Correlates of acceptance of HIV testing and post-test counseling in the obstetrical setting

Recent results of AZT testing among pregnant women by NIH indicate that early diagnosis and medical intervention can reduce vertical transmission of HIV. Debates have been rekindled concerning whether testing should remain voluntary or be made mandatory. This article analyzes predictors of women's decisions to accept testing voluntarily and return for their test results. Although derived from the postpartum setting, this information is also likely to be useful in understanding voluntary acceptance of prenatal HIV testing, as well as acceptance among those who are hard to reach during pregnancy. Results indicate that the time spent counseling each client and the individual HIV counselor were the best predictors of which women were most likely to test. Minority, self-paid, or uninsured clients, and women with little prenatal care were least likely to return for post-test counseling. The findings of this study point to the central importance of the counselor and the counseling process and to the relatively lesser impact of patient characteristics. Further study of counseling content and counselor performance is recommended.