Irwin K L, Valdiserri R O, Holmberg S D
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
AIDS. 1996 Dec;10(14):1707-17. doi: 10.1097/00002030-199612000-00016.
As the benefits of early diagnosis of HIV increase, US adults are more likely to be offered HIV counseling and testing in settings where they may not seek testing. Rates and determinants of counseling and testing acceptance in these settings are poorly understood.
We reviewed articles and abstracts published from 1985 to 1995 which addressed rates or determinants of counseling and testing acceptance in facilities that provide perinatal, family planning, gynecology, sexually transmitted disease (STD) and drug treatment services, hospitals, and prisons. Data reflected testing experience of more than 240,000 adults.
Acceptance rates varied widely (3-100%), even within settings of the same type. Acceptance was generally higher (> 50%) among persons at high risk for acquiring or transmitting the infection (e.g., STD patients, pregnant women at high risk) than among low-risk persons. Factors associated with high acceptance rates included the client's perception of HIV risk, acknowledging risk behaviors; confidentiality protections; presenting counseling and testing as 'routine' rather than optional; and the provider's belief that counseling and testing will benefit the client. Factors associated with low acceptance rates included prior HIV testing, fears about coping with results, and explicit informed consent.
To institute and evaluate counseling and testing programs for persons who do not specifically seek testing, multiple determinants of acceptance must be considered. Practices that protect confidentiality, endorse counseling directed to a client's unique circumstances, and highlight the medical and social benefits of testing are likely to promote acceptance. Acceptance of counseling and testing offered nonroutinely to the numerous Americans who have been previously tested or are at low risk is likely to be low.
随着早期诊断HIV的益处不断增加，美国成年人在一些他们可能不会主动寻求检测的场所更有可能接受HIV咨询和检测。在这些场所中，咨询和检测接受率及其决定因素鲜为人知。
我们回顾了1985年至1995年发表的文章和摘要，这些文献涉及在提供围产期、计划生育、妇科、性传播疾病（STD）和药物治疗服务的机构、医院及监狱中咨询和检测接受率或其决定因素。数据反映了超过24万名成年人的检测经历。
接受率差异很大（3% - 100%），即使在同一类型的场所中也是如此。在感染或传播该感染风险较高的人群（如STD患者、高危孕妇）中，接受率通常高于低风险人群（>50%）。与高接受率相关的因素包括客户对HIV风险的认知、承认风险行为；保密保护；将咨询和检测作为“常规”而非可选项提供；以及提供者认为咨询和检测将使客户受益。与低接受率相关的因素包括先前的HIV检测、对应对检测结果的恐惧以及明确的知情同意。
要为未特意寻求检测的人群制定和评估咨询及检测项目，必须考虑多个接受率的决定因素。保护保密性、认可针对客户独特情况的咨询并强调检测的医学和社会效益的做法可能会促进接受率。对于众多先前已接受检测或处于低风险的美国人，非例行提供的咨询和检测的接受率可能较低。
