Barriers to universal prenatal HIV testing in 4 US locations in 1997

Objectives. We determined rates of prenatal HIV testing and investigated ba rriers to testing. Methods. We surveyed 1362 representative parturient women from 7 hospitals in 4 locations of the United States. Results. Overall, 89.9% of women reported being offered HIV testing and 69. 6% reported being tested. Proportions of women not offered testing differed by location (range= 5.2%-16.3%), as did proportions not tested (range= 12. 2%-54.4%). Among women who perceived that their clinicians had not recommen ded testing, 41.7% were tested, compared with 92.8% of women who perceived a strong recommendation (P < .05). Private insurance for prenatal care was also associated with not being tested. Women gave multiple reasons for not being tested, most commonly not being at risk, having been tested recently, and the test's not being offered or recommended, cited by 55.3%, 39.1% and 11.1% of women, respectively. Conclusions. Although most parturient women were offered a prenatal HIV tes t and got tested, testing proportions did not reach national goals and diff ered significantly by location and payment-status. Concern about testing co nsequences was not a major barrier. Perception of clinicians' recommendatio ns strongly influenced testing. Changing provider practices will be essenti al to implementing universal prenatal HIV testing.