Trends in the uptake of voluntary counselling and testing for HIV in rural Tanzania in the context of the scale up of antiretroviral therapy

Objectives To describe trends in voluntary counselling and testing (VCT) use and to assess whether high‐risk and infected individuals are receiving counselling and learning their HIV status in rural Tanzania. Methods During two rounds of linked serological surveys (2003–2004 and 2006–2007) with anonymous HIV testing among adults, VCT was offered to all participants. The crude and adjusted odds ratios for completing VCT in each survey were calculated to compare uptake by demographic, behavioural and clinical characteristics, stratified by sex. Repeat testing patterns were also investigated. Results The proportion of participants completing VCT increased from 10% in 2003–2004 to 17% in 2006–2007, and among HIV‐infected persons from 14% to 25%. A higher proportion of men than women completed VCT in both rounds, but the difference declined over time. Socio‐demographic and behavioural factors associated with VCT completion were similar across rounds, including higher adjusted odds of VCT with increasing numbers of sexual partners in the past 12 months. The proportion having ever‐completed VCT reached 26% among 2006–2007 attendees, with repeat testing rates highest among those aged 35–44 years. Among 3923 participants attending both rounds, VCT completion in 2006–2007 was 17% among 3702 who were HIV negative in both rounds, 19% among 124 who were HIV infected in both rounds and 22% among 96 who seroconverted between rounds. Conclusion VCT services are attracting HIV‐infected and high‐risk individuals. However, 2 years after the introduction of antiretroviral therapy, the overall uptake remains low. Intensive mobilisation efforts are needed to achieve regular and universal VCT use.     

Patterns of uptake of HIV testing in sub‐Saharan Africa in the pre‐treatment era

Objectives To compare nationally representative trends in self‐reported uptake of HIV testing and receipt of results in selected countries prior to treatment scale‐up. Methods Demographic and Health Survey (DHS) data from 13 countries in sub‐Saharan Africa were used to describe the pattern of uptake of testing for HIV among sexually active participants. Univariate and multivariate logistic regression were used to analyse the associations between socio‐demographic and behavioural characteristics and the uptake of testing. Results Knowledge of serostatus ranged from 2.2% among women in Guinea (2005) to 27.4% among women in Rwanda (2005). Despite varied levels of testing, univariate analysis showed the profile of testers to be remarkably similar across countries, with respect to socio‐demographic characteristics such as area of residence and socio‐economic status. HIV‐positive participants were more likely to have tested and received their results than HIV‐negative participants, with the exception of women in Senegal and men in Guinea. Adjusted analyses indicate that a secondary or higher level of education was a key determinant of testing, and awareness that treatment exists was independently positively associated with testing, once other characteristics were taken into account. Conclusion This work provides a baseline for monitoring trends in testing and exploring changes in the profile of those who get tested after the introduction and scale‐up of treatment.     

美沙酮服药人员HIV阴性配偶高危性行为及影响因素分析

目的了解云南省美沙酮维持治疗人员艾滋病病毒(HIV)阴性配偶(单阳阴配)高危性行为及其影响因素,为针对性地进行干预提供依据。方法选取云南省13个美沙酮门诊所有HIV阳性服药人员的固定性伴,并通过HIV阳性检测筛检出阴性者,采用调查问卷收集包括人口学特征、知识知晓率及高危性行为等数据,并对高危性行为及影响因素进行分析。结果阴性配偶上次发生性关系时使用安全套的占74%;接受过性病、艾滋病免费咨询和HIV检测的较高,分别为90%、92%;但接受过性病检查治疗的仅有28%。无小孩是其不使用安全套的影响因素(OR=0.197)。结论 HIV阴性配偶发生性行为时高危性行为明显,易受HIV传播直接受害,特别是没有小孩的少数民族女性,应加强对HIV阴性配偶的强化干预,加强安全套的推广使用,以降低配偶间性行为HIV传播概率。     

Perceived risks and benefits of HIV testing, and predictors of acceptance of HIV counselling and testing among pregnant women in Zimbabwe

This project evaluated perceived risks and benefits and determined predictors of acceptance of voluntary HIV counselling and testing (VCT) among pregnant women in Zimbabwe. One hundred and seventy pregnant women attending an urban antenatal clinic were surveyed. Implications of a negative or positive HIV test result and of telling a partner or community members that one is HIV positive were queried. Forty women (23.5%) consented to VCT, and 16 (40%) were HIV positive. Women who saw VCT as lower risk (odds ratio [OR] = 2.3, 95% confidence interval [CI] [1.1-5.0]) and women who had had a stillbirth or child die (OR = 0.4, 95% CI [0.16-0.97]) were more likely to consent. Prenatal HIV VCT offers the best opportunity for prevention of mother-to-child transmission of HIV; however, less than 25% of women consented. If such interventions are to be successful, attention must be directed towards developing culturally appropriate strategies to address women's concerns and improve future acceptance of VCT in Zimbabwe.     

新疆维吾尔自治区人民医院VCT检测服务情况分析

目的在新疆维吾尔自治区人民医院,通过开设艾滋病自愿咨询检测(Voluntary counseling and testing,VCT)门诊,向求询者提供艾滋病相关咨询检测服务,并及时发现艾滋病病毒(Human immunodeficiency virus,HIV)感染者和艾滋病病人。方法在VCT门诊对求询者免费进行HIV咨询和抗体检测,对咨询情况和检测结果进行描述和统计分析。结果自2007年开设VCT门诊至2010年底,共向2 546名求询者提供了免费艾滋病咨询,其中接受HIV检测者有1 865人,占73.2%,检测出HIV抗体阳性者160人,阳性率为8.6%。求询原因,男性以吸毒为主,女性则以高危性接触为主。结论新疆维吾尔自治区人民医院VCT门诊求询者HIV感染率较高,有必要在新疆地区充分利用VCT平台,特别是利用大型综合性医院的优势,开展艾滋病相关健康教育、行为干预和HIV检测监测工作。     

Predictors of voluntary HIV counselling and testing services utilization among people with disabilities in Addis Ababa,Ethiopia

The study investigated HIV testing prevalence and factors associated with the utilization of voluntary HIV counselling and testing (VCT) services among individuals with disabilities in Addis Ababa. The analysis was based on a survey of 209 men and 203 women with disabilities, aged 15–49, who had ever heard about HIV and AIDS in four sub-cities in Addis Ababa. HIV testing prevalence was 53.2%, with no significant difference between males and females. Comprehensive HIV knowledge, living with spouse, and religious affiliations positively predicted utilization of VCT services among participants. Living with both parents and having physical or mental/intellectual disabilities were negative predictors of VCT services utilization. More research on the predictors of utilization of VCT services by gender and urban/rural divides are needed among people with disabilities.     

北京市朝阳区艾滋病自愿咨询检测情况分析

目的调查北京市朝阳区艾滋病自愿咨询检测（VCT）人群的社会人口学特征和艾滋病病毒（HIV）感染状况,有针对性地制定朝阳区艾滋病健康教育和高危干预措施。方法对2007年6月-2008年9月,朝阳区疾病预防控制中心艾滋病VCT门诊求询者的调查结果进行分析。结果868名求询者接受咨询和血清HIV抗体检测,以20～40岁男性青壮年为主,占89.9%;男女比例7.19∶1;未婚占68.9%。求询原因以发生危险性行为为主,占86.3%。HIV抗体阳性41例,感染率为4.7%,以性途径感染为主（75.6%）,22人通过同性性行为感染。结论朝阳区艾滋病的传播以性途径为主,求询者以年轻、未婚和高学历男性为主,HIV感染在男男性行为人群（MSM）中检出率较高。因此,应对男性青壮年、MSM人群进行广泛的艾滋病健康教育,加强针对MSM人群的行为干预措施。     

HIV Voluntary Counseling and Testing Service Preferences in a Rural Malawi Population

Voluntary counseling and testing (VCT) services have become an integral component of HIV prevention efforts in sub-Saharan Africa. This study of a rural Malawi district population examined variation in past and desired use of VCT services among 868 women aged 15 to 34 and 648 men aged 20 to 44 aware of HIV/AIDS. Only 11% of men and 7% of women had been tested, but of those untested, 76% of men and 61% of women desired testing. Ninety percent of respondents willing to know their results preferred to hear them from a test site counselor and on the same day of the test. However, 27% of women wanting to be tested did not want to know their test results, a finding significantly associated with knowing someone affected by AIDS and perceiving oneself at HIV infection risk. Knowledge of the behaviors of HIV prevention, knowing someone with AIDS, knowing the locations of a test site, and perceived risk of HIV infection all had a consistently significant association with past and future VCT use for men and women.     

北京市房山区2009年艾滋病自愿咨询检测情况分析

目的了解2009年艾滋病自愿咨询检测(VCT)人群的社会人口学特征和艾滋病病毒(HIV)感染状况,为今后有针对性地开展防治工作提供科学依据。方法采用描述性流行病学方法,对2009年自愿咨询检测的求询者咨询情况和检测结果进行统计学分析。结果 534名求询者中,自愿检测HIV者532人,男∶女为1.17∶1,18~40岁占95.88%。求询者类型以有非婚异性性行为史的女性居多,占66.67%。检出HIV抗体阳性2例,阳性率0.38%。其中1例为手术史,1例为配偶阳性。结论应进一步做好艾滋病预防控制宣传工作及干预工作,把重点放在青壮年和有非婚异性性行为的女性人群。     

Male and female rural probationers: HIV risk behaviors and knowledge

Individuals involved in the criminal justice system are at substantial risk for HIV infection and have elevated rates of AIDS. Offenders under community supervision, such as probationers, have substantially more opportunities to engage in high-risk behaviors than prisoners. Furthermore, probationers in rural areas are at risk because rural areas may be slower to adopt HIV risk-reduction approaches. Consequently, the primary goal of this study is to describe the HIV risk behaviors and level of HIV knowledge of 800 rural felony probationers. Bivariate results indicate that males have substantially greater criminal histories and engage in more substance use risk behaviors than females. Overall, there was minimal and inconsistent use of condoms, but there were no significant differences by gender. Gender differences prevailed in perceived HIV knowledge, with females reporting high levels of perceived HIV knowledge. Multivariate models did not support the hypothesis that perceived knowledge would be a more robust correlate of scores on the HIV Risk Behavior Knowledge Test for males than females. Results suggest that rural residents are not protected from engaging in HIV risk behaviors and future studies should examine gender discrepancies between perceived and actual HIV knowledge among offenders under community supervision.     

Post-abortion care and voluntary HIV counselling and testing--an example of integrating HIV prevention into reproductive health services

OBJECTIVE: To assess the acceptance and outcome of voluntary HIV counselling and testing (VCT) among women who had an unsafe abortion. METHOD: 706 women were provided with post-abortion contraceptive service and offered VCT. We collected data on socioeconomic characteristics and contraceptive use and determined the HIV status of those who accepted VCT. Using a nested case-control design, we compared women who accepted HIV testing with women who did not. To study the association between socioeconomic factors, HIV testing acceptance and condom use in more detail, we did stratified analyses based on age and marital status. RESULTS: 58% of the women who had an unsafe abortion accepted HIV testing. Women who earned an income were more likely to accept testing than housewives. Women who accepted testing were more likely to accept using a condom. The HIV prevalence rate was 19% among single women aged 20-24 years and 25% among single women aged 25-45 years. CONCLUSION: HIV testing and condoms were accepted by most women who had an unsafe abortion. The poor reproductive health of these women could be improved by good post-abortion care that includes contraceptive counselling, VCT and condom promotion.     

HIV-related knowledge, attitudes, perceived benefits, and risks of HIV testing among pregnant women in rural Southern India

The rising prevalence of HIV among pregnant women in rural India is of great concern. Prenatal voluntary counseling and HIV testing (VCT) is critical to prevent mother-to-child transmission of HIV (PMTCT). We surveyed 202 pregnant women attending a rural antenatal clinic in Southern India to investigate HIV-related knowledge, attitudes toward infant feeding practices, and perceived benefits and risks of HIV testing. Of the total of 202 women surveyed, 189 women (94%) had heard of HIV/AIDS and 60% of them had relatively good knowledge regarding risk factors for HIV transmission. However, 48% did not know that there are "means to prevent mother-to-child HIV transmission." If women were not to breastfeed her baby, negative attitudes expected from the partner would include 84% thinking that that the mother is harming the baby, 78% thinking she is not a good mother, 74% thinking she has HIV, and 66% thinking she has been unfaithful. Ninety-seven percent of women did not perceive themselves at risk for HIV and only 57% had been tested for HIV. Although, 85% of women expressed their willingness to be tested, most were concerned about confidentiality and disclosing HIV serostatus because of fear of negative reactions from their husbands, parents, and community. Many social and cultural barriers confront pregnant women when they decide to opt for HIV testing. If VCT and PMTCT interventions are to be successful, urgent attention must be focused on education, development of innovative culturally appropriate interventions that empower women to make decisions about HIV testing, involvement of men, and addressing stigma and discriminatory attitudes toward people living with HIV/AIDS.     

Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort

OBJECTIVES: To examine the determinants of uptake of voluntary counselling and testing (VCT) services, to assess changes in sexual risk behaviour following VCT, and to compare HIV incidence amongst testers and non-testers. METHODS: Prospective population-based cohort study of adult men and women in the Manicaland province of eastern Zimbabwe. Demographic, socioeconomic, sexual behaviour and VCT utilization data were collected at baseline (1998-2000) and follow-up (3 years later). HIV status was determined by HIV-1 antibody detection. In addition to services provided by the government and non-governmental organizations, a mobile VCT clinic was available at study sites. RESULTS: Lifetime uptake of VCT increased from under 6% to 11% at follow-up. Age, increasing education and knowledge of HIV were associated with VCT uptake. Women who took a test were more likely to be HIV positive and to have greater HIV knowledge and fewer total lifetime partners. After controlling for demographic characteristics, sexual behaviour was not independently associated with VCT uptake. Women who tested positive reported increased consistent condom use in their regular partnerships. However, individuals who tested negative were more likely to adopt more risky behaviours in terms of numbers of partnerships in the last month, the last year and in concurrent partnerships. HIV incidence during follow-up did not differ between testers and non-testers. CONCLUSION: Motivation for VCT uptake was driven by knowledge and education rather than sexual risk. Increased sexual risk following receipt of a negative result may be a serious unintended consequence of VCT. It should be minimized with appropriate pre- and post-test counselling.     

Patterns of Self-reported Behaviour Change Associated with Receiving Voluntary Counselling and Testing in a Longitudinal Study from Manicaland, Zimbabwe

Voluntary counselling and testing (VCT) is promoted as a potential HIV prevention measure. We describe trends in uptake of VCT for HIV, and patterns of subsequent behaviour change associated with receiving VCT in a population-based open cohort in Manicaland, Zimbabwe. The relationship between receipt of VCT and subsequent reported behaviour was analysed using generalized linear models with random effects. At the third survey, 8.6% of participants (1,079/12,533), had previously received VCT. Women who received VCT, both those positive and negative, reduced their reported number of new partners. Among those testing positive, this risk reduction was enhanced with time since testing. Among men, no behavioural risk reduction associated with VCT was observed. Significant increases in consistent condom use, with regular or non-regular partners, following VCT, were not observed. This study suggests that, among women, particularly those who are infected, behavioural risk reduction does occur following VCT.     

Prevalence of HIV and Chlamydia trachomatis infection in 15--19-year olds in rural Tanzania

OBJECTIVE: To estimate the prevalence of HIV and Chlamydia trachomatis (CT) infections amongst adolescents in rural Mwanza Region, Tanzania and their association with demographic variables. DESIGN: Population-based cross-sectional survey. METHODS: All 15--19-year olds living in households selected by random cluster sampling were invited to participate. After interview, urine was tested for HIV and CT. RESULTS: 9445 15--19-year olds were enrolled. HIV prevalence was 0.6% (95% CI: 0.4--0.8%) in males and 2.4% (95% CI: 2.0--2.8%) in females, and increased steeply with age (trend: P < 0.006 and P < 0.001, respectively). After adjustment for age, risk of HIV infection was significantly associated with female sex (OR=4.3), never having been to primary school in males (OR=2.7), and current symptoms of genital discharge (OR=2.3) or genital ulcer (OR=5.3) in females. The prevalence of CT was 1.0% (95% CI: 0.8--1.4%) in males and 2.4% (95% CI: 2.0-2.9%) in females. After adjustment for age, CT infection was associated with female sex (OR=2.4), reported current symptoms of STD (males OR=2.5, females OR=1.9) and positive leucocyte esterase (LE) test (males OR=3.1, females OR=2.6). Eighty-two percent of males and 79% of females with CT were asymptomatic. There was no association between CT and HIV infection in either sex. CONCLUSIONS: There is a high prevalence of HIV and CT amongst adolescents, especially young women, in this rural population, highlighting the need for effective interventions to improve adolescent reproductive health. The high rates of asymptomatic infection imply that innovative strategies are needed to reach and treat young people with STD.     

湖州市2011年艾滋病自愿咨询检测结果分析

目的了解湖州市接受艾滋病自愿咨询检测（VCT）服务人群的现状,为艾滋病防治措施的制定提供科学依据。方法对2011年在湖州市接受VCT服务的人员的人口学状况、求询原因、危险行为等进行统计学分析。结果3 778名求询者中,3 759人（99.5%）接受了HIV抗体检测,检出阳性9例,HIV检出率为0.24%。求询者男女性别比为0.8∶1;年龄主要集中在20～49岁,占90.3%;初中学历占38.6%。各类高危行为中,有性乱史者占58.8%。结论青壮年和性接触是湖州市艾滋病传播的高危人群及方式;加强艾滋病知识宣传和VCT服务、提高求询者阳性者转介率,是今后VCT工作的重点。     

The Role of HIV-Related Knowledge and Ethnicity in Determining HIV Risk Perception and Willingness to Undergo HIV Testing Among Rural Women in Burkina Faso

We conducted a random community based survey of 300 young (15–29 years) rural women in Nouna, Burkina Faso. Only one-third of women were aware that a person could have HIV without having symptoms and these women were significantly more likely to classify themselves to be at high risk for getting HIV. Furthermore, multiple partners, Bwaba ethnicity and having mentioned a health worker as a source of HIV information were significantly associated with perceived high personal risk. Perceived willingness to participate in VCT was high (69%). The dissemination of information on the asymptomatic nature of HIV infection could potentially be very important in forming risk perception, awareness, and their willingness to participate in HIV interventions.     

艾滋病自愿咨询检测人群的特征及HIV感染率分析

目的了解艾滋病自愿咨询检测（VCT）人群的特征和艾滋病病毒（HIV）的感染情况。方法对2008-2011年浦东新区VCT人群进行HIV检测和人群特征分析,并对部分VCT求询者进行艾滋病相关知识和心理测试。结果 2008-2011年,VCT人群HIV感染率分别为1.52%、2.33%、3.92%、4.25%,感染途径以性接触为主。其中男男同性行为占51.11%,非婚异性性行为占31.11%,婚内性行为占8.89%;异性性行为与男男同性性行为之间感染率的差异有统计学意义（P〈0.05）。VCT求询者平均年龄为（29.69±7.52）岁,20～45岁的青壮年占94.80%;92.84%因非婚性接触（同性及异性）来咨询检测;男男同性性行为与非婚异性性行为之间的完全用套率差异有统计学意义（P〈0.05）,大专及以上、高中（含中专）和初中及以下3组不同文化程度的非婚异性性接触者,完全用套率的差异也有统计学意义（均P〈0.05）。抽查人群的艾滋病知识水平、自我效能感相对较高。结论 VCT是发现HIV感染者和开展干预的重要窗口,应针对不同人群进一步完善健康教育和行为干预。     

Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda

OBJECTIVE: To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda. METHODS: In a rural cohort, 10 694 consenting adults were interviewed, provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively. RESULTS: Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85-0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90-0.99) or higher (adj. RR = 0.91; 95% CI, 0.87-0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68-0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90-0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82-0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08-1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04-1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT. CONCLUSION: In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.     

Socioeconomic status and risk of HIV infection in an urban population in Kenya

OBJECTIVE: To examine the relationship between socioeconomic status (SES), risk factors for HIV infection and HIV status in an urban population with high prevalence of HIV infection in sub-Saharan Africa. METHODS: Cross-sectional population survey of adults from the city of Kisumu, Kenya, in 1996. Around 1000 men and 1000 women aged 15-49 years were interviewed using a structured questionnaire, and most gave a venous blood sample for HIV testing. SES was represented by a composite variable of educational status, occupation and household utilities. Multiple regression was used to examine whether SES was associated with HIV infection or with risk factors for HIV infection. RESULTS: Human immunodeficiency virus prevalence was 19.8% in males and 30.2% in females. Higher SES was associated with a more mobile lifestyle, later sexual debut and marriage among both sexes, and with circumcision among men aged 25-49 and condom use among women aged 25-49. Higher levels of alcohol consumption were associated with an increased risk of HIV infection and were more common amongst those of higher SES. HSV-2 infection was strongly associated with an increased risk of HIV infection and was more common among those of lower SES. HIV was associated with a lower SES among females aged 15-24 whereas in males aged 15-24 and females aged 25-49 there was some indication that it was associated with higher SES. Among males aged 25-49 there was no association between HIV infection and SES. CONCLUSIONS: Risk of infection was high among groups of all SES. Risk profiles suggested men and women of lower SES maybe at greater risk of newly acquired HIV infection. New infections may now be occurring fastest among young women of the lowest SES.