HIV seroprevalence and reasons for refusing and accepting HIV testing

We sought to evaluate the HIV seropositivity of patients who refused or accepted human immunodeficiency virus (HIV) testing in a South Carolina sexually transmitted diseases (STD) clinic, and the patients' reasons for refusing or accepting testing.

A serologic and self-administered survey done Jan. 9 through June 1, 1989. For those who refused HIV testing, a routine syphilis serology sample was tested blindly for HIV.

Of 1,929 patients in the study, 398 (21%) refused HIV testing. HIV test refusers were 2.2 times more likely to be HIV antibody positive than HIV test acceptors (3.0% versus 1.4%, prevalence ratio = 2.2, CI95 1.1-4.4), with this difference mainly occurring among males. Seven of eight patients reporting that they refused testing because they were HIV positive were found to be HIV negative. The principal reason indicated for test refusal was not feeling at risk for HIV infection. The principal reasons indicated for test acceptance were wanting to know the results for their own health status and wishing to prevent spread of the virus to partners.

We conclude that: (1) a higher seropositivity exists among HIV test refusers than acceptors; (2) patient reporting HIV seropositivity should be viewed with caution; (3) many STD patients deny their risk for HIV; and (4) STD patients are concerned about transmission of HIV to their partners.