Acceptability of HIV Testing Sites Among Rural and Urban African Americans Who Use Cocaine

Abstract

African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate that rural AA who use cocaine have lower odds of viewing local health departments (OR=0.09, 95%CI=0.03–0.21), physician offices (OR=0.19, 95%CI=0.09–0.42), and drug use treatment centers (OR=0.49; 95% CI=0.30–0.80) as acceptable relative to their urban counterparts. The findings have implications for further targeting HIV testing toward AAs who use of cocaine, particularly those residing in the rural South.

“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

“…HIV-related discrimination and poor treatment in healthcare settings was identified as another barrier to HIV testing. This finding is consistent with US research showing pervasive HIV-related discrimination in clinical settings [8,24,25]. Currently, the majority of HIV testing in the United States occurs in STI clinics, which are more successful at identifying new positives among White men and those already connected to healthcare [20].…”

“…HIV-related stigma among healthcare workers has been shown to be pervasive in the Deep South, particularly among those who are Protestant, White, and working in an HIV/STI clinic [8]. As a consequence, highly affected populations within African American communities delay HIV testing due to anticipated HIV stigma [8], and regard local health departments, physical offices and drug use treatment centers as places to avoid being tested [25]. Participants' suggestions to disconnect testing from clinical settings and limit interactions with health care providers (i.e., testing kiosks, HIVST kits, community testing) may assist with reducing negative perceptions about HIV testing experiences.…”

Barriers to HIV Testing and Opportunities for Expansion Using Home-Based HIV Self-Testing: Results of a National Study of Higher HIV Risk Young Men Who Have Sex With Men

“…As in previous studies, we did observe greater enthusiasm for home-based HIV self-testing among those not tested in accordance with national guidelines (Katz et al, 2018; Lightfoot et al, 2018; Sharma et al, 2014; Zhang et al, 2017). In addition to not necessitating access to traditional HIV testing venues, home-based self-testing does not require having a clinician nor asking a clinician for a test, which is one of the major barriers to testing (Branham et al, 2017; Frye et al, 2018; Levy et al, 2014; Qin et al, 2018). Both promotion and distribution of home-based self-testing can be facilitated online, eliminating geographic barriers (Wesolowski et al, 2018).…”

Assessing Differences in CDC-Funded HIV Testing by Urbanicity, United States, 2016

“…However, the percentages of persons referred to partner services and referred to HIV prevention services were highest in urban areas; the proportion of persons interviewed for partner services was highest in rural areas. This may be due to various reasons, including differences in population sizes (e.g., fewer number of persons to follow up with in rural areas); the availability of HIV prevention and medical services (e.g., greater availability in urban areas compared to rural areas); the utilization of medical services (e.g., rural persons were more likely to visit a doctor in the past year and to have a regular doctor than non-rural persons [28]); and/or other factors.…”