Background: The Centers for Disease Control and Prevention (CDC)’s new revised guidelines for HIV testing (September 2006) recommend routine voluntary HIV testing in all health care settings. This HIV testing approach has been a subject of intense debate and controversy among HIV stakeholders, activists, and people living with HIV and AIDS in Nigeria and elsewhere. Here, the objective was to identify potential patient barriers to routine HIV testing in Nigeria

Methods:  We screened for enrolment 840 consecutive admissions into the medical wards of 3 Nigerian tertiary hospitals. Interviewer-administered structured questionnaire was administered by house interns. The questionnaire included questions on sociodemographic data, reasons for nonparticipation in the study and for not testing for HIV, high-risk behaviors, and other risk factors for HIV. Consented patients could choose to complete the questionnaire alone, or to complete the questionnaire and undergo rapid HIV test.

Results:  Of the patients screened for enrolment, 622 (74%) consented to participate in the study, of whom 508 (82%) chose to complete the questionnaire and undergo rapid HIV test, and 114 (18%) chose to complete the questionnaire alone. Another 118 (26%) declined to participate in the study. Patients who declined to participate in the study were more likely to be female (75% vs 44%, p = 0.014), single (66% vs 51%, p = 0.02), of low socioeconomic class (89% vs 32%, p <0.001), and younger than 35 years (62% vs 54%, p = 0.04). Major reasons for nonparticipation were:  fear of stigma (42%), not considering themselves having risk factors for HIV (37%), and having previously been tested for HIV (29%). Of the patients who participated in the study, 260 (42%) had ≥1 risk factor for HIV, while 174 (28%) had >2 risk factors, but did not consider themselves at risk of HIV; 37 of 508 patients (7.2%) who did the HIV testing were positive for HIV; more than three-quarters of whom had ≥risk factors for HIV.

Conclusions:  The study shows that almost half of patients who participated in the study had ≥1 risk factors for HIV, but never considered themselves at risk of HIV. This study reinforces the assertion that risk-based HIV testing fails to identify all HIV⁺ and the feasibility of routine rapid HIV testing in inpatients not only in Nigeria but all of Sub-Saharan Africa.