Knowledge of HIV status prior to a community HIV counseling and testing intervention in a rural district of south Africa: results of a community based survey

Hanani Tabana,Sonja Swanevelder,Tanya Doherty,Debra Jackson,Reshma Naik,Wanga Zembe,Carl Lombard

doi:10.1186/1471-2334-12-73

Abstract

BackgroundThe low uptake of facility-based HIV counseling and testing (HCT) in South Africa, particularly amongst men and youth has hindered attempts to increase access to effective treatment and prevention strategies. Many barriers to HIV testing have been described including long waiting times, transport to reach facilities, fear of lack of confidentiality and health systems factors such as stock outs of HIV test kits. The aim of this study was to undertake a community survey to determine rates of HCT in a rural area in order to plan a community intervention.MethodsA community-based survey was undertaken in 16 communities in Sisonke district, KwaZulu-Natal between September and November 2008. A total of 5821 individuals participated in the survey of which 66% were females. Gender specific mixed effects logistic regression models were used to describe differences in socio-economic characteristics, and their association with HIV testing histories.ResultsOverall 1833 (32%) individuals in this rural area knew their HIV status. Prior testing was higher amongst women (39%) than amongst men (17%). Older men (> 24 years) were more likely to report having tested for HIV previously, with the highest likelihood (adjusted OR = 4.02; 95% CI: 2.71-5.99) among men in age group, 35-49 years. For women, age group 25-34 years had the highest likelihood of having been previously tested (adjusted OR = 1.30; 95% CI: 1.05-1.66). Being currently pregnant (adjusted OR 3.31; 95% CI: 2.29 - 4.78) or having a child under five (adjusted OR 7.00; 95% CI: 5.84 - 8.39) were also associated with prior HIV testing amongst women.ConclusionsOverall, knowledge of HIV status in this rural sub-district is low. The relatively higher uptake of HIV testing among women is encouraging as it shows that PMTCT services are well functioning. However, these data suggest that there is an urgent need for scaling up HIV testing services in rural communities specifically targeting men and youth.

Highlights

The low uptake of facility-based HIV counseling and testing (HCT) in South Africa, amongst men and youth has hindered attempts to increase access to effective treatment and prevention strategies
HIV counseling and testing (HCT) has become an integral part of HIV prevention in sub-Saharan Africa [1] and an entry point to care, treatment and support for people living with HIV/AIDS
In an effort to address the high HIV prevalence, the South African government launched a national HCT campaign in 2010, targeting 15 million South Africans to test for HIV by June 2011 [9]

Summary

Introduction

The low uptake of facility-based HIV counseling and testing (HCT) in South Africa, amongst men and youth has hindered attempts to increase access to effective treatment and prevention strategies. The low uptake of facility-based HCT in South Africa, amongst poorest rural populations may be limited. South Africa currently has an overall national HIV prevalence of 17.8%, while the antenatal clinic (ANC) prevalence in women aged 15-49 years was 30.2% in 2010 [8]. These high HIV prevalence rates warrant interventions to increase the optimal use of HCT services.

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