INDIVIDUAL- AND COMMUNITY-LEVEL
                                                DETERMINANTS OF ANTENATAL HIV TESTING IN
                                          ZIMBABWE

SummaryThis study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women’s economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community. Important individual-level enabling and perceived need factors included high socioeconomic status, not having observed HIV-related stigma and knowledge of HIV status (based on a previous HIV test), such that these groups of individuals had a significantly higher likelihood of being tested for HIV during pregnancy than their counterparts of lower socioeconomic status, and who had observed HIV-related stigma or did not know their HIV status. The results further revealed that community HIV awareness is important for improving antenatal HIV testing, while stigma is associated with reduced testing uptake. Most contextual community-level factors were not found to have much effect on the uptake of antenatal HIV testing. Therefore, policies should focus on individual-level predisposing and enabling factors to improve the uptake of antenatal HIV testing in Zimbabwe.

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Back to Basics: Correlates of HIV Risk in a Community Sample of Haiti

10.1101/2020.10.10.20210476 ◽

2020 ◽

Author(s):

Manisha Joshi ◽

Guitele J. Rahill ◽

Christopher Rice ◽

Paul Phycien ◽

Cameron Burris ◽

...

Keyword(s):

Hiv Prevention ◽

Hiv Testing ◽

Hiv Risk ◽

Community Sample ◽

Hiv Prevalence ◽

Hiv Status ◽

Hiv Knowledge ◽

The Past ◽

Hiv Test ◽

Hiv Awareness

AbstractHaiti has a 2.2 % HIV prevalence (highest in the Caribbean); this has diminished from over 12% in the past three decades (depending on sex and gender, province, and neighborhood). Preliminary studies indicate that in the Cite Soleil neighborhood of Haiti (HIV prevalence >3%) as in socioeconomically equivalent adjacent neighborhoods, over 50% of girls and women experience non-partner sexual violence (NPSV), typically perpetrated by groups of men. Rates of NPSV against men in those neighborhoods were not available. Coercive sex heightens HIV risk. Accurate HIV knowledge empowers individuals (including survivors of NPSV) to assess personal HIV risk and increases likelihood of getting tested and of determining personal HIV status; thus, accurate HIV knowledge is foundational to behavioral risk reduction for victims in future consensual relationships and to engagement in either the HIV prevention or care continuum.Between March and July 2017, we surveyed individuals 18 years or older (210 women, 257 men), assessing experience of NPSV, HIV knowledge, history of HIV testing, knowledge of HIV status, assessment of self-risk, and sexual risk behaviors. Nearly 30% of men and 24% of women endorsed having experienced NPSV. Knowledge of HIV transmission was low: 90% endorsed HIV myths, e.g. transmission occurs via public toilets, via sharing a glass with or by being exposed to a cough or sneeze from a person living with HIV. High endorsement of these myths contrasted with low endorsement of protective behavior: Only 14.3 % used a condom during consensual sex in the past year. Only 47.9% of the respondents had ever attended an HIV awareness program; 16% of knew their HIV status, although 79% assessed their HIV risk as moderate to high. Results regressing knowledge of HIV testing on participant characteristics indicated that women (OR=2.8), individuals with a partner (OR=2.2), individuals who attended an HIV awareness class (OR=2.1), individuals who knew someone with HIV (OR=3.9), and individuals who had an HIV test (OR=33.5) were more likely to know what an HIV test is. Participants who endorsed experiencing NPSV (OR=0.33) and those who had been diagnosed with an STI (OR=0.44) were less likely to know about HIV testing.Experience of NPSV combined with low HIV knowledge, awareness and testing heighten the HIV prevention needs of Cite Soleil residents and underscore the need to return to basics on the road to HIV eradication in that context.

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Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru

BMC Infectious Diseases ◽

10.1186/s12879-021-06455-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Thiago S. Torres ◽

Lara E. Coelho ◽

Kelika A. Konda ◽

E. Hamid Vega-Ramirez ◽

Oliver A. Elorreaga ◽

...

Keyword(s):

Socioeconomic Status ◽

Latin American ◽

Low Socioeconomic Status ◽

Low Income ◽

Sexual Attraction ◽

Hiv Positive ◽

Sociodemographic Characteristics ◽

Hiv Status ◽

Hiv Test ◽

Young Msm

Abstract Background Despite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increase in the region especially among young MSM (YMSM). This study aims to assess if sociodemographic characteristics are associated with self-reported HIV positive status among YMSM from three Latin American countries. Methods Cross-sectional web-based survey advertised on dating apps (Grindr and Hornet) and Facebook in Brazil, Mexico and Peru. For this analysis, we included YMSM aged 18–24 years who self-reported their HIV status. We used multivariable logistic regression models for each country separately to verify if sociodemographic characteristics (race, education and income) were associated with HIV self-reported status after adjusting for behavior characteristics (sexual attraction and steady partner). Results Among 43,687 MSM who initiated the questionnaire, 27,318 (62.5%) reported their HIV status; 7001 (25.6%) of whom were YMSM. Most YMSM (83.4%) reported an HIV test in the past year, and 15.7% reported an HIV positive status in Peru, 8.4% in Mexico and 7.7% in Brazil. In adjusted models, low-income was associated with higher odds of self-reported HIV positive status in Brazil (aOR = 1.33, 95%CI: 1.01–1.75) and Peru (aOR = 1.56, 95%CI: 1.02–2.40), but not in Mexico. Lower education was associated with higher odds of self-reported HIV positive status only in Brazil (aOR = 1.35, 95%CI: 1.05–1.75). Conclusions In this large, cross-country study, self-reported HIV positive status among YMSM was high. Lower socioeconomic status was associated with higher odds of self-reported HIV positive status in Brazil and Peru. There is an urgent need for HIV prevention interventions targeting YMSM, and efforts to address low-income YMSM are especially needed in Peru and Brazil.

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Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053195 ◽

2017 ◽

Vol 94 (3) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

James Blain Johnston ◽

Joss N Reimer ◽

John L Wylie ◽

Jared Bullard

Keyword(s):

Viral Load ◽

Hiv Testing ◽

Clinical Outcomes ◽

Point Of Care ◽

Age Groups ◽

Linkage To Care ◽

Hiv Positive ◽

Hiv Status ◽

Viral Load Suppression ◽

Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

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Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV ‘test and treat’ trial

PLoS ONE ◽

10.1371/journal.pone.0249462 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0249462

Author(s):

Cecilia Akatukwasa ◽

Monica Getahun ◽

Alison M. El Ayadi ◽

Judith Namanya ◽

Irene Maeri ◽

...

Keyword(s):

Hiv Testing ◽

Physical Violence ◽

Marital Dissolution ◽

Care Seeking ◽

Internalized Stigma ◽

Test And Treat ◽

Hiv Test ◽

Related Stigma ◽

Enacted Stigma ◽

Anticipated Stigma

HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies.

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Stigma, sexual risk and desire for HIV tests in Ghana

Sexual Health ◽

10.1071/sh09095 ◽

2011 ◽

Vol 8 (1) ◽

pp. 110 ◽

Cited By ~ 7

Author(s):

Emmanuel F. Koku

Keyword(s):

Hiv Prevention ◽

Hiv Testing ◽

Treatment Programs ◽

Negative Interaction ◽

Sexual Behaviours ◽

Hiv Test ◽

Related Stigma ◽

Risky Sexual Behaviours ◽

Positive Effect

Background: Although various HIV prevention and treatment programs have been implemented in Ghana since 2003, desire for and uptake of HIV testing is still low, owing largely to HIV-related stigma. This study examined the effect of stigma on desire for HIV testing, while controlling for socio-demographic and other influences. Method: The study used data from the 2003 Ghana Demographic and Health Survey to regress desire for an HIV test on levels of stigma while controlling for selected socio-demographic, socio-cognitive and socio-behavioural covariates. Results: The study revealed significant associations between several socio-demographic and socio-cognitive variables and the desire for an HIV test. For example, both male (adjusted odds ratio (AOR) = 0.41; 95% confidence interval (CI) = 0.24–0.72) and female (AOR = 0.62; 95% CI = 0.41–0.93) respondents in the wealthiest households, and those who know someone infected with HIV (AOR = 0.65; 95% CI = 0.43–1.00) have lower odds of desiring an HIV test. The study showed a significant but negative interaction between risky sexual behaviours and community stigma (AOR = 0.44; 95% CI = 0.19–0.67), indicating that the positive effect of risky sex on HIV testing is attenuated among females who live in communities with high levels of stigma. Conclusion: Since community-level education and risk reduction programs have demonstrable influences on reducing HIV stigma, it is imperative that the Ghana government’s ongoing anti-stigma campaigns and other HIV prevention programs recognise the role of community stigma in influencing HIV testing decisions, especially in the context of risky sexual behaviours.

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1498Community-level risk factors for birth size of child in selected developing countries (1992-2018): multilevel analysis

International Journal of Epidemiology ◽

10.1093/ije/dyab168.066 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Rahul Bawankule ◽

Abhishek Singh

Keyword(s):

Risk Factors ◽

Developing Countries ◽

Significant Risk ◽

Binary Logistic Regression ◽

Community Level ◽

Demographic And Health Surveys ◽

Birth Size ◽

Level Variation ◽

Logistic Regression Models ◽

Individual Level

Abstract Background We aimed to identify emerging community-level risk factors for birth size in the last two decades in developing countries, particularly in Bangladesh, India, Indonesia, and Nigeria, having the highest burden of low birth weight (LBW) births globally. Methods We used data from multiple rounds of the Demographic and Health Surveys (DHS) conducted throughout the last two decades in the selected countries. We applied multilevel binary logistic regression models and estimated the intra-correlation coefficient (ICC) and median odds ratio (MOR) with a 95% confidence interval (CI) to analyze community-level variation in the birth size of child. Results The odds of having a smaller than average size birth increased by 1.28 times (95% CI: 1.11-1.79) in Bangladesh (2014), 3.03 times (95% CI: 2.90-3.18) in India (2015-16), 1.40 times (95% CI: 1.28-1.58) in Indonesia (2017) and 2.32 times (95% CI: 2.15-2.53) in Nigeria (2018) when women moved from low-risk to high-risk communities. The children residing in communities with a higher level of female illiteracy, higher level of inadequate antenatal care visits (ANC), higher use of unimproved toilet facilities were more likely to born with smaller than average birth size during 1992-2018. Conclusions The study confirms a significant community-level variation in smaller than average birth size among all analysed countries. Community with higher levels of female illiteracy, inadequate ANC visits, use of unimproved toilet facilities emerged as significant risk factors throughout the last two decades. Key messages The community-level risk factors have an independent association with the birth size of child regardless of individual-level characteristics of women and children.

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Sociodemographic, Sociocultural, and Individual Predictors of Reported Feelings of Meaninglessness among South African Adolescents

Psychological Reports ◽

10.2466/pr0.95.3f.1271-1278 ◽

2004 ◽

Vol 95 (3_suppl) ◽

pp. 1271-1278 ◽

Cited By ~ 4

Author(s):

Neo K. Morojele ◽

Judith S. Brook

Keyword(s):

Socioeconomic Status ◽

South African ◽

Female Students ◽

Sociocultural Factors ◽

Hiv Status ◽

Lower Socioeconomic Status ◽

Parental Occupation ◽

Individual Level ◽

Symptoms Of Depression ◽

Lower Socioeconomic

The purpose of the study was to predict adolescents' sense of meaninglessness about South Africa's sociopolitical situation from sociodemographic, individual level, and sociocultural factors. The participants comprised 39 male and 64 female students from three schools in Cape Town, and had a mean age of 15.2 yr. ( SD = 1.8 yr.). They completed an adaptation of Neal and Groat's Meaninglessness scale and measures of sociodemographic (age, sex, and parental occupation, household amenities, and household hunger as proxy measures of socioeconomic status), sociocultural (cultural pride and an adaptation of McClosky and Schaar's anomy scale), and individual level (depression, general life satisfaction, and knowledge of HIV status) factors. A multiple regression analysis indicated that the adolescents with higher reported scores for meaninglessness about South Africa's sociopolitical situation reported lower socioeconomic status, a stronger sense of anomy, and more symptoms of depression.

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“When you have a high life, and you like sex, you will be afraid”: a qualitative evaluation of adolescents’ decision to test for HIV in Zambia and Kenya using the health belief model

BMC Public Health ◽

10.1186/s12889-021-10391-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Leila Katirayi ◽

Job Akuno ◽

Bright Kulukulu ◽

Rose Masaba

Keyword(s):

Hiv Testing ◽

Health Belief Model ◽

Health Belief ◽

Qualitative Evaluation ◽

Hiv Status ◽

Healthy Life ◽

Hiv Test ◽

Belief Model ◽

Living With Hiv ◽

The Health Belief Model

Abstract Background HIV testing among adolescents is significantly lower than among adults and many adolescents living with HIV do not know their status. Adolescent perceptions of HIV testing are poorly understood and may negatively affect testing uptake. Using a qualitative design, this study sought to explore perceptions about HIV testing and treatment among adolescents living with HIV and adolescents of unknown HIV status in Lusaka, Zambia and Kenya. Methods Study participants were adolescents aged 15–19 years old. The adolescents living with HIV were recruited from HIV support groups at health facilities. Adolescents of unknown HIV status were recruited from existing adolescent groups within the community. In both Zambia and Kenya, four focus group discussions (FGDs) were conducted with adolescents living with HIV and four FGDs were conducted with adolescents whose HIV status was unknown, for a total of 16 FDGs. FGDs consisted of 6–12 participants, a moderator, and a note-taker. FGDs were audio-recorded, transcribed, and translated into transcripts. Transcripts were coded in the qualitative analysis software program MAXQDA v. 12. Data reduction and summary tables were generated to help identify themes across the two study population groups. Data were interpreted within the health belief model. Results Adolescents discussed the challenges of facing a positive HIV test result, including fear of a positive result and need to change their lifestyle, fear of social isolation, and perception of the lost opportunity to achieve future dreams. Most adolescents of unknown status were not as aware of the benefits of learning their HIV status, nor were they aware of the ability to live a long and healthy life on ART. HIV-positive adolescents reported that the messages targeted towards adolescents focus on the need to remain HIV-negative, as opposed to the benefits of knowing one’s status. Adolescents described age and requirements for parental permission as a significant limitation in their ability to access HIV testing. Conclusions Adolescents require more information about the benefits of testing early and the ability to live a long and healthy life on ART. Educating adolescents that HIV testing is a normative behavior among their peers could strengthen HIV testing among adolescents.

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HIV-Positive Out-of-Treatment Drug Users Who are Unaware of Their HIV Status: Predictors of Who Gets Tested and Who Returns for Test Results

Journal of Drug Issues ◽

10.1177/002204260203200401 ◽

2002 ◽

Vol 32 (4) ◽

pp. 1017-1032 ◽

Cited By ~ 1

Author(s):

Shiela M. Strauss ◽

Sherry Deren ◽

David M. Rindskopf ◽

Gregory P. Falkin

Keyword(s):

Hiv Testing ◽

Risk Behaviors ◽

Drug Users ◽

Hiv Positive ◽

Test Results ◽

Hiv Status ◽

Biological Specimen ◽

The Past ◽

Hiv Test ◽

Using Data

Many HIV positive drug users are unaware that they have the virus, either because they never obtained testing for HIV or because they submitted a biological specimen for testing but never returned to obtain the result of the test. Using data collected from a large multi-site sample of out-of-treatment HIV positive drug users (N=1,544), we identify a variety of socio-demographic characteristics and drug use and sexual risk behaviors that differentiate HIV-positive individuals who had obtained HIV testing in the past and those who had not and, among those who had been tested, what differentiates individuals who had returned to obtain their HIV test results and those who had failed to return. Results of the analyses suggest that there is a need to target different subgroups of high risk drug users for interventions to obtain HIV testing as compared with those that need encouragement to obtain the results of this testing.

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