Abstract
Background: Despite the ongoing efforts to promote HIV testing, the majority of adults in Tanzania remain untested, and many remain unwilling to know their HIV status. Understanding the underlying reasons for this unwillingness to test and know one’s status will support the development of targeted interventions to promote the uptake of HIV testing. This paper explores the willingness of and barriers faced by self-perceived healthy individuals to test for HIV in selected districts of Tanzania. Methods: A cross-sectional survey was conducted in urban and rural wards between October 2011 and March 2012. Structured questionnaires with closed- and open-ended questions were administered to heads of randomly selected households. Information collected included socioeconomic, demographics, rural/urban backgrounds and the perceived reasons which hinder household heads/members to access and utilise HIV-testing services. Regression analysis was conducted to assess the relationship between the same factors and participants’ willingness to go for an HIV test in the near future. Results: There were 1,429 respondents from randomly selected households interviewed, and out of these, 57.1% were women, and 42.9% were men. The mean age of all respondents was 33.6 years; men were slightly older (mean age, 37 years) than women (mean age, 34 years). Almost one-third (n=433, 30.3%) of the respondents reported having ever tested for HIV, of whom 294 (61.8%) were women, and 139 (38.2%) were men. Being educated to at least the primary school level, being an urban resident, and being female increased the probability of HIV testing by 1.7% (P<.001), 1.3% (P<.005) and 0.2% (P<.005) respectively. Further, for each year, one’s age increased the probability of positive future intentions to test for HIV increased by 0.4 % (P<.005). Education, residence and marital status were not significantly associated with future willingness to test. Fear of being stigmatised and discriminated was observed to be one of the important barriers for HIV testing among those who had never tested and those who were unwilling to test in the future. Conclusion: In urban areas, knowledge of the benefits of HIV testing is higher than in rural areas. Overall stigma remains the most salient barrier to HIV testing and interventions that address this, and other structural drivers for stigma need to be addressed in order for people’s willingness to test to increase. Finally, health systems need to be strengthened to further encourage testing and be ready to provide quality and non-discriminatory services once people’s willingness to test becomes apparent.
Highlights
In December 2013 the UNAIDS set the 90-90-90 targets, which called for 90% of people to know their status, among whom 90% should be linked to care, among whom 90% should be virally suppressed.[1]
Our study suggests that being an urban resident is an important predictor for HIV testing
That VCT and its associated services such as availability of IEC materials are concentrated in urban areas and the infrastructure and the health workforce needed to offer these services are more developed in urban areas than in rural areas
Summary
In December 2013 the UNAIDS set the 90-90-90 targets, which called for 90% of people to know their status, among whom 90% should be linked to care, among whom 90% should be virally suppressed.[1] Despite high and improved knowledge about HIV across the country,[2] in Tanzania the first “90” remains a bottleneck. The majority of adults in the United Republic of Tanzania remain either untested or unwilling to know their HIV status.[3] Reasons for this pattern had not been systematically and comprehensively established in the Tanzanian literature. Information collected included socioeconomic, demographics, rural/urban backgrounds and the perceived reasons which hinder household heads/members to access and utilise HIV-testing services. Overall stigma remains the most salient barrier to HIV testing and interventions that address this, and other structural drivers for stigma need to be addressed in order for people’s willingness to test to increase. Health systems need to be strengthened to further encourage testing and be ready to provide quality and non-discriminatory services once people’s willingness to test becomes apparent
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