Why might clinicians in Malawi not offer HIV testing to their patients?

In order to identify reasons clinicians in Malawi might not offer HIV testing to patients, a cross-sectional descriptive postal census with telephone and fax follow-up was conducted. Proportions were calculated for each reason given for not offering HIV testing. Multiple logistic regression was used to determine whether responses differed by demographic characteristics. The response rate was 54.3%. The five most common reasons for not offering HIV testing were: (1) inadequate training in HIV counselling (50.3%); (2) perception that the patient is not ready (49.5%); (3) no indication (35.6%); (4) testing facilities unavailable (35.4%); and (5) insufficient time (28.9%). Differences in reasons for not offering HIV tests amongst clinician groups were few. Thus, development of one general programme based on common reasons identified in this study could be effective in increasing HIV testing rates. Further investigation of the identified reasons should be undertaken to facilitate programme development.