This document discusses barriers to HIV testing like fear, cost, and stigma. It presents research showing that HIV self-testing could increase testing rates by improving access and reducing stigma compared to traditional testing. Studies found that tests were most acceptable if done at home, provided immediate results, and were free. Oral rapid HIV self-tests that are private may help address stigma by allowing discreet testing. While not perfect, self-testing has the potential to boost rates by overcoming barriers like lack of access and moral judgment associated with clinical testing.

1. Psychology of HIV Self-Testing
Sean D. Young, PhD, MS
UC Institute for Prediction
Technology
UCLA

2. Barriers to HIV Testing
§ Fear of results
§ Cost
§ Lack of information/knowledge
§ Access
§ Potential moral stigma
Young, Nussbaum, & Monin. Potential Moral Stigma and Reactions to Sexually Transmitted Diseases: Evidence for a Disjunction Fallacy.
Personality and Social Psychology Bulletin, 33(6), 2007; 789-799.

3. Serostatus Awareness
§ Opportunity to reduce new HIV infections
§ 25% are unaware of their HIV infection
§ Half of new HIV cases occur from sero-unaware individuals

4. Access to Testing
§ Study showed an HIV test is most acceptable if:
§ 1) Done at home
§ 2) Immediate
§ 3) Free
Lee SJ, Brooks R, Bolan RK, Flynn R. Assessing willingness to test for HIV among men who have sex with men using conjoint analysis, evidence
for uptake of the FDA-approved at-home HIV test. AIDS Care. 2013; 1-7. [PMID: 23651439]

6. Potential Moral Stigma
§ Voice Trial
¤ On the basis of returned product counts -- adherence to drugs
was 86%.
¤ Random blood testing suggested the true rate of adherence
was less than 40%, the researchers found.
§ They found that many women were afraid to use the
medications, either because they feared toxicity or
because they were worried about being falsely labeled as
having HIV.
§ Similar findings for HIV testing (NHAMCS data)

7. Ways to Address Stigma
§ Change social norms to destigmatize
§ Give people an excuse to test for HIV(not related to HIV)
§ High incentives for testing
§ Opt-out/default
§ Increase access
§ Change situation to avoid potential moral stigma
§ Make behavior private

9. Oral rapid HIV tests
§ Oral test
§ Results in 20-40 minutes
§ Self-administered
§ Private testing experience
§ False negatives

10. 22
15
8
Very Strongly or strongly prefers
OraQuick
Equal or near equal Preference Very Strongly or strongly prefers
traditional testing
NumberofParticipants Preference of OraQuick vs Traditional testing:

11. Conclusion
¤ People avoid HIV testing because of
§ Fear of results
§ Cost
§ Lack of information/knowledge
§ Access
§ Potential moral stigma
¤ Self-testing has the potential to increase testing by increasing
access and reducing stigma

12. Thank You!
CFAR NIMH
LA Gay and Lesbian Center Robert Marlin
Jeffrey Klausner Justin Kwok
Robert Bolan Emily Huang
Risa Flynn Mark McGrath