Influence of perceived and assessed risk on STD clinic clients' acceptance of HIV testing, return for test results, and HIV serostatus

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Abstract
The provision of counselling and testing (CT) for human immunodeficiency virus (HIV) is an important component of publicly funded HIV prevention efforts in the US and is routinely provided in sexually transmitted disease (STD) clinics. We examined data from 51,359 client visits to Illinois STD clinics from 1991 to 1993 to evaluate the relationships of self-perceived and assessed risk for HIV infection with: (1) receiving HIV pretest counselling, (2) having blood drawn for HIV testing, (3) returning for HIV test results and post-test counselling, and (4) HIV serostatus. Overall, 22.7% of clients perceived themselves to be at risk, while 28.7% were assessed at-risk, with more than two-thirds of all clients correctly perceiving their assessed risk for HIV. Individuals who perceived themselves to be at risk were more likely than those without perceived risk to complete each stage of CT. Assessed risk was not, however, significantly associated with returning for test results. Those with either perceived risk or assessed risk were more likely to be seropositive than those with no perceived or assessed risk. African Americans (25%) were much less likely (p < 0.001) to return for test results than either Hispanics (43%) or Whites (56%), yet perceived risk was most strongly associated with return rates for African Americans. Additional significant differences associated with gender, ethnicity, and their interaction with perceived and assessed risk were also observed for CT participation and HIV serostatus. Implications of these findings for HIV prevention efforts are discussed.