“I don't know when it might pop up”

Purpose: The study sought to understand the HIV testing patterns of low-income drug users. Methods: Sixty-seven low-income drug users were recruited from street outreach venues in three San Francisco Bay Area counties. Participants were interviewed using an open-ended questionnaire eliciting information on HIV testing histories, sexual behavior, and drug use. Transcripts from interviews were coded and analyzed using methods consistent with the grounded theory approach of qualitative research. Results: Participants identified four themes related to HIV testing: (1) anticipating positive results, (2) belief in a 10-year window period during which the virus is undetectable, (3) regular HIV testing as part of self-care, and (4) the HIV test as a means of control. These themes did not relate to personal risk behavior but rather to the community experience of HIV in small, dense populations of low-income drug users with high rates of HIV infection. Implications: Participants used HIV testing like regular mammograms or blood pressure checks, as if it were a screening procedure for a chronic illness. This is a reasonable response given the context of HIV within their communities. HIV testing in this population should not be limited.