Articles tagged as "HIV testing"

Risk Assessment

Bailey A, Hutter I. Cultural heuristics in risk assessment of HIV. Cult Health Sex 2006;8:465-77.

Behaviour change models in HIV prevention tend to consider that risky sexual behaviours reflect risk assessments and that by changing risk assessments behaviour can be changed. Risk assessment is however culturally constructed. Individuals use heuristics or bounded cognitive devices derived from broader cultural meaning systems to rationalize uncertainty. In this study Bailey and Hutter identified some of the cultural heuristics used by migrant men in Goa, India to assess their risk of HIV infection from different sexual partners. Data derives from a series of in-depth interviews and a locally informed survey. Cultural heuristics identified include visual heuristics, heuristics of gender roles, vigilance and trust. The paper argues that, for more culturally informed HIV behaviour change interventions, knowledge of cultural heuristics is essential.

Editors’ note: Heuristics (a good word to impress your friends with, pronounced ‘hyu-RIS-tik’, from the Greek ‘heuriskein’ meaning ‘to discover’) are basically rules of thumb. We clearly need to know more about the specific heuristics used by people to guide their risk assessments – yet another reason for engaging people in programme design rather than ‘intervening’.

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HIV Testing

Romero-Gutierrez G, Delgado-Macias AA, et al. Mexican women's reasons for accepting or declining HIV antibody testing in pregnancy. Midwifery 2006 Aug 21[Epub ahead of print] http://www.sciencedirect.com/

Romero-Gutierrez and colleagues determined pregnant women's reasons for accepting or declining the HIV test in Leon, Mexico, in a cross-sectional study using a face-to-face questionnaire. 1009 of 1184 (85.2%) women accepted the HIV test. The main reason for accepting was the feeling that the test could be beneficial to their babies (45.1%). The two main reasons for women rejecting the HIV test were the belief that their husbands did not have sexual intercourse with other women (32.6%) and lack of permission from their husbands for the test (23.5%). None of the women tested positive for HIV. The authors conclude that the reasons for accepting the HIV test were similar to those reported in developed countries. The acceptance rate for HIV testing in pregnant women could be improved by counselling men on the value of their wives being tested in pregnancy.

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HIV Testing and Counselling

Bucharski D, Reutter LI, Ogilvie LD. "You Need to Know Where We're Coming From": Canadian Aboriginal women's perspectives on culturally appropriate HIV counselling and testing. Health Care Women Int 2006;27:723-47.

The purpose of this qualitative descriptive study was to determine Canadian Aboriginal women's perspectives on culturally appropriate HIV counselling and testing. Data were collected through semi-structured individual interviews with 7 Aboriginal women, and one focus group, in a western Canadian city. Four major categories were elucidated through thematic content analysis: Aboriginal women's life experiences that may influence their risk of HIV infection and their response to testing; barriers to HIV testing; guiding principles of the ideal HIV testing situation; and characteristics of culturally appropriate HIV testing. The fear of being judged by both the Aboriginal and non-Aboriginal communities and the need for sensitivity to the historical and current context of Aboriginal women's life experiences were pervasive themes throughout the findings.

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HIV Testing and Counselling

Macphail CL, Pettifor A, et al. "You Must Do the Test to Know Your Status": Attitudes to HIV Voluntary Counseling and Testing for Adolescents Among South African Youth and Parents. Health Educ Behav 2006 Jul 26; [Epub ahead of print]

Reduced HIV risk behaviour and increased use of care and support services have been demonstrated among adults accessing HIV voluntary counselling and testing (VCT). The impact of VCT on adolescents is, however, not known. Focus group discussions were held with adolescents and parents in two South African townships to establish the perceptions of and needs for VCT among young people. Ecological theory informed the analysis. Adolescents had limited experience of VCT, were afraid of knowing their HIV status, and felt that testing was only for symptomatic individuals. Youth felt that they would disclose their HIV status to family members who they felt would be most supportive. Youth were afraid of stigma and discrimination; rarely referring to the community as a source of support. Discussions highlighted the inappropriateness of clinical facilities for youth VCT. The authors conclude with recommendations for youth-friendly VCT services.


Hutchinson AB, Branson BM, et al. A meta-analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status. AIDS 2006;20:1597-1604Alternatives to conventional HIV counselling and testing (HIV-CT) have been used to improve receipt of HIV test results. Hutchinson and colleagues assessed the effectiveness of alternative HIV-CT methods on the receipt of HIV test results. They identified studies by a systematic search of the literature using English-language databases from 1990 to 2005. Studies were included if they used an alternative method for HIV-CT, reported the receipt of HIV test results and had a comparison group. Pooled effect sizes [risk ratios (RR)] were calculated using a random effects model. Seventeen effect sizes (k) were included n = 21 096). Alternative HIV-CT methods included rapid testing (k = 12), oral fluid testing (k = 2), home testing (k = 1), and telephone post-test counselling (k = 2). All alternatives except for oral fluid testing significantly increased receipt of results compared with conventional testing. In stratified analysis, rapid testing was most effective [RR, 1.80; 95% CI 1.46-2.22) followed by telephone post-test counselling (RR, 1.38. 95% CI, 1.24-1.47). Hutchinson and colleagues conclude that here is strong evidence that clients are substantially more likely to receive their HIV test results with rapid testing than with conventional tests or other alternatives. Therefore, to increase knowledge of HIV status, rapid testing is preferable in settings with low rates of return for test results.

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HIV Testing

Thierman S, Chi BH, et al. Individual-level predictors for HIV testing among antenatal attendees in Lusaka, Zambia. Am J Med Sci 2006;332:13-17.

Despite the availability of antiretroviral prophylaxis, roughly one-fifth of public-sector antenatal patients decline HIV testing in Lusaka, Zambia. Thierman and colleagues administered a survey to determine individual-level predictors of HIV testing. Of 1064 antenatal attendees approached after pre-test counselling, 1060 (>99%) participated. Of these, 686 (65%) agreed to HIV testing. On bivariate analysis controlling for clinic of attendance, women younger than 20 years old (RR 1.14), unmarried (RR 1.14), pregnant for the first time (RR 1.14), with lower educational attainment (RR 1.15), and with lower income (RR 1.14) were all more likely to undergo testing. When HIV risk was considered, women with low self-perceived risk were most likely to undergo HIV testing. As risk perception increased, likelihood for testing decreased (P for trend < 0.001). The authors conclude that although not statistically predictive, they identified prevalent community beliefs that may act as barriers to testing. Because individual-level characteristics were only weakly predictive of HIV testing, they recommend that future work should concentrate on community-level factors.

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HIV Testing

Weiser SD, Heisler M, et al. Routine HIV testing in Botswana: A population-based study on attitudes, practices, and human rights concerns. PLoS Med 2006;3:e261. http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030261

Photo credit: UNAIDS/G-Pirozzi
Photo credit: UNAIDS/G-Pirozzi
The Botswana government recently implemented a policy of routine or “opt-out” HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. Weiser and colleagues conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favour of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (OR 1.5, 95% CI 1.1–1.9), higher education (OR 2.0, 95% CI 1.5–2.7), more frequent healthcare visits (OR 1.9, 95% CI 1.3–2.7), perceived access to HIV testing (OR 1.6, 95% CI 1.1–2.5), and inconsistent condom use (OR 1.6, 95% CI 1.2–2.1). Individuals with stigmatising attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV (OR 0.7, 95% CI 0.5–0.9) or to have heard of routine testing (OR 0.59, 95% CI 0.45–0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning one's status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%). Routine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing.

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HIV Testing

Warwick Z. The influence of antiretroviral therapy on the uptake of HIV testing in Tutume, Botswana. Int J STD AIDS 2006;17:479-81.

Warwick describes how the ART programme in Botswana has influenced the willingness of the community of Tutume District, Botswana to come forward for HIV testing. A retrospective review of Tutume Primary Hospital records was performed for three different periods: prior to the national ART programme, once ART was available in limited centres, and once ART was available locally. There was a five-fold increase in the number of HIV tests performed once treatment became available locally, primarily due to increased uptake by women. The author concludes that access to free ART increases the HIV testing rate of previously reluctant communities.

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Testing

Homsy J, Kalamya JN, et al. Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital. J Acquir Immune Defic Syndr 2006;42:149-54. http://gateway.ut.ovid.com/gw2/ovidweb.cgi

In Africa, prevention of mother-to-child HIV transmission (PMTCT) programs are hindered by limited uptake by women and their male partners. Routinely offering HIV counselling and testing during labour has been proposed as a way to increase PMTCT uptake, but little data exist on the impact of such intervention in a programmatic context in Africa. In May 2004, PMTCT services were established in the antenatal clinic (ANC) of a 200-bed hospital in rural Uganda; in December 2004, ANC PMTCT services became opt-out, and routine opt-out intrapartum HIV counselling and testing was established in the maternity ward. Homsy and colleagues compared acceptability, feasibility, and uptake of maternity and ANC PMTCT services between December 2004 and September 2005. They found routine HIV counselling and testing acceptance was 97% (3591/3741) among women and 97% (104/107) among accompanying men in the ANC and 86% (522/605) among women and 98% (176/180) among their male partners in the maternity. Thirty-four women were found to be HIV seropositive through intrapartum testing, representing a 12% (34/278) increase in HIV infection detection. Of these, 14 received their result and nevirapine before delivery. The percentage of women discharged from the maternity ward with documented HIV status increased from 39% (480/1235) to 88% (1395/1594) over the period. Only 2.8% undocumented women had their male partners tested in the ANC in contrast to 25% in the maternity ward. Of all male partners who presented to either unit, only 48% (51/107) came together and were counselled with their wife in the ANC, as compared with 72% (130/180) in the maternity ward. Couples counselled together represented 2.8% of all persons tested in the ANC, as compared with 37% of all persons tested in the maternity ward. The authors conclude that routine intrapartum HIV counselling and testing may be an acceptable and feasible way to increase individual and couple participation in PMTCT interventions.

Editors’ note: An important consultation is being convened this coming week by WHO and UNAIDS to examine the public health and individual benefits on one hand and the human rights concerns on the other associated with provider-initiated testing, with a view to developing operational guidance for countries.

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HIV Testing

Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing: Cochrane systematic review. Int J Epidemiol 2006;35:233-34.http://ije.oxfordjournals.org/cgi/content/full/35/2/233

Vidanapathirana et al conducted a systematic review of the scientific literature to assess the effect of mass media interventions on the uptake of HIV testing services. The multimedia interventions in the 14 studies identified were based on watching, reading, or hearing information. Pooling the results from all the studies showed that mass media interventions have immediate and overall effects in the promotion of HIV testing. Although this review was limited to developed countries, television and radio can be used in both literate and non-literate communities. Therefore the findings are likely to be generalisable to low and middle income countries as well. The authors conclude that additional research is needed to identify the effectiveness of different types of mass media interventions, the cost effectiveness of the interventions, and characteristics of messages.

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