Barriers and facilitators to HIV testing and linkage to primary care: narratives of people with advanced HIV in the Southeast

Abstract

Persons with unrecognized HIV infection forgo timely clinical intervention and may unknowingly transmit HIV to partners. However, in the USA, unrecognized infection and late diagnosis are common. To understand barriers and facilitators to HIV testing and care, we conducted a qualitative study of 24 HIV infected persons attending a Southeastern HIV clinic who presented with clinically advanced illness. The primary barrier to HIV testing prior to diagnosis was perception of risk; consequently, most participants were diagnosed after the onset of clinical symptoms. While most patients were anxious to initiate care rapidly after diagnosis, some felt frustrated by the passive process of connecting to specialty care. The first visit with an HIV care provider was identified as critical in the coping process for many patients. Implications for the implementation of Centers for Disease Control and Prevention HIV routine screening guidelines are discussed.

Keywords:

• HIV infection
• voluntary counseling and testing
• delivery of health care
• Southeastern USA
• social support

Acknowledgements

The authors are grateful to all of the patients who participated in the study and to Blair Turner and Ben Kirkley for assistance with recruitment. We are also appreciative of Marie Leak, Crystal Shakleford, and Kim Hayes for transcribing the interviews. Paul Mihas at the Odum Institute provided helpful instruction on qualitative research methods. This work was supported in part by a grant from the University of North Carolina Center for AIDS Research (P30 AI50410) and the US Centers for Disease Control and Prevention Grant for Public Health Dissertations (1R36PS000848-01). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the US Centers for Disease Control and Prevention.