Research has identified a range of factors that affect people’s motivation to take an HIV test. Studies conducted with men who have sex with men have found that new circumstances, such as a new relationship or unexplained health problems, can prompt some people to test. However, individuals who test regularly tend to see it as the ‘responsible’ thing to do and are not necessarily motivated by specific risky incidents. While many people test in order to eliminate the uncertainty of not knowing their HIV status, others may respond to uncertainty with denial – for example, through assessing their own behaviours in a way that minimises the possibility of an HIV-positive status. Individuals may fear that discovery of an HIV-positive status would mean facing difficult decisions and responsibilities, especially in relation to sexual partners.

The stigma associated with HIV infection is identified as a barrier to testing in all populations, but especially so in black African communities. People fear exclusion and social isolation as consequences of being diagnosed with HIV. Many people associate HIV with promiscuity or unfaithfulness, and see themselves as being at very low risk of infection – many are unaware of the high rates of HIV infection in UK African communities. Other urgent priorities (economic survival, immigration problems, childcare responsibilities etc.) may take precedence over health-seeking behaviour, especially as not everybody is aware of the value of a test in the absence of symptoms or knows where to get tested.

Many people with undiagnosed HIV who have symptoms go to GPs and other health services, but may be treated by clinicians who are reluctant to recommend an HIV test, or who do not consider the possibility of HIV infection (although guidelines recommend HIV testing if a patient has an ‘indicator condition’). Research suggests that more routine or ‘opportunistic’ offers of HIV tests by healthcare professionals (outside of sexual health services) are acceptable and would facilitate greater uptake of testing, especially in African communities.