Perceived racism, neighborhood characteristics and human immunodeficiency virus (HIV) testing behaviors among African American community residents and sexually transmitted disease (STD) clinic patients

African Americans have higher rates of human immunodeficiency virus (HIV) infection than do members of other racial/ethnic groups; yet, little is known about factors influencing African Americans' use of public sexually transmitted disease (STD) clinics for HIV diagnosis. Perceived racism is associated with negative attitudes towards HIV preventive services in this population. Few studies, however, have examined associations between perceived racism and testing-related behaviors. No published studies have measured both perceived racism and neighborhood context to explain African American HIV antibody testing-related behaviors. This study integrated Critical Race Theory and the Andersen Access to Care Model to guide examinations of these relationships.; Everyone who presents at the public STD clinic is offered an HIV antibody test. This research aimed to determine whether: (1) perceived racism and neighborhood characteristics were barriers to African Americans seeking care at the public STD clinic; and, (2) perceived racism and neighborhood characteristics were associated with African American STD patients refusing HIV antibody tests offered during their clinical visits.; Data collected from a population-based, probability sample (N = 173) and an STD clinic-based, non-probability sample (N = 373) included: perceived racism, neighborhood characteristics (e.g., percentage black), HIV prevention-related constructs (e.g., perceived risk), demographics, STD clinic care-seeking behavior, and "observed" HIV antibody testing behavior. Statistical analyses included logistic regression, generalized estimating equations and analysis of variance.; Some 29% reported seeking care at the clinic; 55% obtained a test. More than 90% of participants perceived racism; however, perceived racism was not associated with care-seeking behavior (OR = 1.03; 95% CI 0.95, 1.12; p = 0.45). Only one neighborhood characteristic (relative income) was associated with care-seeking behavior (OR = 3.14; 95% CI = 1.18, 8.40; p = 0.02). Perceived racism was associated with slightly lower odds of refusing HIV antibody testing (OR = 0.96; 95% CI = 0.92, 1.00; p = 0.02). Both percentage black (OR = 1.01; 95% CI = 1.00, 1.03) and mean educational attainment (OR = 1.48; 95% CI = 1.01, 2.16) were associated with refusing testing.; Future research should explore whether perceived racism's association with HIV antibody testing is influenced by individuals' coping responses or levels of social support. The neighborhoods in which public STD clinic patients reside reflect socioeconomic diversity and extend beyond the "high risk" areas most proximal to the clinic.