Abstract: Structural Level HIV Testing for Women in Ethiopia and Bringing Men into the Fold (Society for Prevention Research 23rd Annual Meeting)

Schedule:

Wednesday, May 27, 2015

Bunker Hill (Hyatt Regency Washington)

* noted as presenting author

Michelle R. Kaufman, PhD, Assistant Professor, The Johns Hopkins University, Baltimore, MD

Lakew Abebe Gebretsadik, MPH, Assistant Professor, Jimma University, Jimma, Ethiopia

Alyssa Mooney, MPH, Doctoral Student, University of California San Francisco, San Francisco, CA

Rupali J. Limaye, PhD, Director of HIV/AIDS Global Program, The Johns Hopkins University, Baltimore, MD

Eshetu Girma, PhD, Assistant Professor, Jimma University, Jimma, Ethiopia

Rajiv Rimal, PhD, Professor and Chair, George Washington University, Washington, DC

Morankar N. Sudhakar, PhD, Professor, Jimma University, Jimma, Ethiopia

Introduction: HIV counseling and testing is the cornerstone of HIV prevention, care, and treatment. Individual factors (demographic, psychosocial) associated with uptake of HIV testing have been studied across multiple populations, including Ethiopia. Testing is not just an individual-level phenomenon, however. In 2007, the Ethiopian Ministry of Health introduced provider-initiated routine counseling and testing using the opt-out approach for all antenatal care (ANC) clients. This study assessed the extent to which routine testing during ANC further contributes to Ethiopian women being tested, above and beyond individual factors leading to testing uptake for both men and women.

Methods: Secondary analyses of the Ethiopian Demographic and Health Survey data was conducted to look at individual level factors (socio-demographics, HIV knowledge, HIV stigma) predicting HIV testing, as well as the influence of ANC attendance. The sample size used in the analysis included 4,137 women and 13,662 men.

Results: HIV testing was associated with being younger, Orthodox, more educated, urban residence, higher wealth, and lower levels of stigma. The relationships between stigma and HIV testing and between knowledge and testing were stronger for females than males. Logistic regression analyses were conducted, with HIV testing in the past two years as the outcome. Age was not significantly associated with testing among women (OR=.997, p>.05), though, among men, age was negatively associated with testing (OR=.991, p<.001). Among men, those who lived with a partner were significantly more likely to get tested (OR=1.378, p<.001), whereas the pattern was reversed for women (OR=.673, p<.01). Controlling for demographics, those holding stigmatizing HIV attitudes were less likely to get tested (men: OR=.813, p<.001; women: OR=.751, p<.001). Knowledge about HIV was positively associated with testing for both genders (men: OR=1.043, p<.05; women: OR=1.183, p<.001). Finally, the model was run including ANC attendance among women. Attendance at last pregnancy was a significant predictor of HIV testing, above and beyond all other variables in the model (OR=3.830, p<.001).

Conclusion: A simple structural intervention (testing during ANC services) was a predictor of HIV testing among women above and beyond any individual factors. To equally target routine testing of men, similar structural interventions where opt-out HIV testing is available must be implemented on a large scale. It is only by including men in regular HIV testing services that test and treat initiatives can be most effective in slowing the epidemic.

Abstract: Structural Level HIV Testing for Women in Ethiopia and Bringing Men into the Fold (Society for Prevention Research 23rd Annual Meeting)

45 Structural Level HIV Testing for Women in Ethiopia and Bringing Men into the Fold