Patients like the idea of opt-out HIV testing at GP surgeries but some have concerns about confidentiality, a qualitative UK study has found.

The study used focus groups drawn from Brighton, which has a diagnosed HIV prevalence of 7.59 per 1,000 patients, to elicit attitudes and concerns regarding HIV opt-out testing.

Participants were recruited via email or letters to community organisations as well as classified advertising on websites. They were divided into focus groups based on sexual orientation, age, sex and ethnicity by using a quota sampling framework.

The 54 participants, aged 17-58, average 29 years, were allocated to nine distinct groups with a variety of HIV-testing experiences. There were difficulties recruiting black African HIV-negative women so a group of HIV-positive black African women were recruited instead. All other groups were HIV negative or untested.

The nine focus groups were:

• Untested/HIV-negative younger (≤ 24 years) heterosexual men

• Untested/HIV-negative older (≥ 25) heterosexual men

• Untested/HIV-negative younger heterosexual women

• Untested/HIV-negative older heterosexual women

• HIV-negative younger men who have sex with men (MSM)

• HIV-negative older MSM

• Untested younger MSM

• Untested/HIV-negative black African men

• HIV-positive black African women

Each focus group had an average of six people and the meeting lasted 45-120 minutes. Discussion focused on a topic guide developed from a literature search which included: aspects of HIV testing, experiences of HIV testing, potential barriers or motivators to testing, hypothetical situations for offering an HIV test and views on opt-out proposals. Participants were offered £15 to compensate for their time.

There appeared to be an affirmative view from all groups that opt-out testing is acceptable. However, there were misconceptions about negative HIV tests affecting health insurance applications. Although many thought testing at GP registration was appropriate and acceptable, younger participants were concerned about confidentiality and worried other members of their family registered with the same practice might find out.

Groups with higher HIV prevalence were most concerned about HIV testing at acute hospital admissions. Some participants from the same groups also voiced concerns that a doctor’s status and authority might pressurise people to test against their will and any perceived pressure was considered a factor that might discourage them to accept it.

Interestingly, in the groups with low HIV prevalence, there appeared to be a view that there was a social pressure for those at risk to test, and declining a test was considered to be selfish. People in high prevalence groups would prefer some time to consider the test and its implications.

Participants from high prevalence and some younger groups thought being offered HIV testing meant they were being judged on their sexuality, race or sexual practice. However, participants felt that a universal offer to all eligible patients with the opportunity to opt-out was more likely to normalise HIV testing and increase the likelihood of acceptance.

Although the study failed to recruit some key risk groups such as older MSM and black African women of any age who have never been tested, the findings from this study are likely to be generalisable to areas where HIV prevalence is > 2 per 1,000.

It was reassuring to read that many people felt general practice was a suitable place for opt-out HIV testing, but also disheartening to hear some concerns about confidentiality and the misconception that negative HIV tests affect future insurance applications. These barriers are not insurmountable and can be dealt with by simple leaflets or posters to encourage testing, especially by groups who are hard to reach.

Dr Richard Ma

• Glew S, Pollard A, Hughes L, Llewellyn C. Public attitudes towards opt-out testing for HIV in primary care. Br J Gen Prac 2014; DOI:10.3399/bjgp14X6777103