Client Characteristics and HIV Risk Associated with Repeat HIV Testing Among Women in Ethiopia

In Ethiopia, the number of HIV tests administered doubled from 2007 to 2008. However, very little is known about the number of clients testing repeatedly in one year, or their motivations for doing so. We examine repeat HIV testing among 2,027 Ethiopian women attending eight VCT facilities in 2008. Multivariate logistic regression was used to examine associations between repeat HIV testing and demographic, behavioral, and psychosocial characteristics, as well as HIV status. Nearly 40% of clients had tested previously for HIV. Women with high sexual risk are nearly four times more likely than those with no sexual risk to have tested previously, but HIV prevalence was lower among repeat testers (6.5%) than first-time testers (8.5%). Moderate perceived vulnerability, or feeling powerless to prevent HIV infection, is associated with a 50% increased likelihood of being a repeat tester. High perceived behavioral risk is associated with a 40% reduction in the likelihood a woman is testing for at least the second time. Costs associated with repeat testing should be balanced against identification of new HIV cases and prevention benefits.     

Provider-Initiated HIV Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review

Provider-initiated HIV testing and counseling (PITC) has expanded since 2007 WHO guidelines were established. We conducted a systematic review of PITC in low- and middle-income countries. Peer-reviewed studies were included if they measured pre-post or multi-arm outcomes. Two coders abstracted data using standardized forms. Nineteen studies were included, all from sub-Saharan Africa (N = 15) or Asia (N = 4). Studies were conducted in clinics for antenatal/family planning/child health (N = 12), tuberculosis (N = 4), outpatient (N = 1), sexually transmitted diseases (N = 1), and methadone maintenance (N = 1). HIV testing uptake increased after PITC. Condom use also increased following PITC in most studies; nevirapine uptake and other outcomes were mixed. Few negative outcomes were identified. Findings support PITC as an important intervention to increase HIV testing. PITC’s impact on other outcomes is mixed, but does not appear to be worse than voluntary counseling and testing. PITC should continue to be expanded and rigorously evaluated across settings and outcomes.     

HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review

HIV testing uptake continues to be low among Female Sex Workers (FSWs). We synthesizes evidence on barriers and facilitators to HIV testing among FSW as well as frequencies of testing, willingness to test, and return rates to collect results. We systematically searched the MEDLINE/PubMed, EMBASE, SCOPUS databases for articles published in English between January 2000 and November 2017. Out of 5036 references screened, we retained 36 papers. The two barriers to HIV testing most commonly reported were financial and time costs—including low income, transportation costs, time constraints, and formal/informal payments—as well as the stigma and discrimination ascribed to HIV positive people and sex workers. Social support facilitated testing with consistently higher uptake amongst married FSWs and women who were encouraged to test by peers and managers. The consistent finding that social support facilitated HIV testing calls for its inclusion into current HIV testing strategies addressed at FSW.     

A Cluster-Randomized Trial of Traditional Healer-Delivered Counseling and Rapid HIV Testing in Tanzania

AIDS and Behavior - Collaborations with traditional healers have been proposed to improve HIV testing uptake. We hypothesized that healer-delivered HIV testing would improve HIV testing uptake,...     

Healthcare Seeking Intention if Diagnosed with HIV Among Young MSM in Taiwan: A Theory-Based Comparison by Voluntary Counseling and Testing Experience

The number of HIV cases in Taiwan exceeded 30,000 in 2016. Per the UNAIDS 90–90–90 target, 81% of people living with HIV should receive medication. However, numerous previous studies focused on adherence rather than the initial healthcare seeking intention if diagnosed with HIV (HIV HSI). Based on the Theory of Planned Behavior (TPB), anonymous online survey data were collected from December 2016 through February 2017 from 2709 young MSM (YMSM) ages 15–39. Multivariate logistic regression found the significant factors and strengths of associations with HIV HSI varied by their HIV voluntary counseling and testing (VCT) experience. YMSM without VCT experience perceiving high support from salient others (AOR?=?1.28) and high control under facilitating conditions (AOR?=?2.73) had higher HIV HSI. YMSM with VCT experience perceiving high control under facilitating (AOR?=?1.79) and constraining (AOR?=?1.54) conditions had higher HIV HSI. Regardless of VCT experience, YMSM with positive attitudes toward positive healthcare seeking outcomes (AOR?=?3.72–3.95) had highest HIV HSI, highlighting the importance of increasing positive outcome expectations in YMSM.     

2012年深圳市福田区艾滋病自愿咨询检测情况分析

目的 对深圳市福田区2012年艾滋病自愿咨询检测(VCT)情况分析,为调整VCT策略提供依据.方法 收集2012年4 534名求诊者相关资料及实验室检测结果进行分析.结果 2012年共有4 534名求询者接受咨询,男∶女比例为1.6∶1;年龄15～34岁的青壮年占79.4％;求询类型主要包括非商业非固定异性性行为史24.2％,商业异性性行为史16.7％,男男性行为史3.8％,手术史3.0％,及吸毒者0.1％等.所有求询者检测出HIV抗体阳性67人,阳性率1.5％ (67/4 534);其中男性同性性接触者比例较高,占34.3％.结论 深圳市福田区2012年VCT求询者男性较女性多,其中阳性求询者中男性同性性接触感染者比例较高,提示VCT点应加强对高危人群检测咨询后的行为转变的健康教育.     

Effectiveness of Brief Counseling in Reducing HIV Risk Behavior in Injecting Drug Users: Final Results of Randomized Trials of Counseling with and Without HIV Testing

We evaluated the behavioral effects of brief counseling designed to assist injecting drug users in problem-solving situations in which they engage, or are tempted to engage, in practices that place them at risk of infection with HIV. Two hundred ninety-five (295) heroin detoxification clients were randomly assigned to receive either 50 min of the experimental preventive counseling or a packet of educational brochures. Follow-up interviews were conducted 3 and 12 months after randomization to assess the effects of counseling versus brochures. In a follow-up study with 109 clients, the experimental counseling was modified to be conducted in the context of notifying drug users of their HIV test results. In the follow-up study, we conducted standard pretest counseling before randomizing subjects to receive or not to receive the 50 min of experimental counseling. Follow-up interviews conducted 6 and 12 months after randomization assessed the impact of the experimental counseling versus standard pretest counseling. Substantial decreases in injection-related and sexual risk behavior were observed among subjects in both conditions in both studies. The decreases were for the most part sustained to 12-month follow-up interviews. The results suggest that many drug users may not require intensive counseling to reduce or eliminate high-risk practices. We determined that the reductions in risk behavior for both groups and both studies were probably not the result of secular historical trends, contamination of the experimental by the comparison group, volunteer bias, or regression or maturation effects, but very likely were in part a consequence of participating in research. Implications include the potential preventive effectiveness of a widely practiced form of health promotion known as the health risk assessment.     

Early Uptake of HIV Clinical Care After Testing HIV-Positive During Home-Based Testing and Counseling in Western Kenya

Home-based HIV testing and counseling (HBTC) has the potential to increase access to HIV testing. However, the extent to which HBTC programs successfully link HIV-positive individuals into clinical care remains unclear. To determine factors associated with early enrollment in HIV clinical care, adult residents (aged ≥13 years) in the Health and Demographic Surveillance System in Kisumu, Kenya were offered HBTC. All HIV-positive residents were referred to nearby HIV clinical care centers. Two to four months after HBTC, peer educators conducted home visits to consenting HIV-positive residents. Overall, 9,895 (82 %) of 12,035 residents accepted HBTC; 1,087 (11 %) were HIV-positive; and 737 (68 %) received home visits. Of those receiving home visits, 42 % reported HIV care attendance. Factors associated with care attendance included: having disclosed, living with someone attending HIV care, and wanting to seek care after diagnosis. Residents who reported their current health as excellent or who doubted their HBTC result were less likely to report care attendance. While findings indicate that HBTC was well-received in this setting, less than half of HIV-positive individuals reported current care attendance. Identification of effective strategies to increase early enrollment and retention in HIV clinical care is critical and will require coordination between testing and treatment program staff and systems.     

HIV Testing, Gay Community Involvement and Internet USE: Social and Behavioural Correlates of HIV Testing Among Australian Men Who have Sex with Men

A significant minority of Australian men who have sex with men (MSM) have never been tested for HIV and many men do not test as often as recommended. Using data from 1770 HIV-negative and untested MSM collected in a national, online survey, we compared men who had never tested for HIV with those who had tested over 12 months ago and men who had tested over 12 months ago with those that had tested in the past year. Two multivariate logistic regression models were constructed. Compared with men tested over 12 months ago, untested men were younger, less educated, less likely to have unprotected anal intercourse with a regular male partner, less likely to have sought advice from a doctor, nurse or community organisation, more likely to expect HIV-negative disclosure, had fewer gay friends and spent more time using social networking websites. Compared with men who had tested over 12 months ago, men who had tested within the last year were younger, more likely to expect HIV-negative disclosure and disclose to casual partners, more likely to have sought advice from a doctor or nurse, had attended gay pools, gyms or beaches and had more gay friends and more male sex partners. Our findings suggest that the Internet and sex education in schools are important ways to promote HIV testing to untested MSM. Testing reinforcement messages delivered through gay community outreach and primary care will reach previously tested MSM.     

Choice-Disability and HIV Infection: A Cross Sectional Study of HIV Status in Botswana, Namibia and Swaziland

Interpersonal power gradients may prevent people implementing HIV prevention decisions. Among 7,464 youth aged 15–29 years in Botswana, Namibia and Swaziland we documented indicators of choice-disability (low education, educational disparity with partner, experience of sexual violence, experience of intimate partner violence (IPV), poverty, partner income disparity, willingness to have sex without a condom despite believing partner at risk of HIV), and risk behaviours like inconsistent use of condoms and multiple partners. In Botswana, Namibia and Swaziland, 22.9, 9.1, and 26.1% women, and 8.3, 2.8, and 9.3% men, were HIV positive. Among both women and men, experience of IPV, IPV interacted with age, and partner income disparity interacted with age were associated with HIV positivity in multivariate analysis. Additional factors were low education (for women) and poverty (for men). Choice disability may be an important driver of the AIDS epidemic. New strategies are needed that favour the choice-disabled.     

Predictors of Linkage to Care Following Community-Based HIV Counseling and Testing in Rural Kenya

Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18-25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrollment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.     

Prevalence and Correlates of Condom Use and HIV Testing Among Female Sex Workers in Tashkent,Uzbekistan: Implications for HIV Transmission

Little is known about sex work in Tashkent, Uzbekistan, despite rapid increases in HIV infection. Consistent client condom use and prior HIV testing are described among 448 female sex workers (FSW) completing a self-administered questionnaire, health provider interview, and HIV testing between April 2003 and March 2004. Participants were recruited through outreach workers using modified snowball sampling. Consistent client condom use was more likely for FSW who were married, knew condoms prevent HIV, and from countries in south Central Asia. Prior HIV testing was less likely for FSW younger than 21 years, who shared drugs with clients, initiated sex work at 18 years or less and had engaged in sex work less than 2 years. Low rates of condom use, particularly by those with risky drug behaviors, indicate that targeted risk-reduction interventions are urgently needed.     

Clients' Perspective of the Role of Voluntary Counseling and Testing in HIV/AIDS Prevention and Care in Dar Es Salaam, Tanzania: The Voluntary Counseling and Testing Efficacy Study

There is a growing body of evidence that voluntary HIV counseling and testing (VCT) is effective for the primary prevention of HIV as well as for the care and support of individuals affected by HIV in developing countries. This qualitative study offers an additional perspective: the experiences and perceptions of men and women receiving VCT services. As a substudy of a large multisite clinical trial testing the effectiveness of VCT, 81 study participants at the Tanzania study site who were randomized to VCT at baseline were interviewed at the time of their 6-month follow-up. Findings are based on textual analysis of the following themes: HIV in the context of other life issues, motivations for receiving services, positive and negative consequences of VCT, and the role of VCT in risk reduction. Implications for service provision in developing countries are discussed.     

Children's conceptions of AIDS,HIV and condoms: A study from Botswana

This study aimed at exploring how young children in Botswana conceptualise AIDS, HIV and condoms. Data were collected from a sample of 75 children aged four to seven years who were asked to draw a picture about AIDS and tell a story about the drawing; this was followed by three questions in which participants were asked to explain what AIDS, HIV and a condom is. Narratives and responses were categorised and coded to enable statistical analysis. Most children had conceptions of AIDS (80.0%) and condoms (78.7%), but only 45.3% of HIV; the rationality attached to them varied widely at all ages. The results suggest that four- to seven-year-old children construct their own individual and unique meaning about AIDS, HIV and condoms and they also illustrate how children utilise their own experiences to arrive at their conclusions. Even when children narrated some correct HIV and AIDS information, their understanding of it contradicted its correct meaning. Children's interpretations of AIDS-related knowledge carried a potential for emotional distress. Many children had a negative conception of condoms associated with fear and the belief that a condom would cause illness and AIDS. The findings are of significance for parent education, HIV prevention education and for health care professionals providing antiretroviral treatment to children.     

HIV Voluntary Counseling and Testing among Injection Drug Users in South China: A Study of a Non-Government Organization Based Program

HIV voluntary counseling and testing (VCT) programs are usually delivered by government health agencies in China. This study examined the feasibility of using a Chinese non-government organization (NGO) to deliver a VCT program to injection drug users (IDUs) in a southern Chinese city. The process data indicated the program successfully recruited and served 226 male and female IDUs in 4 months. The HIV prevalence rate of the study population was 57.5% by rapid HIV testing with a secondary rapid test to confirm. Quantitative and qualitative evaluations indicated that the VCT program was implemented appropriately and participants' HIV knowledge and safe drug and sex practices were significantly improved after participation in the VCT program. This study demonstrates the feasibility of a Chinese NGO to provide VCT for IDUs and documents the processes and outcomes of the program. There remains a great need to find additional sources to provide VCT and other HIV prevention services to IDUs and other high-risk populations in China. Chinese NGOs have the potential to fill this need.     

Cost-Effectiveness of Counseling and Testing to Prevent Sexual Transmission of HIV in the United States

In this paper we review the cost-effectiveness of HIV counseling and testing in various settings and populations in preventing the sexual transmission of human immunodeficiency virus, and we discuss how multiple and changing goals have influenced economic evaluations of these programs. The literature indicates that these interventions are generally cost-effective if targeted to groups of infected or high-risk individuals, although there is continuing debate over the efficacy of HIV counseling and testing in changing sexual behavior. For these reasons, HIV counseling and testing programs should be part of an overall prevention strategy which also includes more intensive sexual risk-reduction interventions such as individual, small-group, and community-level approaches.     

Correlates of HIV/STD Testing and Willingness to Test among Rural-to-Urban Migrants in China

This study investigates socio-demographic, behavioral, psychological, and structural factors associated with self-reported HIV/STD testing and willingness to test among 1,938 Chinese migrants. Overall, 6% and 14% of participants had ever been tested for HIV and STD, respectively. The results of multivariate analyses indicate that working at entertainment sectors, engaging in commercial sex, and utilization of health care were positively associated with both HIV and STD testing. Younger age, selling blood, perceived peer sexual risk involvement, and satisfaction with life were associated with HIV testing only. Female gender, early sexual debut, multiple sexual partners, and perceived vulnerability to HIV/STD were associated with STD testing only. Male gender, having premarital sex, perceived higher severity of and vulnerability to HIV/STD, and utilization of health care were associated with willingness to be tested for both HIV and STD. Interventions designed to raise the perception of vulnerability to HIV/STD and to improve access to and utilization of health care may be effective in encouraging more HIV testing in this vulnerable population.     

The Cost-Effectiveness of Integrating HIV Counseling and Testing into Primary Health Care in the Ukraine

We estimate the number of HIV cases diagnosed, costs, and cost per HIV case detected associated with integrating HIV counseling and testing (HCT) into primary health care facilities in Ukraine. The study uses a difference-in-difference design with four districts implementing the intervention compared to 20 districts where HCT were offered only at specialized HIV clinics. There was a 2.01 (95 % CI: 1.12–3.61) times increase in the number of HIV cases detected per capita in intervention districts compared to other districts. The incremental cost of the intervention was $21,017 and the incremental cost per HIV case detected was $369. The average cost per HIV case detected before the intervention was $558. Engaging primary health care facilities to provide HCT is likely desirable from an efficiency point-of-view. However, the affordability of the intervention needs to be assessed because expansion will require additional investment.