Lauby, Bond, Eroğlu, and Batson (2006) assessed how decisional balance or "the relative weight of perceived advantages (pros) compared to perceived disadvantages (cons)" (p. 84) and self-perceived HIV risk were associated with HIV testing by surveying a community sample of 1,523 men and women at elevated risk for HIV. Lauby and colleagues "developed scales to measure ... pros ... and ... cons ... of taking an HIV test and assessed their content using factor analysis. Perceived risk was highly related to the pros and cons scales. Multivariate analyses revealed that the pros scale had positive associations with having ever tested and the number of tests taken, while the cons scale had negative associations with these testing measures. ... [As in earlier studies, p]erceived risk was not related to testing practices" (p. 83).
The investigators suggest that
[p]erceived advantages can be leveraged as motivators for HIV test-taking, while perceived disadvantages can be targets of communication efforts. ... [R]esults suggest that perceived advantages may have a stronger effect than perceived disadvantages on both the decision to take a first HIV test and to take repeated tests. Analysis of the pros subscales indicates that promoting testing as part of a person's responsibility to one's self and family may be more influential for persons who are not infected with HIV than stressing testing as a way to protect partners from transmission.
Among the cons subscales, preferring not to know one's HIV status decreases the likelihood of ever testing, as does fear of needles used in testing. (p. 90)
Even though the relatively high refusal rate (50%) among persons selected to be in the study sample may limit the generalizability of these findings, the investigators observe that "[e]levated perceived risk leads to testing only when the perceived advantages of testing outweigh the disadvantages. Thus interventions to increase testing must focus on addressing positive and negative perceptions about the test in addition to helping individuals assess their risk of infection" (p. 90). Additionally, "[i]nterventions to increase HIV testing need to reinforce feelings of security and responsibility linked to testing and to decrease fear of testing and of knowing one's HIV status. In addition, providing a range of testing options, including oral tests and anonymous tests, may help to mitigate some of the negative perceptions of testing" (p. 91).
Women in ongoing heterosexual relationships face a variety of challenges when they decide to undergo testing for HIV, express interest in their partner being tested, and attempt to institute safer sexual practices. Morrill and Noland (2006) conducted a study in which 81 "women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in … focus groups (women only, men only, or couples)" (p. 183). Among the challenges identified were "difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing" (p. 183).
"The most dramatic, and disturbing, discovery of this study is a pervasive belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. In essence, whether consciously or not, one partner is testing on behalf of the other. ... [Morrill and Noland] have labeled this phenomenon 'testing by proxy'" (p. 194). Additionally, "[r]espondents confirmed that a woman's decision to test elicits strong emotions and doubts about fidelity. It is difficult to discuss testing and safer sex, especially for couples who have been together for as long as 10 years or more. Women who broach the subject may be cast as threatening the stability of the relationship" (p. 195).
Through these respondents, Morrill and Noland
also discovered … ways to overcome or avert couples coming to loggerheads over such issues. For instance, it may be more acceptable to attribute the need for mutual testing and safer sex to the unknown status of the man's past partners. Emphasis also might be placed on positive feelings generated by taking ongoing, proactive responsibility for one's own health. To promote couple communication about HIV prevention in spite of such obstacles, it is important to (a) be nonjudgmental and (b) normalize HIV testing and condom use even …in … established, loving relationship[s] ... . (p. 195)
Morrill and Noland conclude that "programs aiming to reduce heterosexual HIV risk for women must include their male partners, and must incorporate effective interpersonal communication skills. ... [Clinicians] must [also] refute the misconception that a person's serostatus can be revealed through their partner's test result. Such endeavors would constitute important contributions to the national goal of prevention through HIV counseling and testing" (p. 196).
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Summer 2006 Newsletter / Volume 7, Issue 4 
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