Abstract
BackgroundThe Sierra Leone Demographic Health Survey 2008 found an HIV prevalence of 1.5%. This study investigates associations with HIV infection and HIV testing.MethodsHouseholds were selected using stratified multi-stage sampling. In all selected households women aged 15–49 were eligible. In every second household men aged 15–59 were also eligible. Participants were asked to consent for anonymous HIV testing. All participants interviewed and tested were analysed. Multiple logistic regression identified associations with HIV infection, undiagnosed infection and with ever having a voluntary HIV test among sexually active participants.ResultsOf 7495 invited 86% (6,475) agreed to an interview and HIV test. Among 96 HIV positive participants, 78% had never taken a voluntary HIV test so were unaware of their serostatus, and 86% were sexually active in the last 12 months among whom 96% did not use a condom at last intercourse. 11% of all participants had previously voluntarily tested. Among women who had tested, 60% did so in antenatal care. We found that those living in an urban area, and those previously married, were more likely to be HIV infected. Voluntary HIV testing was more common in those aged 25–44, living in an urban area, females, having secondary or higher education, having first sexual intercourse at age 17 years or older, and using condoms at last sex. Although 82% of men and 69% of women had heard of HIV, only 35% and 29% respectively had heard of antiretroviral therapy.ConclusionsThe HIV prevalence in Sierra Leone has been stable. HIV testing, however, is uncommon and most infected individuals are unaware of their serostatus. This could allow the epidemic to escalate as individuals with undiagnosed infection are unlikely to change their behaviour or access treatment. Improving knowledge and increasing testing need to remain central to HIV prevention interventions in Sierra Leone.
Highlights
Among 96 HIV positive participants, 78% had never taken a voluntary HIV test so were unaware of their serostatus, and 86% were sexually active in the last 12 months among whom 96% did not use a condom at last intercourse. 11% of all participants had previously voluntarily tested
82% of men and 69% of women had heard of HIV, only 35% and 29% respectively had heard of antiretroviral therapy
Improving knowledge and increasing testing need to remain central to HIV prevention interventions in Sierra Leone
Summary
Several studies across Africa have reported that up to 84% of infected individuals are unaware of their HIV status [1,2,3,4], the vast majority of whom remain sexually active [1,2,4]. Sexual behaviour [5,6,7,8,9,10] and factors that influence the transmission of HIV during sexual intercourse [11] (such as sexually transmitted infections (STIs) [12], male circumcision [13] and condom use [11]), are acknowledged as the main risk factors associated with the generalised HIV epidemic that has taken hold in sub-Saharan Africa. Between 2003 and 2011, forty-seven Demographic Health Surveys (DHS) were conducted in 29 sub-Saharan countries [18].
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