Date of Award

11-15-2006

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Frederick Altice

Abstract

We examined health beliefs among drug users about mandatory HIV testing of newborns and voluntary versus mandatory testing of pregnant women. We also examined to what extent negative experiences and stigmatization affect attitudes towards HIV testing. Baseline structured interviews of active drug users from 1997-2001 were examined. Multivariate data analysis was performed using SAS statistical software. Subsequently, five distinct focus groups were conducted in September 2003. Focus groups were transcribed, coded and analyzed using Microsoft Word 2000. Of 610 drug users interviewed, nearly all (89%) had been previously HIV tested. Nearly all (91%) subjects believed pregnant women should be tested for HIV. More subjects who had prior HIV testing believed all pregnant women should be HIV tested (92.9% vs. 82.6%, p=0.008). Though 86% of subjects agreed with testing of all newborns, only 57% of all subjects believed that this should be mandatory. Among women, however, more injectors than non-injectors would avoid prenatal care if HIV testing was required during pregnancy (16.2% vs. 6.1%, p<0.01). Of the 499 subjects reporting a usual site for care, 31.8% believed that "certain types of people" received better treatment than others. Not using drugs, being of a certain race/ethnicity, and having private insurance were associated with receiving better care. Perceived discrimination by the healthcare system was also cited as a barrier to acceptance of testing strategies. In the focus groups, arguments against mandatory testing of pregnant women included the loss of choice, right not to know HIV status, and the belief that mandatory testing was both a means of provoking rebellion and promoting discrimination. Concern for the babys health was the primary reason for supporting mandatory newborn testing. The current practice of mandatory newborn and voluntary prenatal screening for HIV in Connecticut appears to have been acceptable to a population of stigmatized drug users with or at risk for HIV. Despite acceptance, perceived discrimination by the healthcare system persists and may result in adverse outcomes for drug using men and women.

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This is an Open Access Thesis.

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