Background:  As the HIV epidemic continues at the pace of 40,000 new cases per year, the Centers for Disease Control and Prevention (CDC) announced new revised guidelines for HIV testing in September 2006. These guidelines recommend routine voluntary HIV testing in all health care settings. Patient barriers to routine voluntary HIV testing in hospitalized patients have not been evaluated in New York City, 1 of the epicenters of the United States HIV/AIDS epidemic. Our objective was to identify potential patient barriers to routine, voluntary HIV testing in a high prevalence community in New York City.

Methods:  Consecutive admissions to the General Internal Medicine service were screened for enrollment. Participants could choose to complete a survey only, or to complete the survey and undergo HIV testing using the OraQuick Rapid HIV test.  Limited demographic data and the reason for declining were obtained in those patients who choose not to participate.

Results:  Of the 420 patients we approached to participate in this study, 100 patients participated in both the survey and rapid HIV test, 18 of whom chose to take the survey only; 302 patients declined to participate. Patients who chose not to participate in the study were more likely to be female (65% vs 52%, p = 0.018) and over age 50 years (73% vs 51%, p <0.001). These patients commonly reported that they had no risk factors for HIV (26%) or that they had previously been tested (25%). Of the 118 patients who completed the survey, 37% did not consider themselves at risk for HIV acquisition despite reporting ≥1 risk factors. Among the 100 patients who underwent rapid HIV testing, there were 3 new diagnoses of HIV. While 2 of these patients reported high-risk behaviors, the third patient, a 68-year-old man, reported no risk factors for HIV acquisition.

Conclusions:  Despite 25 years of educational programs targeting the HIV/AIDS epidemic, nearly 40% of subjects in the current study reported at least 1 risk factor for HIV acquisition, yet failed to recognize that they were at risk for HIV. These results suggest that risk-based testing will continue to fail, and provide further support for routine, voluntary HIV testing. This study also demonstrates the feasibility of rapid HIV testing in hospitalized patients, expanding the opportunities for timely diagnosis and intervention.