HIV counseling and testing of pregnant women and women of childbearing age by primary care providers: self-reported beliefs and practices.

This study describes primary care providers' beliefs and self-reported practices regarding HIV counseling and testing of pregnant women and women of childbearing age. The Centers for Disease Control and Prevention (CDC) recommends that providers counsel and encourage all pregnant women and women of childbearing age to be voluntarily tested, and California requires providers to offer voluntary testing to all pregnant women. We randomly sampled 180 primary care providers in 1995 from the nine-county San Francisco Bay area using a self-administered, mailed survey (response rate = 73%, N = 121). Eighty-six percent of primary care providers (obstetricians/gynecologists, internists, family practitioners, or general practitioners) support voluntary testing, 61% support routine testing without explicit consent, and 55% support mandatory testing. Although 90% of providers are very likely to encourage pregnant women with risk factors to be tested, only 34% are very likely to encourage pregnant women without risk factors to be tested and only 9% are very likely to encourage women of childbearing age without risk factors to be tested. Few providers state that they support policies targeting testing to women with risk factors, yet in practice, providers are much more likely to encourage testing for women with risk factors than those without risk factors. We conclude that providers may be missing opportunities to encourage women to be tested, and women may not be receiving adequate information to make an informed testing decision. Future research is needed to determine the viability of voluntary testing and how to remove barriers to its implementation.