Objectives The objective of the study was to examine and compare the HIV testing attitudes, perceptions and behaviours between African-American and East African immigrant women in the Washington, DC metropolitan area. Methods Adopting an inductive, qualitative methodological approach, we conducted a total of 40 in-depth, semistructured interviews between October 2012 and March 2013. Qualitative thematic analysis was used to analyse the data. Results Overall, African-American women held more favourable views towards HIV testing than East African immigrant women. Very few East African immigrant women sought HIV testing intentionally. The majority of East African participants were tested inadvertently, while others tested for immigration-related or employmentrelated purposes. There were many barriers that impede women from seeking an HIV test including negative assumptions (eg, "Getting an HIV test implies that I am HIV positive"), negative emotions (eg, "Fear of being diagnosed with HIV and what this will mean for me") and potential negative reactions from partner or others (eg, "Getting an HIV test can signal distrust, disrespect, or infidelity"). There were nuances in how each group articulated some of these barriers and East African women expressed unique concerns that originated from experiences in their home countries. Conclusions The study shed light into the complexity of factors that constrain women from presenting themselves voluntarily for an HIV test and highlighted the nuances between African-American and East African perceptions. Implications of findings for effective targeted HIV screening promotion and communication strategies among these groups of women are discussed.

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perception immigrant HIV Infections home health promotion Human immunodeficiency virus infection mass screening interpersonal communication human epidemiology HIV test middle aged District of Columbia immigration statistics and numerical data Health Behavior priority journal screening test Respect persuasive communication ethnology African American qualitative research human relation interview United States infidelity Humans migrant family attitude Cross-Cultural Comparison psychology Interviews as Topic Emigrants and Immigrants semi structured interview female Trust Black person African Continental Ancestry Group Africa clinical article cultural factor Health Knowledge, Attitudes, Practice Article emotion help seeking behavior thematic analysis adult patient attitude Patient Acceptance of Health Care Social Perception East African Fear employment attitude to health African Americans Africa, Eastern