Factors behind HIV testing practices among Canadian Aboriginal peoples living off-reserve

Abstract

The objective of this study was to examine factors associated with HIV testing among Aboriginal peoples in Canada who live off-reserve. Data were drawn for individuals aged 15-44 from the Aboriginal Peoples Survey (2001), which represents a weighed sample of 520,493 Aboriginal men and women living off-reserve. Bivariable analysis and logistic regression were used to identify factors associated with individuals who had received an HIV test within the past year. In adjusted multivariable analysis, female gender, younger age, unemployment, contact with a family doctor or traditional healer within the past year, and "good" or "fair/poor" self-rated health increased the odds of HIV testing. Completion of high-school education, rural residency, and less frequent alcohol and cigarette consumption decreased the odds of HIV testing. A number of differences emerged when the sample was analyzed by gender, most notably females who self-reported "good" or "fair/poor" health status were more likely to have had an HIV test, yet males with comparable health status were less likely to have had an HIV test. Additionally, frequent alcohol consumption and less than high-school education was associated with an increased odds of HIV testing among males, but not females. Furthermore, while younger age was associated with an increased odds of having an HIV test in the overall model, this was particularly relevant for females aged 15-24. These outcomes provide evidence of the need for improved HIV testing strategies to reach greater numbers of Aboriginal peoples living off-reserve. They also echo the long-standing call for culturally appropriate HIV-related programming while drawing new attention to the importance of gender and age, two factors that are often generalized under the rubric of culturally relevant or appropriate program development.

Tuberculosis infection control in a high drug-resistance setting in rural South Africa: Information, motivation, and behavioral skills

“…Numerous factors influence an HCW's decision to get tested for HIV, and the items used in the present study were mostly limited to TB-related reasons for diagnosis. Not surprisingly, this relatively unsophisticated model was inadequate in characterizing a very complex and highly context-driven behavior [34][35][36]. A refined model is needed in future studies.…”

A systematic review of HIV testing among Canadian populations

“…The increased risk of HIV infection is influenced by high rates of incarceration, substance use, historic inequalities, poverty, social stigma surrounding testing, and low health literacy. 46 Those living on-reserve or in rural areas are less likely to get an HIV test compared to those living in urban settings, 24 which may be due to systemic barriers including concerns about confidentiality and access to testing. 22 Injection drug use is the main exposure category for Aboriginal people infected with HIV.…”

“…23 Finally, 13.2% of Aboriginal people living off-reserve had an HIV test in the previous year (Table 3). 24 …”

“…The pooled prevalence was 55.5% (95% CI 34.7-75.5) from the three studies (Table 3). [22][23][24] A sensitivity analysis was not conducted for this subgroup, as there were no studies assessed as being low quality or with sample sizes of less than 250.…”

Perceived health and alcohol use in individuals with HIV and Hepatitis C who use drugs

“…These studies suggest that individuals who feel poorly may not see value in avoiding risk behaviors, perhaps due to hopelessness or perceived futility. However, other studies show poor perceived health to be associated with positive health behaviors, including adherence to medication among individuals with tuberculosis (Naidoo et al, 2013), and HIV testing among Canadian aboriginal women (Orchard et al, 2010). This alternate possibility, that poor health may incur health-promoting behaviors to offset current problems, should also be considered.…”