Human immunodeficiency virus screening in rural communities of Rivers State, Nigeria: challenges and potential solutions.

Abstract

Human immunodeficiency virus (HIV) testing and counseling has remained significantly low in rural communities of Nigeria despite the huge benefits of early case detection and treatment. This study aims at evolving strategies based on the health-seeking attitudes of rural people in order to improve their HIV testing access. A cross-sectional study was carried out between May and June 2011 among persons of reproductive ages, that is, 15 years and above for men and 15-49 years for women; normally resident in rural communities of Rivers State, Nigeria, selected using a multistage sampling technique. A total of 267 (42.0%) males and 368 (57.9%) females were interviewed. Most of the respondents (619, 97.5%) had heard about HIV, and 498 (78.4%) were aware of its transmission by sexual route. Condom use was low and non-use with a nonmarital partner 12 months preceding the survey was 33.8% (191). Only 242 (38.1%) had ever tested for HIV: 90 (37.2%) men and 152 (62.8%) women (χ2 = 15.14, degree of freedom (df) =1, P = 0.000), while only 33 (13.6%) had tested for HIV based on sexual risk perceptions. The commonest reasons for HIV testing were pregnancy, premarriages, and test for concordance. Reasons for not testing were lack of perception of HIV risk, fear of stigmatization, and discrimination from positive test result. This study highlights the persistence of low HIV testing culture in rural settings in Nigeria and underscores the need that HIV programs should look beyond the healthcare settings and involve the communities, using home and community-based testing approaches in order to expand HIV testing access.