Table 1. Description of barriers and facilitators.

Barriers	Definition
Lack of perceived risk of HIV infection	For patients: the patient does not believe he/she has a risk of acquiring HIV, or believes that his/her behaviours prevent risk. For providers: the provider does not believe his/her patients have a risk of acquiring HIV, or assumes they are at low risk, and may also believe that HIV is not an issue for his/her patient population or region of practice.
Comfort discussing and lack of knowledge of HIV	For patients: the patient does not feel comfortable discussing HIV or other sexual issues with the provider, and may have a general lack of knowledge about HIV, or how and where to get tested. For providers: the provider feels discomfort or anxiety in asking sexual questions to the patient, or in eliciting patient fears regarding HIV. He/she may lack knowledge of consent procedures, how to manage positive results and reporting procedures for their jurisdiction, and may feel that a lack of specific training prevents them from testing for HIV.
Health care provider time constraints	Health care providers have a lack of time for HIV testing and associated counselling, or have competing priorities during a visit that prevent them from testing for HIV.
Fear, stigma and discrimination	The patient fears a positive result, social repercussions for seeking testing or for testing positive (discrimination, rejection), being unable to cope with results, or that he/she will see someone he/she knows at the clinic.
Access to testing	A lack of ability to access testing in general (due to remote/rural location, lack of insurance [U.S. studies], testing location hours of operation, language barriers), or an inability to access a variety of testing services that are typically available (e.g., lack of anonymous testing in rural locations vs. metropolitan locations) acts as a barrier to testing.
Financial and human resource constraints	Cases where providers may not perform HIV testing due to a lack of compensation, or there is an inability to run HIV testing initiatives due to lack of staff.
Facilitators	Definition
Normalizing HIV testing	Reducing the negative stigma surrounding HIV by making it a routine test (similar to checking cholesterol, for instance). Offering testing as part of regular care.
Opt-out testing	HIV testing is offered and administered unless the patient specifically refuses.
Increasing knowledge and awareness	Using patient-centred educational material to make patients more knowledgeable, more likely to see HIV testing as a positive thing, and improve interest in testing. Using provider-centred materials to enhance training around HIV testing, and improve provider-patient communication.