Public attitudes towards opt-out testing for HIV in primary care: a qualitative study

Background The rate of new HIV infections in the UK continues to rise, with one-quarter of cases undiagnosed. Opt-out HIV testing - in which tests are routinely offered to all patients, with the offer to decline - have proved effective in antenatal care. Pilot studies of HIV opt-out testing at GP registration and acute medical admission to hospital have described service-level issues and the clinician's perspective, but not the views of the general public. Aim To further understand the public's perspective on opt-out testing for HIV in England. Design and setting Focus groups [n = 9] with a total of 54 participants in Brighton, England, where HIV prevalence is high. Method Quota sampling on sexual orientation, age, sex, and testing experience was applied to groups with high and low HIV prevalences, and analysed using framework analysis. Results Opt-out testing for HIV was acceptable. Testing on GP registration was regarded as a more appropriate setting than acute medical admission. Participants from groups in which HIV has a higher prevalence felt HIV testing required consideration that may not be possible during acute hospital admission. However, there was concern that screening would still be targeted at groups in which HIV prevalence is higher, based on clinicians' judgement of patients' behaviours, sexuality, or ethnicity. Conclusion The opt-out method of testing for HIV must be routinely offered to all who are eligible, to increase test uptake and to prevent communities feeling targeted. Any pressure to test is likely to be poorly received. Inaccurate concerns about medical records being shared with financial services are a disincentive to test. Primary care should be an active setting for opt-out HIV testing.