Elsevier

Nursing Outlook

Volume 60, Issue 2, March–April 2012, Pages 72-80
Nursing Outlook

Article
Policy
Recommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions

https://doi.org/10.1016/j.outlook.2011.06.002Get rights and content

Abstract

In 2006, the Centers for Diseases Control and Prevention (CDC) released recommendations calling for routine HIV testing to be offered to those ages 13 to 64 as a standard of general health care. This recommendation included a plan to conduct HIV testing as part of a general consent. The reasoning and evidence for this recommendation is supported by experts, patients, and sponsored screenings by the CDC. The rationale behind this approach includes that knowledge of one’s HIV status helps (1) infected individuals adopt risk-reduction behaviors and access to life-prolonging treatment and (2) uninfected individuals maintain behaviors that reduce their risk of becoming infected. This article discusses the perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions that can be part of a nurse-led contribution to develop and adopt innovative, patient-centered care models that can address the need for screening.

Section snippets

CDC Recommendations on HIV Testing

In light of the changing shape of the epidemic, the Centers for Disease Control and Prevention (CDC) released revised recommendations for HIV testing calling for routine HIV testing to be offered to those ages 13 to 64 in all health care settings as a standard component of general health care.13 Important changes included in this recommendation include eliminating the endorsement of a separate written consent form before an HIV test can be performed, instead calling for HIV testing to be

Perceived Patient Barriers

Although there is evidence that negative attitudes, beliefs, and policies directed toward those perceived to have HIV have declined over the years, HIV-related stigma and mental health sequelae from stigma remains the most significant barriers to routine HIV testing from a patient perspective.17 More than one-third of those surveyed in a poll conducted by the Kaiser Family Foundation reported they would feel “very” or “somewhat” concerned that people would think less of them if they learned

Summary

Barriers to the CDC’s recommendation for routine testing from a patient, provider, and policy perspective are complex (Table 2) and require solutions in which nurse leaders can transform barriers to opportunities. Concentrated, sensitive, and respectful efforts must advance solutions that recognize state power, the abject perceived and real fears of stigma and discrimination, and the need to find ways to develop payment for screening kits and to expand linkages for services after a positive

Acknowledgments

Thanks to the members of the American Academy of Nursing, Emerging and Infectious Disease Expert Panel for their supportive suggestions.

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