The decision-making process of self-initiated HIV testing among youth: A qualitative study

Background In the United States, youth have the lowest rates of HIV testing in comparison to the general population. Only 33% of youth aged 18 to 24 years have ever been tested for HIV infection, and approximately 51% of HIV-infected youth are unaware of their HIV serostatus. Low rates of HIV testing drive transmission, late diagnoses, and poor health outcomes including difficulty achieving viral suppression and death. Self-initiated testing (i.e., testing without the immediate recommendation of a clinician) has been identified as a strategy that can improve testing rates in this population. However, little is known about how youth self-initiate HIV testing or strategies that can enhance its uptake. Therefore, the purpose of this study was to describe the decision-making process of youth who self-initiated HIV testing. Methods A qualitative study was conducted with 30 youth aged 18 to 24 years who self-initiated HIV testing, recruited directly from multiple HIV testing sites in South Florida. Data was collected using a demographic and sexual history questionnaire and audio-recorded individual in-depth interviews. Data analysis occurred using interpretative phenomenological analysis, allowing the rigorous exploration of participant’s experiences and perspectives. Results The findings from this study describe how youth acknowledge their vulnerability to HIV infection and navigate the process of deciding and self-initiating testing. Some supporting themes that further explain this finding include Self-convincing, Conversation Prompts, The Right Place and Right Time, and Finding HIV testing sites. Conclusion Despite current clinical guidelines recommending routine HIV testing, there are still challenges in HIV testing among youth. Findings from this study are pivotal for subsequent studies that seek to further understand self-initiated HIV testing among youth and design targeted interventions that will improve testing uptake. Additionally, this study will reveal areas for recommendations that will enhance structuring and targeting of HIV testing services for youth.