Expanding HIV Testing Efforts in Concentrated Epidemic Settings: A Population-Based Survey from Rural Vietnam

Abstract

BackgroundTo improve HIV prevention and care programs, it is important to understand the uptake of HIV testing and to identify population segments in need of increased HIV testing. This is particularly crucial in countries with concentrated HIV epidemics, where HIV prevalence continues to rise in the general population. This study analyzes determinants of HIV testing in a rural Vietnamese population in order to identify potential access barriers and areas for promoting HIV testing services.MethodsA population-based cross-sectional survey of 1874 randomly sampled adults was linked to pregnancy, migration and economic cohort data from a demographic surveillance site (DSS). Multivariate logistic regression analysis was used to determine which factors were associated with having tested for HIV.ResultsThe age-adjusted prevalence of ever-testing for HIV was 7.6%; however 79% of those who reported feeling at-risk of contracting HIV had never tested. In multivariate analysis, younger age (aOR 1.85, 95% CI 1.14–3.01), higher economic status (aOR 3.4, 95% CI 2.21–5.22), and semi-urban residence (aOR 2.37, 95% CI 1.53–3.66) were associated with having been tested for HIV. HIV testing rates did not differ between women of reproductive age who had recently been pregnant and those who had not.ConclusionsWe found low testing uptake (6%) among pregnant women despite an existing prevention of mother-to-child HIV testing policy, and lower-than-expected testing among persons who felt that they were at-risk of HIV. Poverty and residence in a more geographically remote location were associated with less HIV testing. In addition to current HIV testing strategies focusing on high-risk groups, we recommend targeting HIV testing in concentrated HIV epidemic settings to focus on a scaled-up provision of antenatal testing. Additional recommendations include removing financial and geographic access barriers to client-initiated testing, and encouraging provider-initiated testing of those who believe that they are at-risk of HIV.

Women living with HIV in Vietnam: desire for children, use of sexual and reproductive health services, and advice from providers

“…19 A study in the Bavi district of Hanoi found that only 6% of pregnant women were tested for HIV and that 79% of those who perceived they were at risk of HIV infection had never been tested. 21 Little is known about access to sexual and reproductive health services among people living with HIV, 22 and there is evidence that women who are not drug users or sex workers are not accessing HIV prevention, care and treatment. 23 A recent study in Hai Phong found that pregnant women do not get tested for HIV in the course of antenatal care, 24 suggesting that some women living with HIV (WLHIV) may lack the knowledge of and access to treatment and prevention of mother-to-child transmission services.…”

Individual- and contextual-level factors associated with client-initiated HIV testing

“…Being aware of the AIDS treatment is also a determining factor for client-initiated testing among women. Other studies have also observed an association of good knowledge about HIV/AIDS with client-initiated testing 6,17 . Having knowledge about HIV infection and treatment can reduce fear of death in case of positive test results and help overcome psychological barriers to testing.…”

“…We can conclude that client-initiated testing is more frequent during life stages in which people are more sexually and reproductively active. Conversely, younger males (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and older men (> 45 years) and women may be less likely to seek testing and benefit from early diagnosis 11,12 . In a population-based survey carried out in nine sub-Saharan African countries, lower testing rates were found among older (aged 50 or above) respondents, irrespective of reasons for testing, as well as lower levels of knowledge about testing, AIDS treatment, and condom use 13 .…”

“…They are more likely to engage in unprotected sex, which may be attributed to difficulties in negotiating condom use with male partners. They are also repeatedly exposed to violence perpetrated by their partners [17][18][19][20][21] , and may use more health care services 22 . Client-initiated testing may reflect health concerns as these women perceive themselves at risk for HIV exposure because they have a history of non-consensual sex and use of health services as part of self-care.…”

“…Pharris et al (2011) 17 reported a positive association of testing with high income, living in urban areas and having a high schooling level. Living in a neighborhood with good basic education and socioeconomic conditions may have a positive impact on health-related attitudes at an individual level and promote women's empowerment.…”