Factors Associated with Participation in Hiv Antibody Screening and Results Disclosure

Human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), subverts the body's immune system. Infection is usually diagnosed through the enzyme-linked immunosorbent assay (ELISA) and the Western blot tests for antibody to HIV. Seroconversion from negative to positive for HIV antibodies usually occurs within several months after initial infection. However, in very rare cases there may be 12 months or more between infection and the development of antibodies (Wolinsky et al., 1989). HIV antibody testing has been controversial since these tests were developed in 1985. The controversy has centered around a number of issues, including the accuracy of the tests; their usefulness as a prevention tool; the widespread use of the tests with low-risk populations; the psychological impact of testing; use of the tests for insurance screening, employment, and admittance to school; the reporting of test results; and the decision whether to contact partners of people who test positive (Bayer, 1989; Siegel, Levine, Brooks, & Kern, 1989). One result of this controversy has been increased doubt among gay and bisexual men about the usefulness of these tests (Lyter, Valdiserri, Kingsley, Amoroso, & Rinaldo, 1987). Because of psychological problems and possible addiction relapse for intravenous drug users sometimes associated with learning test results, some health care providers have been reluctant to advocate for testing and have supported the decision of asymptomatic patients to not be tested (Cunningham, 1985). As a result, early in the AIDS epidemic many HIV-infected people were not tested for HIV antibodies and may continue to be unaware of their infectious state (Hull et al., 1988). This state of affairs appears to be a continuing problem. In October 1991, the Centers for Disease Control (CDC) found that a large proportion of people at risk for HIV infection had not been tested. The extent of this lack of compliance with public health recommendations is difficult to measure given that the people at highest risk--gay and bisexual men, intravenous drug users, and their sexual partners--cannot easily be counted and surveyed. However, the CDC reported that only about 17,000 HIV-infected gay and bisexual men were tested for HIV in 1990; hundreds of thousands of such men are believed to be infected, and thousands of men are newly infected each year (Staff, 1991). This reluctance to be tested has increasing clinical significance given that treatments to lessen the effects of opportunistic infections or to prevent the development of HIV-related symptoms or disease are being developed at an accelerated rate (Staff, 1987; Volberding et al., 1990). To take advantage of these new developments, people need to be tested, and if they test positive, need to seek treatment, even if they are asymptomatic. Studies on health care utilization, especially those on preventive services, suggest that higher educational levels, greater HIV-related knowledge, and higher socioeconomic status are positively related to the likelihood of seeking out and using preventive interventions (Aday, Anderson, & Fleming, 1980; Becker, 1974; Joseph, Montgomery, Emmons, Kessler, & Ostrow, 1987; Rachlin & Green, 1972, Slovic, Fischhoff, & Lichtenstein, 1987; Winkelstein & Graham, 1959). In a 1986 review of the literature over the previous 20 years, Mueller suggested that cultural factors may also be important in explaining the utilization of health care. Studies about the HIV antibody testing of gay and bisexual men have focused on the decision to be tested and on the decision to return and learn the results (Brendstrup & Schmidt, 1990; Foldspang, Melbye, & the Aarhus Research Group on AIDS, 1990; Kegeles, Catania, Coates, Pollack, & Lo, 1990). The reasons given for being tested and for returning for results reflect peoples' perceptions of the positive and negative implications they associate with HIV testing and results disclosure (Catania, Kegeles, & Coates, 1990; Fox, Odaka, Brookmeyer, & Polk, 1987; Lyter et al. …