Table 4.

Themes and quotations from qualitative interviews

SPEAKER	QUOTATION
Theme: Support for testing
Sub-theme: Lack of support
PT02 No one has ever said to me, “Let’s get tested.” Never, never, never.
Sub-theme: Support from Friends
PT07	I have many lesbian friends [who have suggested that I get tested].
PT11	A female friend advised me to get tested. “Do you need money? Do you need me to take you? To go with you?” The support is important.
PT12	A female friend recommended [that I get tested]. I told her that I was homosexual, and she said, “Why don’t you get tested? It is very important.”
PT20	A [male] friend… informed me that [a research study] was doing free tests, so I took advantage of that.
Sub-theme: Support from Partners
PT13	{Speaking of his conversation with the partner with whom he has a stable, non-monogamous relationship.} We are always saying, “Hey, get tested because it’s been six months. One has contact with the virus all the time”.
PT17	My current partner and I have helped each other, because we tell each other, “Let’s do it. Let’s get it over with.” {However, this person has not been tested}
Theme: Reasons for testing
Sub-theme: Sense of responsibility
PT01	I began to think that I owe it to myself, to get tested every six months.
Sub-theme: Risk perception
PT01	{When asked why he was tested five times} Because I was so promiscuous.
PT05	[I always have sex] with a condom and with a stable partner. Therefore, I don’t think that I need to get tested.
PT12	I’ve been with various partners and two stable partners…. I think that it would be healthy to get tested, because even though I consider myself at low risk, it is still important. {However, this person has not been tested.}
PT15	I had my first test because I was starting a relationship with a partner who had had a reactive test a month earlier. {This person did not have a second test for 10 years, which he explained.} I didn’t see the need to do it.
PT18	You think that it is not going to affect you. I mean, not me, so why should I have to get tested? {This person had tested positive in the quantitative phase of this research project.}
KI06	There are three circumstances under which people agree to be tested: When they realize that they had risky sex, when one of their partners is diagnosed with HIV, or when they get sick and a physician requests the test.
KI09	Unfortunately many people get tested only because they have had a risky episode, or when they find out that a boyfriend from 5 years ago got sick and died, and they don’t know why.
KI10	People engage in risky behaviors and then get tested; they engage in risky behaviors and then get tested; they engage in risky behaviors and then get tested, until one day the test results are positive.
Theme: Barriers to testing
Sub-theme: Fear of needles
PT02	I’m afraid [to get a blood test for HIV], but I’ve had blood drawn for other tests.
PT10	I’m afraid of needles, but the important thing is to know if one is okay or not. {However, this person has not been tested.}
Sub-theme: Stigma
PT02	{Explaining why he would not ask for an HIV test} Because of the way the doctor would look at me…. I mean, there are people who have requested an HIV test, and the doctor backed away…as if he were seeing a “sidoso” [a pejorative term for someone with AIDS].
PT03	{Explaining why he has never discussed his sexual orientation with a doctor} He would send me to get tested,… and I’m afraid because of the stigma around HIV.
PT04	If I told my family that I was going to have an HIV test, they would think that I have sex with guys or that I’m gay.
PT12	{Explaining why he is reluctant to ask a doctor for an HIV test} I think it is somewhat difficult because I’m very shy…. It would bother me that they would think that “this guy has been going to bed with a lot of guys” or something like that.
KI09	The social stigma is so huge for someone with HIV: the consequences can be enormous. So [people] don’t get tested or they don’t request the test.
KI11	In the context of a country like ours, where there is somuch stigma and discrimination, not only would they kick you out of the house, but they could displace you or kill you.
Sub-theme: Fear of lack of confidentiality
PT02	[If I were to get tested], what if my friends found out? I might lose my friends because they found out that I had HIV/AIDS. My family might reject me; I might end up alone; no one would love me; all of that.
PT07	{Describing the process for calling people for consultations concerning test results in the waiting room at his health care provide} There is a big notebook, a red notebook, where all the people with HIV are listed.
PT13	One goes to get the test and encounters all his friends there. And [the staff] comes out and yells, for example, “Hey, reactive patient. Send him to see the doctor.” There is no protocol that guarantees confidentiality.
PT15	I think that people are a little afraid because they still don’t trust the health care system or the people who do the testing. People think that the information will slip out from somewhere, and someone will learn their status at some point.
PT17	{Describing the process in his EPS, where tests results are given in an envelope with other people present} Seeing oneself exposed is not cool…. Everyone is looking, … pointing out “this guy probably has something.”
PT17	{This person, who described himself as a public figure, explained that he tried to get tested abroad.} The issue is not to leave evidence.
KI03	Many people come [to Bogotá] from small towns in other states because they fear confidentiality could be violated [in their small towns] or because their cousin or their friend works at the hospital. And here [in Colombia] barriers can be complex: with our armed conflict, people are afraid that their information could be leaked…
Sub-theme: Lack of money
PT11	I was very young and dependent on my parents. I would have had to tell my parents that I needed money for a medical appointment. How would I justify it?
PT16	If I needed to get an emergency HIV test because I had risky sex or I was with someone who told me that he was positive, I would have to pay out of pocket [an amount] that would be complicated for me right now…. Therefore, I would possibly opt not to get tested and to wait until I had the money to do it.
KI02	{Describing how some people approach testing} “If in addition to having to pay $45,000 pesos, that test might mean that I am going to die soon. In that case I prefer not to know. ” That is a lot of money.
KI04	The context of vulnerability is a challenge. A patient from Ciudad Bolivar, making less than $300,000 pesos per month, has to go to one clinic to receive the referral, then to the EPS for the authorization, then another trip back to the hospital to get the lab tests. Transportation costs become prohibitive.
Sub-theme: Lack of correct information
PT08	I don’t have much information about where to go or how to access [HIV testing].
PT13	This is not the case for me, but lack of knowledge is everywhere. No one knows that … the test is a right that people can demand, therefore no one accesses the test…. Another barrier is the fear of HIV that is generated by the lack of knowledge regarding the infection itself…. We’ve been sold the idea that AIDS equals death and HIV equals AIDS.
KI05	Many hospitals don’t promote testing because even they don’t know that in the health care system a person is entitled to two tests per year.
KI09	There are lots of misconceptions about HIV.
Sub-theme: Fear of being positive
PT02	{Describing how he would feel if he found out he was positive.} I would think of the future that lies ahead for me…. It would be so, so different. I would have to take care of myself, see the doctor all the time…. It would be a psychological trauma… being day and night, every second, thinking “I have this disease and I might die.”
PT08	I believe that it is the fear of finding out yes or no. People say, “If I am positive, I die. My life is over. And if I am negative, I wouldn’t know what to do.”
PT09	Given that I have never been tested [and have had some risky sex], it makes me anxious to open the envelope, when I don’t know if it will say yes or no.
PT11	Having to face [a positive diagnosis] with my partner and my family…. Why would I worry them with that? I would take the treatment without their knowing.
PT16	Obviously, it is scary, especially when you know that you have taken risks…. I think that most people would prefer to remain ignorant.
KI04	{Quoting people with whom he or she engages in work} “I don’t want to find out that I am going to die. If I have HIV, I’d rather not know.” That is all part of the stigma and discrimination of HIV.
KI09	Fear of the results is what stops people from accessing the test. Many come to get tested and don’t come back for the results.
Sub-theme: Health care system barriers
PT11	{Describing being turned away for testing} The [staff person] told me that I could not be under the influence of alcohol or have the flu.
PT13	If the protocol requires a venipuncture blood test, then it has to be a venipuncture blood test. If the protocol requires that the patient be fasting, then the patient has to be fasting…. Many people don’t want to get up early in order to be stuck [with a needle], and moreover to go without eating, so I think that creates a barrier to accessing [the test.]
PT13	I had to endure the whole process of profiling that the doctor goes through to decide whether to order the test, as if I [did not know my own risk]. So I had to tell him that I live and have sex with a serodiscordant partner, which is something that I shouldn’t disclose to anyone, but until I said that, he refused to approve the test.
PT13	In an EPS, from the door man to the nurse, the psychologist, the sociologist, the social worker, etc., there are moralistic attitudes….If the security guard is homophobic and you act like a queen, he would beat you up and throw you out in the street.
PT14	Every time I get tested, they start inquiring about my personal life.
PT14	To avoid doing the test, [the EPS staff] say that there are no counselors, therefore, they cannot do the test.
PT14	I had to pay the co-payment [so the doctor] would refer me for pre-test counseling. Then I had to pay the co-payment for the counseling,… and [to spend] an hour and a half [to go between locations] and [pay for] transportation….Moreover, everyone finds out that one is there to get an HIV test.
PT19	There are many structural problems. Many EPS don’t have testing facilities, but they should have their own facilities, rather than referring everyone to a different location.
KI01	It’s easiest for a person with contributory insurance to be referred for testing. You go, they authorize the test for you, and you leave having been tested, maybe having some counseling in between…. But if you are a person with subsidized insurance, you have to deal with the EPS. You go get authorization, which is a process that can take time, because generally that authorization takes place elsewhere. That means that it becomes a geographic barrier.
KI03	Many health institutions are intimidating…, so the patient does not open up with the doctor. Moreover, doctors are not trained to provide HIV counseling.
KI04	A person has to go to the appointment [for the test], and it is one trip; he goes back home, it’s another trip. He goes to the appointment to get the results and post-test counseling, that is another trip; and then he goes home. These multiple trips come out of his pocket. If the person makes more than two or three times the minimum wage, he can handle it… but if he only makes $300,000 pesos a month, he is in trouble. He might say “why am I going to spend all that [money] in transportation, when I don’t have money to buy meat or a pound of rice for dinner?”
KI05	It is necessary to convince doctors to overcome their prejudices.