Utilization of Voluntary Counseling and Testing services in the Eastern Cape, South Africa

Department of International Health and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
AIDS Care (Impact Factor: 1.6). 08/2006; 18(5):446-55. DOI: 10.1080/09540120500213511
Source: PubMed


This analysis uses data from a population-based household survey and a government clinic survey in the Eastern Cape Province of South Africa to examine attitudes towards voluntary counseling and testing (VCT) services, patterns of utilization of VCT services and the relationships between HIV/AIDS-related stigma, VCT service availability and quality and the use of VCT. The household survey data are linked with clinic-level data to assess the impact of expanded VCT services and access to rapid testing on the likelihood of being tested in rural areas and on HIV/AIDS stigma. Our analysis finds that while overall use of VCT services is low, utilization of VCT services is positively associated with age, education, socioeconomic status, proximity to clinics, availability of rapid testing and outreach services and lower levels of HIV/AIDS stigma. Importantly, the effects of stigma appear considerably stronger for females, while men are more heavily influenced by the characteristics of the VCT services themselves.

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    • "A positive association between the experience of benefits related to HIV testing and willingness to consider VCT has been found in various studies (Dorr et al. 1999, Zak-Place and Stern 2004, de Wit and Adam 2008). Additional factors that increase the likelihood of accepting RCT and participating in VCT have also been identified in the literature including having access to HIV care (Peltzer et al. 2004, Mwamburi et al. 2005, Hutchinson and Mahlalela 2006, Nakanjako et al. 2007, de Wit and Adam 2008); a high subjective personal risk assessment (Gage and Ali 2005, Cunningham et al. 2009); knowledge of how HIV is transmitted (Hutchinson et al. 2004, Mwamburi et al. 2005, Gage and Ali 2005, Bassett et al. 2008, de Wit and Adam 2008); appropriate positive social support and encouragement from others and a decrease in stigma associated with HIV (Fortenberry et al. 2002, Spielberg et al. 2003, Gage and Ali 2005, Weiser et al. 2006, de Wit and Adam 2008); and support and encouragement from romantic partners (Hutchinson et al. 2004, Peltzer et al. 2004, Gage and Ali 2005). Various factors that decrease the likelihood of accepting RCT and participating in VCT have also been identified in the literature. "
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    ABSTRACT: Routine HIV counseling and testing (RCT) is a necessary first step in accessing health care for persons who may test HIV-positive. Despite the availability of RCT in many South African settings, uptake has often been low. We sought to determine whether the main components of the Health Belief Model (HBM), namely perceived susceptibility, perceived severity, perceived benefits and perceived barriers could predict acceptance of RCT, and whether cues to action predicted uptake of RCT. A sample of 1 113 students at a large South African university completed a battery of instruments measuring acceptability of RCT, previous uptake of HIV testing, and the various HBM variables. Regression analysis showed that perceived susceptibility to HIV, perceived severity of HIV, perceived benefits of RCT, and perceived barriers to RCT explained 25.1% of the variance in acceptance of RCT. The findings of the study are located in the context of existing literature on RCT.
    Full-text · Article · Dec 2013 · African Journal of AIDS Research
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    • "With the wide scale ART roll out and better management of HIV in much of Sub-Saharan Africa, the fear of developing AIDS has now decreased [20]. However, there are continued challenges of the low uptake of voluntary counselling and testing and the late presentation of men, for example, for treatment, which may point to an underlying epidemic of stigma which continues to persist [26-28]. "
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    ABSTRACT: Stigma is a barrier to HIV prevention and treatment. There is a limited understanding of the types of stigma facing people living with HIV (PLHIV) on antiretroviral therapy (ART). We describe the stigma trajectories of PLHIV over a 5-year period from the time they started ART. Longitudinal qualitative in-depth interviews were conducted with 41 members of The AIDS Support Organisation (TASO) from 2005 to 2008 in Jinja, Uganda, who were part of a pragmatic cluster-randomised trial comparing two different modes of ART delivery (facility and home). Participants were stratified by gender, ART delivery arm and HIV stage (early or advanced) and interviewed at enrolment on to ART and then after 3, 6, 18 and 30 months. Interviews focused on stigma and ART experiences. In 2011, follow-up interviews were conducted with 24 of the participants who could be traced. Transcribed texts were translated, coded and analyzed thematically. Stigma was reported to be very high prior to starting ART, explained by visible signs of long-term illnesses and experiences of discrimination and abuse. Early coping strategies included: withdrawal from public life, leaving work due to ill health and moving in with relatives. Starting ART led to a steady decline in stigma and allowed the participants to take control of their illness and manage their social lives. Better health led to resumption of work and having sex but led to reduced disclosure to employers, colleagues and new sexual partners. Some participants mentioned sero-sorting in order to avoid questions around HIV sero-status. A rise in stigma levels during the 18 and 30 month interviews may be correlated with decreased disclosure. By 2011, ART-related stigma was even more pronounced particularly among those who had started new sexual relationships, gained employment and those who had bodily signs from ART side-effects. This study has shown that while ART comes with health benefits which help individuals to get rid of previously stigmatising visible signs, an increase in stigma may be noticed after about five years on ART, leading to reduced disclosure. ART adherence counselling should reflect changing causes and manifestations of stigma over time.
    Full-text · Article · Sep 2013 · BMC Public Health
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    • "Both education and wealth are significant in bivariate models, but educational attainment is more consistently significant in bivariate analyses and remains independently significant after adjustment for wealth. These results are consistent with those of other studies conducted in sub-Saharan Africa where VCT was associated with knowledge of HIV and education (Hutchinson & Mahlalela 2006; Tenkorang & Owusu 2010; Venkatesh et al. 2011), and with an analysis of survey data from 13 countries of sub-Saharan Africa, showing that prior to the availability of treatment, VCT testing was associated with secondary education (Cremin et al. 2012). Because in this study, we used the same measures of socio-economic status across the four sites, the consistency of the results is compelling. "
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    ABSTRACT: Research indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested. Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses. Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested. Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent.
    Full-text · Article · Sep 2013 · Tropical Medicine & International Health
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