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Acceptability of voluntary population screening for antibodies against HIV. Aarhus Research Group on AIDS
1Institute of Social Medicine, University of Aarhus, Denmark.
Insights
Most Danish men surveyed would accept voluntary HIV testing. However, low response rates and participant anonymity concerns may bias results, suggesting combined surveillance methods for accurate HIV prevalence estimates.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Surveillance
Background:
- Voluntary population screening for human immunodeficiency virus (HIV) is a key public health strategy.
- Assessing public acceptability and potential biases in HIV testing programs is crucial for effective surveillance.
Purpose of the Study:
- To evaluate the acceptability of voluntary HIV antibody screening among Danish men.
- To identify factors influencing participation and non-participation in HIV testing programs.
- To assess the impact of low response rates and anonymity preferences on HIV seroprevalence estimates.
Main Methods:
- A random sample of 300 Danish men (aged 20-49) received a self-administered questionnaire.
- Multiple recruitment attempts were made to increase response rates.
- Respondents were surveyed on their willingness to participate in HIV testing and their preferred anonymity level.
Main Results:
- A high response rate of 76.7% was achieved after repeated recruitment efforts.
- 87.0% of respondents indicated willingness to undergo voluntary HIV testing.
- Reasons for refusal included lack of concern about AIDS, confidentiality issues, and prior testing.
Conclusions:
- Voluntary HIV screening is generally acceptable, but low response rates can introduce bias.
- Anonymity preferences and non-response among high-risk groups may lead to underestimation of HIV prevalence.
- Population-based voluntary screening should be complemented by other surveillance methods for comprehensive HIV monitoring.
Abstract:
In order to assess the acceptability of voluntary population screening for antibodies against human immunodeficiency virus (HIV), a random sample of 300 Danish men, aged 20-49 years, were sent a self-administered questionnaire. Among nonrespondents, recruitment attempts were repeated three times with intervals of 8-10 days. In total, 76.7% responded. Two hundred men (87.0% of the respondents) would accept an offer to be tested in an anti-HIV screening programme. Among respondents, 72.9% agreed to identify themselves to the researchers, 22.1% preferred to be tested under a code number known only by the participant himself, and 5% wanted the test information to be completely anonymous. Among the 30 men refusing HIV testing, 40% reported they were not concerned about AIDS, 16.7% expressed concern with confidentiality problems, and another 16.7% had been tested already and for this reason declined to participate. Previous reports have indicated high seroprevalences among nonrespondents and raised prevalences of behavior at high risk for HIV infection among persons who do themselves take the initiative to be tested or who decline to be tested because they worry about confidentiality. Low respondency and the associated disproportional loss of subjects at high risk of HIV infection may bias HIV seroprevalence estimates based on population probability sampling, especially in areas with low HIV infection prevalence. Because of these biases, voluntary population screening is likely to give only lower bound estimates of HIV seroprevalence. So, this technique should only be used in combination with other surveillance approaches.