A BALANCING ACT - THE TENSION BETWEEN CASE-FINDING AND PRIMARY PREVENTION STRATEGIES IN NEW-YORK STATES VOLUNTARY HIV COUNSELING AND TESTING PROGRAM IN WOMENS HEALTH-CARE SETTINGS

This study sought (1) to identify factors that influence women's willi ngness to accept voluntary HIV counseling and testing at New York Stat e Family Planning Programs (FPPs) and Prenatal Care Assistance Program s (PCAPs) and (2) to-evaluate the effectiveness of such a voluntary co unseling and testing program. Telephone interviews elicited organizati onal-level data from 136 agencies; a combination of telephone and face -to-face interviews was used to gather provider data from 98 HIV couns elors; and client data were gathered from 354 women in face-to-face in terviews at counseling sites. Slightly fewer than 60% of women agreed to be counseled, and, of those, under half consented to an HIV test at the counseling site. Approximately two thirds of the women who were t ested returned for their results and posttest counseling. Clients' rec all of pretest counseling content was relatively poor. Bivariate and r egression analyses suggest that client, provider, and organizational f actors are all associated with rates of pretest counseling and testing . The current voluntary counseling and testing program is achieving on ly moderate success. Although a substantial number of clients accept H IV counseling, many women remain reluctant to consent to HIV testing, and many who accept testing do not return for their results. Moreover, among those who receive pretest counseling, many do not recall import ant informational content, which suggests variation may exist in the q uality of counseling or that one-time HIV counseling interventions are insufficient to communicate complex information. Medical Subject Head ings (MeSH): AIDS, HIV serodiagnosis, women's health, patient educatio n.