Risk Perception As a Barrier to Early HIV Testing
This study aimed to understand the factors contributing to the delayed diagnosis of HIV in order to increase timely testing and diagnosis. People unaware of their positive status account for a disproportionate number of new HIV transmissions, making delayed diagnosis a profound public health concern. Delayed diagnosis sustains HIV transmission, confounds prevention efforts and prevents HIV positive individuals from benefitting from effective antiretroviral therapy, resulting in increased morbidity and mortality.
Methods:
This exploratory case study recruited a non-probability convenience sample of adult Oregon residents identified as late testers (concurrently diagnosed with HIV and AIDS) to discuss past behaviors and experiences with testing. This research is unique because few published studies have analyzed qualitative data retrieved from individuals concurrently diagnosed with HIV/AIDS. Qualitative interviews adhered to a semi-structured schedule and were tape recorded, transcribed and entered into NVivo software for thematic data analysis. Grounded Theory methods were adhered to for data analysis.
Results:
Seventeen adults diverse in age, reported risk behaviors and sexual orientation participated in the study. A principle theme identified in the data was the role that risk perception plays in one’s decision to test for HIV. Each of the respondents conveyed surprise at their HIV diagnosis, regardless of their personal history. Risk perception was sub-categorized into three groups: 1) Unknown Risk representing risk associated with partner behavior, 2) Recurrent Risky Behavior representing individuals regularly engaging in known high-risk behaviors and 3) Episodic Risky Behavior representing periodic engagement in high-risk behavior.
Half of the sample (n=9) was categorized as engaging in episodic risky behavior (primarily unprotected heterosexual intercourse), suggesting that people who do not meet the stereotypical risk factors for HIV often fail to make the connection between their behaviors and risk for HIV. Furthermore, each of those individuals reported visiting physicians over a period of years in relation to HIV symptoms such as significant weight loss, recurrent infections, swollen lymph nodes, fevers and pneumonia. In most cases, patients were not offered HIV tests, suggesting that outdated stereotypes regarding who is at risk for contracting HIV are present in the medical community.
Implications for Practice:
This research implies that perceived risk is significant barrier to early testing for HIV. Perceived risk of HIV infection is categorized into three groups, with half of the sample identified as being in the episodic risk category. Seven out of 9 of these individuals identified as heterosexual and had visited the doctors for years for recurrent symptoms without receiving an HIV test. These findings suggest that risk perception is complex and that outdated stereotypes of who is at risk for HIV influence individual and medical community decisions to test. Social workers can play a key role in helping their clients recognize their risk for contracting HIV, thus facilitating behavior changes and early testing. Future research replicating risk perception categories in a more diverse sample will be used to develop risk perception screening tools and interventions.