Background and Objectives: We sought to evaluate the HIV seropositivit
y of patients who refused or accepted human immunodeficiency virus (HI
V) testing in a South Carolina sexually transmitted diseases (STD) cli
nic, and the patients' reasons for refusing or accepting testing. Stud
y Design: A serologic and self-administered survey done Jan. 9 through
June 1, 1989. For those who refused HIV testing, a routine syphilis s
erology sample was tested blindly for HIV. Results: Of 1,929 patients
in the study, 398 (21%) refused HIV testing. HIV test refusers were 2.
2 times more likely to be HIV antibody positive than HIV test accepter
s (3.0% versus 1.4%, prevalence ratio = 2.2, CI95 1.1-4.4), with this
difference mainly occurring among males. Seven of eight patients repor
ting that they refused testing because they were HIV positive were fou
nd to be HIV negative. The principal reason indicated for test refusal
was not feeling at risk for HIV infection. The principal reasons indi
cated for test acceptance were wanting to know the results for their o
wn health status and wishing to prevent spread of the virus to partner
s. Conclusion: We conclude that: (1) a higher seropositivity exists am
ong HIV test refusers than accepters; (2) patient reporting HIV seropo
sitivity should be viewed with caution; (3) many STD patients deny the
ir risk for HIV; and (4) STD patients are concerned about transmission
of HIV to their partners.