Barriers to HIV testing in Guatemala: A Qualitative Study

Lars Margolis, Narda Medina, Kimberly Gon, Brian Hagan, Kevin McKenna, Blanca Samayoa, Karla Patricia Alonzo Pacheco, Eduardo Arathoon, Matthew Anderson


Background: Early detection and treatment decreases HIV transmission rates and leads to risk reduction in those who are diagnosed. HIV-infected Guatemalans typically present with late-stage disease.

Objective: We employed qualitative methods to explore barriers to HIV testing in Guatemala.

Methods: In depth, qualitative interviews were conducted in an HIV testing and treatment facility in Guatemala City. These were analyzed using the methods of Grounded Theory.

Results: Four major barriers impeded HIV testing in our subjects: psychological factors, stigma/discrimination, gender roles/machismo, and systemic barriers to care. Many of our patients’ fears were grounded in a reality of discrimination, while the systemic problems of the healthcare system reflected misunderstandings and fears on the part of healthcare workers.

Discussion: Our findings are consonant with the international literature. Our narrative suggested potential interventions; presenting HIV testing as a way to “save one’s life” instead of an “automatic death sentence” might foster HIV testing and earlier diagnosis

Full Text:



Girardi E, Sabin CA, Monforte AD. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. Journal of acquired immune deficiency syndromes. 2007;46 Suppl 1:S3-8. doi: 10.1097/01.qai.0000286597.57066.2b. PubMed PMID: 17713423. Available from:

Castilla J, Sobrino P, De La Fuente L, Noguer I, Guerra L, Parras F. Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence. Aids. 2002;16:1945-51. PubMed PMID: 12351955. Available from:

Spielberg F, Kurth A, Gorbach PM, Goldbaum G. Moving from apprehension to action: HIV counseling and testing preferences in three at-risk populations. AIDS education and prevention : official publication of the International Society for AIDS Education. 2001;13(6):524-40. PubMed PMID: 11791784. Available from:

Kellerman SE, Lehman JS, Lansky A, Stevens MR, Hecht FM, Bindman AB, et al. HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing. Journal of acquired immune deficiency syndromes. 2002;31(2):202-10. PubMed PMID: 12394799. Available from:

Fakoya I, Reynolds R, Caswell G, Shiripinda I. Barriers to HIV testing for migrant black Africans in Western Europe. HIV medicine. 2008;9 Suppl 2:23-5. doi: 10.1111/j.1468-1293.2008.00587.x. PubMed PMID: 18557866. Available from:

Sinha G, Dyalchand A, Khale M, Kulkarni G, Vasudevan S, Bollinger RC. Low utilization of HIV testing during pregnancy: What are the barriers to HIV testing for women in rural India? Journal of acquired immune deficiency syndromes. 2008;47(2):248-52. PubMed PMID: 18340657. Available from:

Bond L, Lauby J, Batson H. HIV testing and the role of individual- and structural-level barriers and facilitators. AIDS care. 2005;17(2):125-40. doi: 10.1080/09541020512331325653. PubMed PMID: 15763709. Available from:

Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M. Barriers to HIV testing in Europe: a systematic review. European journal of public health. 2010;20(4):422-32. doi: 10.1093/eurpub/ckp231. PubMed PMID: 20123683. Available from:

Yazdanpanah Y, Lange J, Gerstoft J, Cairns G. Earlier testing for HIV--how do we prevent late presentation? Antiviral therapy. 2010;15 Suppl 1:17-24. doi: 10.3851/IMP1526. PubMed PMID: 20442457. Available from:

Peralta L, Deeds BG, Hipszer S, Ghalib K. Barriers and facilitators to adolescent HIV testing. AIDS patient care and STDs. 2007;21(6):400-8. doi: 10.1089/apc.2006.0112. PubMed PMID: 17594249. Available from:

Lahuerta M, Torrens M, Sabidó M, Batres A, Casabona J. Sexual risk behaviours and barriers to HIV testing among clients of female sex workers in Guatemala: a qualitative study. Cult Health Sex. 2013. doi: 10.1080/13691058.2013.777474. PubMed PMID: 23627770. Available from:

Auerbach C, Silverstein LB. Qualitative data: An introduction to coding and analysis: NYU Press; 2003.



Please feel free to comment on this article:

blog comments powered by Disqus

Editorial Offices:

Department of Family and Social Medicine
Albert Einstein College of Medicine/Montefiore Medical Center
Bronx, New York, 10461

Asociación Latinoamericana de Medicina Social (ALAMES)/Latin American Social Medicine Association:
ALAMES, Southern Cone Region, Cassinoni 1440 – 802, CP 11200 Montevideo, Uruguay.
ALAMES, Mexico Region, San Jerónimo 70 – 1, Col. La Otra Banda, CP 01090, México, D.F.