Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention

Abstract

ObjectivesIncreasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing.Design and settingA cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique.ParticipantsData were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731).MeasuresMeasures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates.ResultsSignificantly fewer men (38.3%) than women (47.6%; p<0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women.ConclusionsMen have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men’s engagement into the HIV care continuum in sub-Saharan Africa.

<p>HIV Voluntary Counseling and Testing Uptake and Associated Factors Among Sexually Active Men in Ethiopia: Analysis of the 2016 Ethiopian Demographic and Health Survey Data</p>

“…Regarding wealth status, the odds of getting tested for HIV/AIDS for the rich males was 58.6% higher than for the poor. Different studies [14][15][16]20,28 also showed that rich people are more likely to accept HIV VCT as compared to the poor. This could be explained by different reasons.…”

“…13,14 Different studies also show that age, gender, region of residence, marital status, being covered by health insurance, age at first sex, stigma toward the HIV patient, comprehensive HIV knowledge, discussion about HIV with partner, HIV risky behavior, wealth index, educational status, religion, and distance from the nearest health facility were significantly associated with HIV VCT uptake. 9,10,[13][14][15][16][17] Although HIV VCT uptake is alarmingly low among males residing in Ethiopia, existing studies were not done at country level and the contributing factors were not well studied. Therefore, the current study objectives were to determine the status of uptake and identify the predictors of HIV VCT among sexually active males in Ethiopia using the nationally representative 2016 EDHS data.…”

HIV Voluntary Counseling and Testing Uptake and Associated Factors among Sexually Active Men in Ethiopia: Evidence from the 2016 EDHS Using Multilevel Modeling

“…Regarding wealth status, the odds of getting tested for HIV/AIDS for the rich males were 58.6% higher than the poor. Different studies (14)(15)(16)20,28) also showed that rich people are more likely to accept HIV VCT as compared to poor people. This could be explained by different reasons.…”

Exploring adaptations and successful implementation of Traditional Healers as adherence partners for people living with HIV in rural Mozambique: A qualitative assessment

“…Patients reported the positive impact of counseling on their ability to see a future with the disease. Given the association of HIV with impending death 60 and high stigma [61][62][63][64] in the region, patients felt overwhelmed after receiving their diagnosis. Healer counseling provided the reassurance that side effects would go away after a short time and offered strategies (e.g.…”