Individual, household and community factors associated with HIV test refusal in rural Malawi

London School of Hygiene and Tropical Medicine, London, UK.
Tropical Medicine & International Health (Impact Factor: 2.33). 11/2008; 13(11):1341-50. DOI: 10.1111/j.1365-3156.2008.02148.x
Source: PubMed


To investigate individual, household and community factors associated with HIV test refusal in a counselling and testing programme offered at population level in rural Malawi.
HIV counselling and testing was offered to individuals aged 18-59 at their homes. Individual variables were collected by interviews and physical examinations. Household variables were determined as part of a previous census. Multivariate models allowing for household and community clustering were used to assess associations between HIV test refusal and explanatory variables.
Of 2303 eligible adults, 2129 were found and 1443 agreed to HIV testing. Test refusal was less likely by those who were never married [adjusted odds ratio (aOR) 0.50 for men (95% CI 0.32; 0.80) and 0.44 (0.21; 0.91) for women] and by farmers [aOR 0.70 (0.52; 0.96) for men and 0.59 (0.40; 0.87) for women]. A 10% increase in cluster refusal rates increased the odds of refusal by 1.48 (1.32; 1.66) in men and 1.68 (1.32; 2.12) in women. Women counsellors increased the odds of refusal by 1.39 (1.00; 1.92) in men. Predictors of HIV test refusal in women were refusal of the husband as head of household [aOR 15.08 (9.39; 24.21)] and living close to the main road [aOR 6.07 (1.76; 20.98)]. Common reasons for refusal were fear of testing positive, previous HIV test, knowledge of HIV serostatus and the need for more time to think.
Successful VCT strategies need to encourage couples counselling and should involve participation of men and communities.

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Available from: Katharina Kranzer, Sep 12, 2014
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    • "Social support is known to mitigate stigma (Takada et al., 2014) and influence HIV testing and treatment. Individuals are more likely to refuse testing if they live in communities with high refusal rates (Kranzer et al., 2008), while positive social support and social networks beneficially affect HIV testing (Denison, McCauley, Dunnett-Dagg, Lungu, & Sweat, 2008; White et al., 2013). Social support promotes adherence to treatment (Kamau, Olsen, Zipp, & Clark, 2012; Katz et al., 2013; Nachega et al., 2006; Ware et al., 2009), while lack of social support has been linked to late stage HIV presentation and poor adherence (Drain et al., 2013; Katz et al., 2013). "
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