Voluntary human immunodeficiency virus testing: acceptance levels and identification of seropositive individuals.

Of 4340 clients of a clinic for those with sexually transmitted diseases who were eligible for voluntary, confidential, serologic testing for the human immunodeficiency virus, 4246 (97.8%) consented to testing; 23 (0.5%) were seropositive. Of 94 persons who declined voluntary testing but who were tested in a blinded study, nine (9.6%) were seropositive. Seropositive persons who declined voluntary testing did not conceal their association with a risk group, while only 61% of seropositive individuals who accepted voluntary testing admitted to inclusion in a risk group before the test. Voluntary testing appears to be insufficient, because 28% of the seropositive individuals were not identified as being seropositive; also, there was a significant deficiency associated with identification of risk at pretest counseling among persons agreeing to voluntary testing.

Voluntary human immunodeficiency virus testing, recidivism, partner notification, and sero-prevalence in a sexually transmitted disease clinic: a need for mandatory testing.

Universal, voluntary testing for antibodies to the human immunodeficiency virus (HIV) was offered to 17,092 eligible clients attending a public sexually transmitted disease clinic between March, 1988 and June, 1989. In an environment of legally mandated reporting and partner notification, 15,649 (91.6%) clients were tested, 160 of whom were HIV sero-positive. Client acceptance of testing is discussed, and the serologic data compared with results of a federally funded sero-prevalence survey conducted in-clinic. A recidivism rate of 20% was observed among sero-positive individuals. Of 159 contacts for whom HIV sero-status was determined, 66 (42%) were seropositive. It is proposed that, in the setting of sexually transmitted disease clinics, HIV testing be changed from a voluntary service to a mandatory test. Some benefits of this change are defined.