ORIGINAL PAPER Does the Centers for Disease Control and Prevention’s Recommendation of Opt-Out HIV Screening Impact the Effect of Stigma on HIV Test Acceptance? Anish P. Mahajan 1,2 • Janni J. Kinsler 2 • William E. Cunningham 2,3 • Saloniki James 4 • Lakshmi Makam 1 • Rishi Manchanda 5 • Martin F. Shapiro 2,3 • Jennifer N. Sayles 1 Published online: 13 October 2015 Ó Springer Science+Business Media New York 2015 Abstract HIV/AIDS-related stigma is a key factor impeding patient utilization of HIV testing services. To destigmatize HIV testing, the Centers for Disease Control and Prevention recommended an ‘opt-out’ screening strategy aimed at all patients in all clinical settings, regardless of HIV risk. This study assessed whether opt-out screening as compared to opt-in screening was associated with increased uptake of HIV testing among patients with HIV/AIDS-related stigma concerns. This study included 374 patients attending two Los Angeles ambulatory care clinics. Stigma items were grouped into three constructs: Blame/isolation, abandonment, and contagion. Individuals endorsing the blame/isolation subscale (AOR = 0.52; 95 % CI 0.29–0.92; p \ 0.05) and abandonment subscale (AOR = 0.27; 95 % CI 0.13–0.59; p \ 0.01) were signif- icantly less likely to accept an HIV test. Additionally, the opt-out model did not counter the negative effects of stigma on HIV test acceptance. These findings indicate that stigma remains a barrier to HIV testing, regardless of the opt-out screening approach. Keywords HIV Á Opt-out testing Á HIV test acceptance Á Stigma Á Underserved populations Introduction Timely HIV testing is integral to HIV prevention, treat- ment, and care and continues to be a major public health challenge in the United States [1]. Early knowledge of one’s HIV status is crucial for preventing the spread of infection to others, linking those with HIV infection to health care services, and reducing HIV/AIDS-related morbidity and mortality [1]. An estimated 16 % of HIV- infected individuals in the US are unaware of their HIV status [2]. HIV/AIDS-related stigma is cited as a key factor impeding utilization of HIV testing services [3–7]. Cross- sectional survey studies in sub-Saharan Africa, the United States, and elsewhere indicate that patients with relatively greater HIV/AIDS related stigma concerns are less likely to report having had an HIV test [8–11]. Even in the context of HIV screening programs that utilize a routine ‘‘opt-in’’ offer of testing, in which patients agree to be tested after receiving pre-test counseling and signing an informed consent form, patients with stigma concerns were less likely to accept testing [12, 13]. To destigmatize and promote HIV testing, in September 2006, the Centers for Disease Control and Prevention (CDC) recommended a new paradigm of HIV testing that utilizes an ‘opt-out’ HIV screening strategy that is aimed at all patients in all clinical settings, regardless of HIV risk [14, 15]. In ‘opt-out’ HIV screening, the provider notifies the patient that HIV testing will be performed and offers the patient the opportunity to ask questions and to decline & Anish P. Mahajan amahajan@dhs.lacounty.gov 1 Department of Health Services, Los Angeles County, 313 N. Figueroa St., Room 901, Los Angeles, CA 90066, USA 2 Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, CA, USA 3 Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA 4 Department of Public Health, Los Angeles County, Los Angeles, CA, USA 5 HealthBegins, Los Angeles, CA, USA 123 AIDS Behav (2016) 20:107–114 DOI 10.1007/s10461-015-1222-8