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An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings

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Published on: March 30, 2014

Opt-out HIV testing in prison: informed and voluntary?

David L Rosen¹, Carol E Golin, Catherine A Grodensky

¹a Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.

|December 16, 2014

Summary

Most prisoners wanted HIV testing and knew if they were tested, but less than 40% understood it was voluntary. Prison opt-out HIV testing needs clear communication to ensure informed consent for this high-risk population.

Keywords:

HIV testing informed consent opt-out prison voluntary

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Area of Science:

Public Health
Epidemiology
Health Policy

Background:

Prison settings are crucial for detecting HIV in high-risk, underserved populations.
Opt-out HIV testing is recommended in healthcare settings, including prisons.
Implementing opt-out testing in prisons presents challenges to ensuring informed and voluntary consent.

Purpose of the Study:

To assess prisoners' perceptions of HIV testing voluntariness within an opt-out system.
To identify factors influencing prisoners' understanding of testing as voluntary or mandatory.
To evaluate the alignment between prisoners' testing preferences, actual testing, and their understanding of test status.

Main Methods:

A survey of adult prisoners in seven intake prisons was conducted.
Participants were sampled within two weeks of their HIV testing opportunity.
Multivariable statistical models analyzed perceptions of voluntary vs. mandatory testing, linked to lab records.

Main Results:

Only 38% of prisoners perceived HIV testing as voluntary.
Younger prisoners (age <25) and those preferring mandatory testing were more likely to perceive it as mandatory.
Most prisoners desired and received HIV testing, but understanding of its voluntary nature was low.

Conclusions:

Despite high desire and uptake, a significant gap exists in prisoners' understanding of opt-out HIV testing as voluntary.
Perceptions of voluntariness varied by prison and individual factors, highlighting implementation challenges.
Prison HIV testing protocols must prioritize clear communication to ensure informed and voluntary participation.