Fatores associados à realização do teste anti-HIV na população brasileira

Abstract

Understanding HIV test-seeking motivation is important to AIDS prevention in the general population. Although free counseling and testing are available, coverage gaps are found in Brazil. This study estimated contextual and individual factors associated with HIV testing among Brazilians. Data analysis was based on a household survey carried out with 4,760 residents of urban areas. The final sample corresponded to 2,566 (51.9%) women who had ever had sex and 2,194 (48.1%) men who had ever had sex. The vulnerability theoretical framework was developed to analyze variables regarded as being of individual level (individual and social dimensions of vulnerability), and those related to the city of residence were considered contextual level (social and programmatic dimensions of vulnerability). Individual level variables included socio-demographic characteristics, sexual and reproductive health, information on AIDS treatment, knowing someone with AIDS, and AIDS-related segregation ideas. Human development index (HDI), AIDS prevalence, and the presence of counseling and testing facilities in the city of residence were contextual level variables. Outcome was defined as ‘not taking the test’, ‘client-initiated testing’, and ‘provider-initiated testing’. Three multilevel Poisson models with random intercept were developed to estimate associated factors. Two models were estimated for women (client and provider-initiated testing) and one for men (provider-initiated testing), as well as one Poisson model excluding men clusters (client-initiated testing). ‘Not taking the last HIV test’ was the reference category in all models. At the individual level, for both males and females, factors associated with client-initiated testing were: age between 26-35 years; inconsistent condom use; self-perception of risk; and knowing someone with AIDS. Different variables were associated with client-initiated testing for each sex. Among women the following variables were associated at the individual level: being single or divorced; first sexual debut until age of 15; having had three or more sexual partners; and information on AIDS treatment. The following were associated at the contextual level: high HDI; and presence of counseling and testing facilities. Among men only individual level variables were associated: high school and college education; and being homo or bisexual. As for provider-initiated testing there were some differences between the variables associated for each sex. For both sexes, some individual level variables were associated – literacy, having children under 6 years old, knowing someone with AIDS, and information on AIDS treatment – and one contextual variable – presence of counseling and testing facility in the city of residence. As for gender differences in provider-initiated testing, the following were associated for women: at the individual level – age between 16-55 years; being married or living with partner; first sexual experience under the age of 15; inconsistent condom use; and having had three or more sexual partners – and at the contextual level – high HDI of city of residence. As for men, the associated individual level variables were: age between 26-45 years; history of STD; being victim of sexual assault; and absence of AIDS-related segregation ideas. We conclude that HIV testing is more frequent among individuals who perceive AIDS epidemic as something familiar. We also conclude that client-initiated testing is associated with individual vulnerability and that provider-initiated testing is associated with programmatic vulnerability for both men and women. Test-seeking motivation is affected by gender inequality: married women and heterosexual men are unprotected as they present HIV testing-seeking behavior less frequently. Provider-initiated testing is in accordance with the Brazilian response to HIV/AIDS epidemic, which prioritizes HIV testing in strategies for preventing vertical transmission, and in the context of STD diagnosis and report of sexual violence. Descriptors: HIV Testing; Vulnerability; Gender.