As AIDS prevention workers, we are concerned about the fact that our clients aren't getting HIV antibody tested, despite the fact that they are at considerable risk of HIV infection and that if they find out that they are HIV positive, they can access early intervention services.

To address this issue, our first question would be:

1) Why do we want our clients to get HIV tested?

Our primary reason for wanting our high-risk clients to be HIV tested is to enable those who test positive to obtain early intervention services for HIV infection.

Our next question then becomes:

2) Why don't our clients get HIV tested, so those who are seropositive can start early intervention services for HIV?

We decided to ask some of our clients this question, and discovered that there were a number of reasons why they have been unable or unwilling to be tested, and that the actual process required for HIV antibody testing is often difficult. We also discovered that the barriers are different among those individuals who believe they are HIV seropositive, as compared with those believe they are negative. We decided to only study the individuals who believe they are serpositive.

Our question then becomes:

3) Among individuals in our client population who believe they are seropositive, what are the barriers to confirming their serostatus and to subsequently obtaining early intervention services?

When we considered the appropriateness of asking this question, we realized that they were several different sub-groups served by our program, each of which might have different barriers to care. Our agency serves a population with 30% involved in sexual relationships and 70 % that are just worried. The majority of the clients were of both male and female and gay or lesbian clients were identified. Primary causes of infection are very different among young men and young women. The HIV epidemic in young men is concentrated among gay men (men who have sex with men) or wives who contract it from their partners.

We felt that understanding the reasons not to have access to testing was crucial, causing the following change in our research question:

4) Are the barriers to HIV testing and early intervention for those who believe they are HIV positive the same

-for those who are having sexual relations as those

-for people who are just worried ?

In the Middle East, sex is taboo. AIDS is linked to sex as a second taboo. Homosexuality, heterosexual affairs (outside of marriage) and the sex trade are all against our cultural beliefs, even though they exist on a large scale, they are not tolerated. This often leads to a tendency to be silent about sexual activities and realities.

Sex practices are another obvious high-risk activity in which it may be difficult for young people to take precautions against HIV and other STDs. Other vulnerable populations, such as emotionally disturbed adolescents in high schools, are at increased risk for HIV and should receive appropriate, targeted prevention interventions.

For us to build confidence with our people means big efforts must be made assuring clients that we are not leaking information to official authorities in their original countries or their relatives here.

Following this thought-process we now decide we would like to pose this question:

5) What is the difference between confidential and anonymous testing?

It is very important that anyone who is getting tested for HIV understand the confidentiality policies of the testing centers.

   Training of human resources for the education of information dissemination agents concerning STDs and HIV/AIDS.
   Confidential Testing: The confidential testing site records the person's name with the test result. Records are supposed to be kept secret from everyone except medical personnel. Usually individuals should ask who will know the results and how the record will be stored, if the HIV-antibody test is done confidentially.

   Anonymous Testing: No name should be given. The person getting tested is the only one who can tell anyone else his/her test results.