Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: Katharina Kranzer, Sep 12, 2014
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about the factors that encourage or discourage refugees to test for HIV, or to access and adhere to HIV care. In non-refugee populations, social support has been shown to influence HIV testing and utilisation of services. The present study enrolled HIV-infected refugees on anti-retroviral therapy (ART) in Uganda, who participated in qualitative interviews on HIV testing, treatment, and adherence. Interviews were analysed for themes about four types of social support: emotional, informational, instrumental, and appraisal support. A total of 61 interviews were analysed. Four roles for these types of social support were identified: (1) informational support encouraged refugees to test for HIV; (2) emotional support helped refugees cope with a diagnosis of HIV; (3) instrumental support facilitated adherence to ART and (4) after diagnosis, HIV-infected refugees provided informational and emotional support to encourage other refugees to test for HIV. These results suggest that social support influences HIV testing and treatment among refugees. Future interventions should capitalise on social support within a refugee settlement to facilitate testing and treatment.
    Full-text · Article · Jan 2016 · Global Public Health
  • Source
    • "For example, studies have found higher numbers of sexual partners among married HIV-negative men (De Paula et al. 2014), increases in unprotected sex and risky partners among all females who are tested, and increases in the number of concurrent partners among all males who are tested (Kabiru et al. 2010). Although these studies have found evidence of increased risky sexual behavior or unintended negative consequences of HTC, other studies have found that this may be because those seeking HIV testing may have alternative motives for testing (Kranzer et al. 2008; Matovu et al. 2005), such as checking HIV status prior to becoming pregnant or prior to switching partners. This makes accounting for selection into HIV testing important when assessing post-testing behavior. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Female empowerment and positive attitudes towards women's rights in sexual relationships have been found to be key elements of successful behaviour-based HIV prevention programmes. However, HIV prevention programmes that do not specifically engage with gender issues may also affect attitudes and beliefs towards women's rights within sexual relationships. Using data from the Malawi Longitudinal Study of Families and Health we compare measures of female empowerment and changing gender norms between intervention participants and non-participants. Results suggest that female intervention participants were more likely than non-participants to believe that: (1) women have more rights within sexual relationships in general and (2) women have the right to protect themselves against HIV risk (indicating possible increases in female self-efficacy in making HIV prevention decisions). Male intervention participants showed no substantial positive change in attitudes towards women's rights. These results highlight an important positive effect of HIV prevention programmes on women's attitudes towards their own rights.
    Full-text · Article · Oct 2015 · Culture Health & Sexuality
  • Source
    • "By understanding how uptake varies with testing strategy, non-facility based testing strategies may be optimized to achieve universal testing coverage. Factors found to decrease uptake of home-based HIV testing (HBT) have varied considerably depending on the population studied, and include older age (>25 years) [4], as well as young adulthood [15], having a concurrent partnership at the time of HBT [4], lack of participation by the male head of household [16], single marital status, higher educational attainment [17], and high (>30%) prior rates of HIV testing in a community [18]. In our study population several factors were associated with lower testing uptake, notably younger age and single marital status. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The high burden of undiagnosed HIV in sub-Saharan Africa is a major obstacle for HIV prevention and treatment. Multi-disease, community health campaigns (CHCs) offering HIV testing are a successful approach to rapidly increase HIV testing rates and identify undiagnosed HIV. However, a greater understanding of population-level uptake is needed to maximize effectiveness of this approach. After community sensitization and a census, a five-day campaign was performed in May 2012 in a rural Ugandan community. The census enumerated all residents, capturing demographics, household location, and fingerprint biometrics. The CHC included point-of-care screening for HIV, malaria, TB, hypertension and diabetes. Residents who attended vs. did not attend the CHC were compared to determine predictors of participation. Over 12 days, 18 census workers enumerated 6,343 residents. 501 additional residents were identified at the campaign, for a total community population of 6,844. 4,323 (63%) residents and 556 non-residents attended the campaign. HIV tests were performed in 4,795/4,879 (98.3%) participants; 1,836 (38%) reported no prior HIV testing. Of 2674 adults tested, 257 (10%) were HIV-infected; 125/257 (49%) reported newly diagnosed HIV. In unadjusted analyses, adult resident campaign non-participation was associated with male sex (62% male vs. 67% female participation, p = 0.003), younger median age (27 years in non-participants vs. 32 in participants; p<0.001), and marital status (48% single vs. 71% married/widowed/divorced participation; p<0.001). In multivariate analysis, single adults were significantly less likely to attend the campaign than non-single adults (relative risk [RR]: 0.63 [95% CI: 0.53-0.74]; p<0.001), and adults at home vs. not home during census activities were significantly more likely to attend the campaign (RR: 1.20 [95% CI: 1.13-1.28]; p<0.001). CHCs provide a rapid approach to testing a majority of residents for HIV in rural African settings. However, complementary strategies are still needed to engage young, single adults and achieve universal testing.
    Full-text · Article · Jan 2014 · PLoS ONE
Show more