The purpose of the proposed dissertation study is to determine the most common barriers and facilitators to testing for the human immunodeficiency virus (HIV) among residents of an impoverished urban African American community located in Baltimore, Maryland. The community of interest sustains high HIV prevalence and incidence rates, and is also burdened with widespread injection drug use and other high risk behaviors known to be the community's predominant modes of HIV transmission. It is hoped that the study's findings will inform new and ongoing public health initiatives, with an emphasis on more effectively encouraging widespread testing among residents of this and similarly high risk urban minority neighborhoods. In turn, wider testing will increase opportunities for prevention and treatment, and address the community's health disparities related to the HIV epidemic. The objectives of the proposed study are as follows: (1) For those residents who have previously been tested for HIV, to determine the factors that motivated them or facilitated their getting tested for HIV (""""""""facilitators""""""""); and (2) for those residents who have not previously been tested for HIV, to determine the factors that dissuaded or impeded them from seeking or getting tested for HIV (""""""""barriers""""""""). Primary cross-sectional data will be collected via a door-to-door household survey from a probability sampling of 200 male and female adult residents (18 years or older) whose households have been randomly selected from all residential households located in the top ranking census tract in Baltimore City for cumulative incident AIDS cases (1994-2002). Residents will be asked a spectrum of questions, based on a variation of the Health Belief Model, about their knowledge, behaviors, access to care, and perceptions related to HIV disease. Subjects' socio-demographics will also be recorded and subjects will be asked if and why they have ever been tested for HIV (outcome variable). Because of the sensitive nature of the data to be collected, the principal investigator will request a Certificate of Confidentiality from NIH to minimize exposure of study subjects' identity. Once data collection is completed, logistic regression analyses will be conducted to identify associations between knowledge, behaviors, access to care, perceptions, and HIV testing. Public Health Relevance This study supports the September 2006 recommendations for expanded HIV testing issued by the Centers for Disease Control and Prevention, and the specific recommendation to test """"""""subpopulations of persons at higher risk, typically defined on the basis of behavior, clinical, or demographic characteristics (italics mine) (CDC, 2006c)."""""""" ? ? ? ?
