Factors that contribute to women declining antenatal HIV testing

In this study we aimed to identify factors that contribute to women's decisions to decline an HIV test during their pregnancy in an antenatal clinic setting in Metropolitan London. Voluntary HIV testing ("opt-in") is recommended by the British Department of Health in areas of higher HIV prevalence. We developed a questionnaire that focused on attitudes toward testing, knowledge of transmission routes, a self-assessment of HIV risk, and reasons for declining the HIV test. All women attending the 16-week antenatal booking appointment were offered an HIV test. Of these 560 women, 124 (23%) had an HIV test and the 436 (77%) who declined the test were asked to complete a questionnaire that explored their reasons for declining. We based our findings on the 393 completed returned questionnaires. The major finding was that women declined testing because they did not think they had been at risk for HIV. However, they based this belief on patchy HIV knowledge. The women were making an important decision during their pregnancy on the basis of poor information. The antenatal setting may not be the most appropriate environment in which to give HIV information, however, this task must be performed also in other health environments.