vance
  • Mirjam-Colette KempfEmail author
Original Paper


Although CDC guidelines call for universal, “opt-out” HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of “opt-out” HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (N = 250) and qualitative data from providers (N = 10) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of “opt-out” HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.


HIV Health knowledge, attitudes, practice Delivery of health care Screening Barriers 


Aunque las pautas de la CDC recomiendan pruebas de VIH universales y de “exclusión voluntaria”, las barreras a dichas pruebas continúan existiendo en todo Estados Unidos, siendo el sur rural particularmente vulnerable a la infección por VIH y a un menor conocimiento de las condiciones vigentes. Por lo tanto, los objetivos de este estudio fueron evaluar la aceptación de las pruebas de VIH de “exclusión voluntaria” y las barreras que existen a dichas pruebas en el entorno de atención de la salud primaria en el sur. Un diseño de triangulación concurrente guio la recopilación de datos cuantitativos de pacientes (N = 250) y datos cualitativos de proveedores (N = 10) en tres clínicas de salud primaria en Alabama. Descubrimos que el 30% de los pacientes nunca habían sido evaluados para detectar el VIH, y que la barrera más alta entre los pacientes es la percepción de los costos, el acceso a la atención especializada y el no sentirse en riesgo. Existen diferencias significativas en la percepción de las barreras entre los pacientes y los proveedores. Tanto una mayor interacción entre proveedores y pacientes, así como la implementación rutinaria de las pruebas de VIH de “exclusión voluntaria” revelarían y mitigarían de manera efectiva las barreras a las pruebas, aumentando así el conocimiento de las condiciones vigentes.



This research was supported by the University of Alabama at Birmingham (UAB) Center For AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, NIDCR and OAR; and the National Institutes of Health (NIH), National Institute on Minority Health and Health Disparities (NIMHD), Gulf States Health Policy grant (U54MD008602).

Compliance with Ethical Standards

Conflict of interest

All authors included on this manuscript declare that he/she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jenni M. Wise
    • 1
  • Corilyn Ott
    • 1
    • 2
  • Andres Azuero
    • 1
  • Robin Gaines Lanzi
    • 3
  • Susan Davies
    • 3
  • Andrea Gardner
    • 5
  • David E. Vance
    • 1
  • Mirjam-Colette Kempf
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.School of NursingUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Infections Disease, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Department of Behavior Health, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.School of NursingTroy UniversityTroyUSA

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