Utilization Of HIV Testing Services Research Articles

Risky sexual behaviours and utilization of HIV testing services among the adolescent girls and young women aged between 15-24 years in Kibra Sub County, Nairobi County, Kenya

Background HIV remains a significant global health challenge, disproportionately affecting adolescent girls and young women (AGYW). HIV testing is crucial in controlling transmission and reducing its prevalence. Understanding risky sexual behaviours among AGYW is pivotal in aligning prevention interventions. Despite global prevention efforts, testing gaps persist among AGYW, linked to risky sexual behaviour (RSB). This study explores the association between these behaviours and HIV testing utilization among AGYW (aged 15–24) in Kibra Sub County, Nairobi. Methods A cross-sectional study sampled 379 AGYW from three wards in Kibra Sub County in Nairobi County. To be an eligible participant, one must have been a resident for at least one year before the time of the study and aged between 15–24 years, employing standardized structured interviewer-administered questionnaires and statistical analyses. Results were analysed using Chi-square tests and logistic regression. Data was collected between June to July 2023. Results Overall, HIV testing prevalence was 60.7% (n=230). Those aged 20–24 were 71.3% (n=164), with secondary education were 63.5% (n=146) and married 28.7% (66) were more likely to undergo testing. Participants engaging in risky behaviours such as lack of condom use (3.96 times more likely), experiencing gender-based violence (4.65 times more likely), or contracting STIs (2.85 times more likely) had higher odds of seeking HIV testing services. Conclusions This study establishes a clear link between risky sexual behaviours and HIV testing among AGYW, with a 60.7% testing prevalence; however, gaps still exist. Efforts to enhance testing rates are vital. Interventions should align with acceptable methods, focusing on this affected community to ensure effective HIV care and prevention.

Assessment of Private Hospitals’ Acceptability to Introduce Human Immunodeficiency Virus Provider Initiated Counseling and Testing (PICT) Policy in Khartoum State, Sudan: A Cross Sectional Survey

Introduction: Sudan shows low coverage and utilization of HIV testing services among general population, according to the WHO indicators 1% of women and men aged 15-49 years old received HIV test and know their result. To increase coverage and utilization of HIV testing services among general population many strategic interventions are introduced in Sudan HIV strategic plan 2019-2025 and one of them is introducing the HIV PITC in private hospitals. Till now no data base available for acceptability of private hospitals to introduce HIV PICT policy. Aims: to study the private hospitals acceptability to introduce HIV provider-initiated counseling and testing policy in Khartoum state. Methods: A mixed qualitative- quantitative analytical cross-sectional study was done. The study was conducted in federal ministry of health, state ministry of health and private hospitals within Khartoum state. The study population was composed of HIV focal person at FMoH, HIV program director at SMoH, private hospitals general directors and health care providers within private hospitals. The study used thematic analysis for the qualitative part and descriptive analysis for the quantitative part. Results: FMoH didn’t start to implement PICT policy in private hospitals to increase the coverage. SMoH believe private hospital adoption of HIV PICT is a major addition and will also increase the coverage. private hospitals admins accepted the PICT policy implementation after training for their health cadre. 77% of the health care providers are willing to be trained in implementation of PICT. Conclusion: This study showed that private hospitals will accept the PICT policy implementation to increase coverage and utilization of HIV testing services among general population.

Correction to: HIV testing service utilization and its association with HIV-related knowledge among students in higher education institutions in Ethiopia: systematic review and meta-analysis

Correction to: HIV testing service utilization and its association with HIV-related knowledge among students in higher education institutions in Ethiopia: systematic review and meta-analysis

An Online Intervention Promoting HIV Testing Service Utilization Among Chinese men who have sex with men During the COVID-19 Pandemic: A quasi-experimental Study.

The COVID-19 pandemic created disruptions in HIV testing service utilization among men who have sex with men (MSM). The present study was to evaluate the effectiveness of an online health promotion program implemented by a community-based organization (CBO) in increasing the uptake of any type of HIV testing and home-based HIV self-testing (HIVST) over a six-month follow-up period. Participants of an observational prospective cohort study conducted during the same period served as the comparison group. This study was conducted between September 2020 and December 2021. Participants were Chinese-speaking adult MSM who were HIV-negative/unknown sero-status recruited through multiple sources in Hong Kong, China. Participants in the intervention group were exposed to the following health promotion components: (1) viewing an online video promoting HIVST, (2) visiting the project webpage, and (3) having access to a chargeable HIVST service implemented by the CBO. Among 400 and 412 participants in the intervention group and the comparison group, 349 (87.3%) and 298 (72.3%) completed follow-up evaluation at Month 6. Multiple imputation was used to replace missing values. At Month 6, participants in the intervention group reported significantly higher uptake of any type of HIV testing (57.0% versus 49.0%, adjusted odds ratios [AOR]: 1.43, p = .03) and HIVST (25.8% versus 14.8%, AOR: 2.04, p = .001), as compared to those in the comparison group. Process evaluation of the health promotion components for the intervention group was positive. Promoting HIVST is a potentially useful strategy to increase HIV testing service utilization among Chinese MSM during the pandemic.

Development and Evaluation of a Digital HIV Risk Assessment Tool incorporated within an App-Based Self-Testing Program.

Low risk perception is an important barrier to the utilisation of HIV services. In this context, offering an online platform for people to assess their risk of HIV and inform their decision to test can be impactful in increasing testing uptake. Using secondary data from the HIVSmart! quasi-randomised trial, we aimed to identify predictors of HIV, develop a risk staging model for South African township populations, and validate it in combination with the HIVSmart! digital self-testing program. Townships in Cape Town, South Africa. Using Bayesian predictive projection, we identified predictors of HIV and constructed a risk assessment model that we validated in external data. Our analyses included 3095 participants from the HIVSmart! trial. We identified a model of five predictors (being unmarried, HIV testing history, having had sex with a partner living with HIV, dwelling situation, and education) that performed best during external validation (AUC-ROC, 89% CrI: 0.71, 0.68 - 0.72). The sensitivity of our HIV risk staging model was 91.0% (89.1% - 92.7%) and the specificity was 13.2% (8.5% - 19.8%); but increased when combined with a digital HIV self-testing program, the specificity was 91.6% (95.9% - 96.4%) and sensitivity remained similar at 90.9% (89.1% - 92.6%). This is the first validated digital HIV risk assessment tool developed for South African township populations and the first study to evaluate the added value of a risk assessment tool with an App-based HIV self-testing program. Study findings are relevant for application of digital programs to improve utilization of HIV testing services.

Socioeconomic Determinants of Use of HIV Testing Services among Gender Based Violence (GBV) Survivors in Matabeleland South, Zimbabwe

This study estimates a binary logistic regression model to examine the socio-economic determinants of utilizing HIV testing services amongst female gender based violence (GBV) survivors in Matabeleland South, Zimbabwe, using cross-sectional data from 130 female survivors of intimate partner violence (IPV). The findings show that number of children, age of survivor and level of access to healthcare are positively associated with the use of HIV testing services, whereas religion and survivor’s marital status are negatively associated with the use of HIV testing services. Programs aimed at improving utilization of HIV testing services should therefore place emphasis on younger women, with a view to raise awareness on the dangers of poor utilization of such services. Furthermore, policy makers should aim to increase resources for improving access to healthcare, particularly by increasing mobile clinics and Victim Friendly Units so that female GBV survivors will be motivated to utilize the HIV testing services.

Analysis on influencing factors of HIV testing services utilization in students with self-assessed high risk of HIV infection based on Andersen's model

Objective: To analyze the influencing factors for HIV testing services utilization in students with self-assessed high risk of HIV infection. Methods: The research framework of the influencing factors for HIV testing services utilization in students was developed based on Andersen's health services utilization behavioral model and related literature. A cross-sectional survey was performed in students with self-assessed high risk of HIV infection by an online HIV infection risk assessment tool from March to April 2019. Multiple logistic regressions were applied with hierarchical model. Results: A total of 526 students were included in the study (age: 19.30±1.19 years old), in whom 96.2% agreed that HIV testing should be received after high-risk behavior. 56.7% (298/526) had sexual behavior and the HIV testing rate was 11.0% (58/526). The HIV testing rates in students who had and had no sex behavior were 13.42%(40/298) and 7.89% (18/228), respectively. According to the results from multivariate logistic regression analysis, non-heterosexual (compared with heterosexual, OR=7.88, 95%CI: 3.98-15.61) and higher score of AIDS knowledge awareness (compared with lower score, OR=2.05, 95%CI: 1.07-3.93) in propensity factor module, and having risk sexual behavior (compared with having no risk sexual behavior, OR=2.66, 95%CI: 1.41-5.03) and having diagnosis of STD infection in hospital (compared with having no such diagnosis, OR=6.35, 95%CI: 2.21-18.27) in demand factor module, and receiving health education about AIDS prevention in the past year (compared with receiving no such health education, OR=0.29, 95%CI: 0.11-0.76) and receiving health education about AIDS testing service in the past year (compared with receiving no such health education, OR=3.67, 95%CI: 1.71-7.90) in ability factor module were the influencing factors for utilization of HIV testing services. Conclusions: The acceptance of HIV testing in students needs to be improved urgently. Propensity factors, such as their AIDS knowledge awareness and sexual orientation, and demand factors, such as having risk sexual behavior and STD infection, have obvious impacts on the utilization of HIV testing services. However, health education about AIDS prevention and HIV testing service can play a more important role in facilitating the utilization of HIV testing in students. In the future, we should further strengthen the publicity of voluntary HIV counseling and testing service in students with particular attention to girls and those with risk sexual behaviors.

Factors Associated with Utilization of HIV Testing Services among Adolescents Aged 10-19 Years in Lira District, Northern Uganda: A Cross-Sectional Study.

Background HIV testing remains a problem among adolescents in low- and middle-income countries, and yet, HIV testing is a cornerstone in the fight against HIV. However, there is scanty literature on the utilization of HIV testing services by adolescents especially in rural settings. This study is aimed at determining the uptake of HIV testing services and associated factors among adolescents aged 10-19 years in Lira District, Northern Uganda. Methods This was a cross-sectional study done among 277 randomly selected adolescents aged 10-19 years attending outpatient clinics in Pentecostal Assembly of God (PAG) Mission Hospital, Ngetta Health Center III, and Boroboro Health Center III. Data were collected using an interviewer-administered structured questionnaire. Data collected included sociodemographic characteristics, history of test and receipt of HIV results in the last three months, and facility-related factors affecting uptake of HIV testing services. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25. Results The uptake of HIV testing services was 43% (119/277) among the study participants. Adolescents who had completed primary education (aOR: 5.47; 95% CI: 1.07-28.15; p = 0.042), are employed (aOR: 2.77; 95% CI: 1.16-6.60; p = 0.022), had used a condom in the last sexual intercourse (aOR: 4.46; 95% CI: 1.78-11.15; p = 0.001), and are involved in HIV testing outreaches (cOR: 10.86; 95% CI: 3.81-30.93; p ≤ 0.001) were more likely to uptake HIV testing services compared to those who had tertiary education, are unemployed, had never used a condom, and are not involved in HIV testing outreaches. Conclusion Utilization of HIV testing services by adolescents aged 10-19 in Lira District, Northern Uganda, is generally low. The Ministry of Health should strengthen HIV testing services targeting adolescents to increase uptake of HIV testing services.

HIV testing service utilization and its association with HIV-related knowledge among students in higher education institutions in Ethiopia: systematic review and meta-analysis

To estimate the pooled prevalence of HIV testing service utilization and its association with HIV-related knowledge among students in higher education institutions in Ethiopia. The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically reviewed for published articles on HIV testing or voluntary counseling and testing (VCT) service utilization among students in higher education institutions in Ethiopia. The Higgins I2 test was used to assess the heterogeneity between the studies. A random-effects model was applied to determine the pooled prevalence of VCT service utilization. After reviewing 348 studies, 14 studies fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. The pooled magnitude of VCT service utilization among students in higher education institutions in Ethiopia was 46.0% (95% confidence interval [CI]: 35.1, 56.9). The odds of VCT service utilization were 2.6 times as high among students who had good HIV-related knowledge as those who had poor HIV-related knowledge (adjusted odds ratio = 2.64; 95% CI: 1.31–5.31). In general, it was found that VCT service utilization among students at higher education institutions in Ethiopia was low. More than half (54.0%) of students did not know their HIV status. Good HIV-related knowledge was positively associated with VCT service utilization. Therefore, to encourage HIV testing utilization, the HIV education program should be strengthened through institutional capacity-building (training) and improving supply chain systems (AIDS leaflets, stickers, newspapers, and billboards).

Factors Influencing Utilization of HIV Testing Services among Boda-Boda Riders in Kabarole District, Southwestern Uganda: A Cross-Sectional Study.

Background HIV testing is an important step for entry and linkage into HIV care. Utilization of HIV testing services among transport workers may be challenging, because of the mobile nature of their jobs. We assessed utilization of HIV testing services and identified factors influencing the utilization of HIV testing services among motorcycle taxi (boda-boda) riders in Fort Portal Municipality, Kabarole District, Southwestern Uganda. Methods We conducted a cross-sectional study among boda-boda riders, aged 18 years and above, from July 15 to July 29, 2020. We recruited participants through simple random sampling. Data were captured using a self-administered questionnaire. Binary logistic regression was used to identify factors associated with utilization of HIV testing services. Results Of the 315 participants who received questionnaires, 305 (97%) responded. The mean age of the participants was 32 (±7.1) years and ranged from 18 to 55 years. Of the 305 participants, 238 reported having taken an HIV test and received results in the past 12 months, for an HIV testing utilization rate of 78.0% (95% CI: 73.0–82.6%). In multivariable analysis, participants who were less likely to utilize HIV testing services were those aged ≥30 years (aOR = 0.33; 95% CI: 0.16–0.70, P = 0.004) and those who had HIV-related stigma (aOR = 0.27; 95% CI: 0.08–0.88, P = 0.030). Participants who were more likely to utilize HIV testing services were those who knew HIV status of their primary partners (aOR = 4.23; 95% CI: 1.24–14.49, P = 0.022) and those who had good knowledge on HIV/AIDS (aOR = 3.94; 95% CI: 1.65–9.41, P = 0.002). Conclusions Utilization of HIV testing services among the boda-boda riders in Fort Portal Municipality, Southwestern Uganda, was high. More efforts should focus on targeting older boda-boda riders for HIV testing, reduction of HIV-related stigma, improving knowledge on HIV/AIDS, and encouraging communication and disclosure between partners, in order to consolidate the gains made in HIV testing services in this bridge population.

Impact of health insurance status among migrants from sub-Saharan Africa on access to health care and HIV testing in Germany: a participatory cross-sectional survey

BackgroundAmong all newly diagnosed HIV cases in Germany in 2015, 16% originated from sub-Saharan Africa. Twelve percent of these infections were contracted within Germany and migrants from sub-Saharan Africa (misSA) are diagnosed later than Germans. Migrants, specifically those without health insurance, face many barriers accessing health care due to their residence status and cultural, socio-economic, legal and linguistic barriers. We assessed whether misSAs’ access to healthcare and utilization of HIV testing services depends on their health insurance status to inform prevention strategies.MethodsFrom January 2015 to February 2016, we conducted a cross-sectional survey on knowledge, attitude, behavior, practice (KABP) regarding HIV, viral hepatitis and sexually transmitted infections among misSA in Germany. The survey was a community-based participatory research project; trained peer researchers recruited participants through outreach. To detect differences between participants with a regular health insurance card compared to asylum seekers with a medical treatment voucher or participants without health insurance or medical treatment voucher, unadjusted and adjusted Odds Ratios, chi-squared tests and 95% confidence intervals were calculated.ResultsA total of 1919 cases were considered. Overall, 83% had a health insurance card, 10% had a medical treatment voucher and 6% had no health insurance. Participants living in Germany for less than 5 years were less likely to have a health insurance card and more likely to have lower German language skills. Participants without health insurance visited a physician in case of health problems less often than participants with medical treatment voucher or a health insurance card (41.2% vs. 66.1% vs. 90%). Participants without health insurance reported less frequently visiting physicians or hospitals and were less likely to undergo a HIV test.ConclusionHaving no health insurance or medical treatment voucher decreased the odds of contact with the healthcare system more than other socio-demographic characteristics. Furthermore, misSA without health insurance had lower odds of ever having done an HIV test than participants with health insurance. To increase health care utilization and testing and to ensure adequate medical care, all migrants should get access to health insurance without increasing costs and consequences for residence status.

Impact of a Community-level Intervention on HIV Stigma, Homophobia and HIV Testing in New York City: Results from Project CHHANGE.

HIV stigma and homophobia are barriers to access to HIV prevention and treatment services. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a multicomponent intervention designed to reduce community-level HIV stigma and homophobia via workshops, space-based events and bus shelter ads delivered to community-based organizations and neighborhood residents in a high HIV prevalence, primarily African-American, Black and/or Afro-Caribbean, neighborhood in New York City (NYC). Serial cross-sectional, street intercept surveys among residents of the invention neighborhood and matched control neighborhood were conducted before and after the intervention. Propensity score matching and generalized estimating equation regression models assessed the impact of CHHANGE on HIV stigma and homophobia. HIV testing service utilization data were assessed and multivariable models of self-reported HIV testing among post-intervention street survey respondents were built. We did not find a significant treatment effect on HIV stigma and homophobia among residents of the intervention neighborhood as compared with control community residents. However, HIV testing increased by 350% at the testing site in the intervention community after the intervention implementation. Further, lower HIV stigma, attending an HIV stigma workshop and having friends or family living with HIV were independently associated with past six-month HIV testing among post-intervention respondents in both neighborhoods. CHHANGE was feasible and acceptable to community residents. Evaluating community-level interventions is challenging. Our triangulated approach yielded somewhat conflicting results, which may be due to design limitations. Further research is needed to understand whether and how CHHANGE affected HIV testing.

Utilization of HIV testing services among pregnant mothers in low income primary care settings in northern Ethiopia: a cross sectional study

BackgroundHIV testing of women in child bearing age is an entry point for preventing mother-to-child transmission of HIV (MTCT). This study aims to identify the proportion of women tested for HIV and to determine factors associated with utilization of HIV testing services among pregnant mothers in primary care settings in northern Ethiopia.MethodsA cross sectional study was conducted in 416 pregnant women from four primary care centers between October 2, 2012 and May 31, 2013 in East Gojjam, Ethiopia.ResultsThe proportion of mothers who tested for HIV was 277(67%). Among mothers who were not tested for HIV, lack of HIV risk perception (n = 68, 49%) was a major self-reported barrier for HIV testing. A multivariable logistic regression analysis showed that those pregnant women who had comprehensive knowledge about MTCT had an Adjusted Odd Ratio (AOR) of 3.73 (95% CI: 1.56, 8.94), having comprehensive knowledge on prevention of mother to child transmission (PMTCT) of HIV an AOR of 2.56 (95% CI: 1.26, 5.19), and a favorable attitude towards persons living with HIV an AOR of 2.42 (95%CI, 1.20, 4.86) were more likely to be tested for HIV.ConclusionOne third of pregnant women had never been tested for HIV until the time of the study. Efforts should be made to improve mother’s knowledge about MTCT and PMTCT to increase uptake of HIV testing. Enhancing mother’s HIV risk perception to scale up HIV testing in resource limited setting is highly recommended.

Does the Centers for Disease Control and Prevention's Recommendation of Opt-Out HIV Screening Impact the Effect of Stigma on HIV Test Acceptance?

HIV/AIDS-related stigma is a key factor impeding patient utilization of HIV testing services. To destigmatize HIV testing, the Centers for Disease Control and Prevention recommended an 'opt-out' screening strategy aimed at all patients in all clinical settings, regardless of HIV risk. This study assessed whether opt-out screening as compared to opt-in screening was associated with increased uptake of HIV testing among patients with HIV/AIDS-related stigma concerns. This study included 374 patients attending two Los Angeles ambulatory care clinics. Stigma items were grouped into three constructs: Blame/isolation, abandonment, and contagion. Individuals endorsing the blame/isolation subscale (AOR = 0.52; 95 % CI 0.29-0.92; p\0.05) and abandonment subscale (AOR = 0.27; 95 % CI 0.13-0.59; p\0.01) were significantly less likely to accept an HIV test. Additionally, the opt-out model did not counter the negative effects of stigma on HIV test acceptance. These findings indicate that stigma remains a barrier to HIV testing, regardless of the opt-out screening approach.

Factors Associated with HIV Counseling and Testing among Males and Females in Ethiopia: Evidence from Ethiopian Demographic and Health Survey Data

Background: HIV counseling and testing is one of the key strategies in the HIV/AIDS prevention and control programs in Ethiopia. However utilization of this service is very low. The aim of the study was to assess and compare factors associated with HIV counseling and testing service utilization among Ethiopian males and females. Methods: The study utilized data from the Ethiopian Demographic and Health Survey (EDHS) 2011, which was a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 14110 males aged 15-59 years and 16,834 females aged 15-49 were selected from all the 9 administrative regions and 2 administrative cities of Ethiopia. Descriptive analysis was done and chi-square test was used to test the association of each independent variable with the dependent variable. Multivariable logistic regression was used to identify potential factors associated with HIV testing service utilization. Results: Generally, 42.5% male and 41.9% female participants had ever been tested and counseled for HIV at least once. Education level, wealth index, area of residence, knowledge about HIV/AIDS and having no stigmatizing attitudes toward people living with HIV/AIDS were found to be strongly and positively associated with HIV testing service utilization in both male and female genders. HIV test rate was higher among younger men and women (aged ≤ 34 years), rich in income, urban residents, exposed to mass media and those of educated secondary and above. Conclusions: HIV testing service utilization among male and females in Ethiopia is low. HIV/AIDS-related stigma, HIV related knowledge, place of residence, educational level, marital status, wealth index, and media exposure were major factors affecting HIV testing service utilization among males and females in the country.

Comparing Data Mining Techniques in HIV Testing Prediction

Introduction: The present work compared the prediction power of the different data mining techniques used to develop the HIV testing prediction model. Four popular data mining algorithms (Decision tree, Naive Bayes, Neural network, logistic regression) were used to build the model that predicts whether an individual was being tested for HIV among adults in Ethiopia using EDHS 2011. The final experimentation results indicated that the decision tree (random tree algorithm) performed the best with accuracy of 96%, the decision tree induction method (J48) came out to be the second best with a classification accuracy of 79%, followed by neural network (78%). Logistic regression has also achieved the least classification accuracy of 74%. Objectives: The objective of this study is to compare the prediction power of the different data mining techniques used to develop the HIV testing prediction model. Methods: Cross-Industry Standard Process for Data Mining (CRISP-DM) was used to predict the model for HIV testing and explore association rules between HIV testing and the selected attributes. Data preprocessing was performed and missing values for the categorical variable were replaced by the modal value of the variable. Different data mining techniques were used to build the predictive model. Results: The target dataset contained 30,625 study participants. Out of which 16,515 (54%) participants were women while the rest 14,110 (46%) were men. The age of the participants in the dataset ranged from 15 to 59 years old with modal age of 15 - 19 years old. Among the study participants, 17,719 (58%) have never been tested for HIV while the rest 12,906 (42%) had been tested. Residence, educational level, wealth index, HIV related stigma, knowledge related to HIV, region, age group, risky sexual behaviour attributes, knowledge about where to test for HIV and knowledge on family planning through mass media were found to be predictors for HIV testing. Conclusion and Recommendation: The results obtained from this research reveal that data mining is crucial in extracting relevant information for the effective utilization of HIV testing services which has clinical, community and public health importance at all levels. It is vital to apply different data mining techniques for the same settings and compare the model performances (based on accuracy, sensitivity, and specificity) with each other. Furthermore, this study would also invite interested researchers to explore more on the application of data mining techniques in healthcare industry or else in related and similar settings for the future.

Spatial and social inequities in HIV testing utilization in the context of rapid scale-up of HIV/AIDS services in rural Mozambique

The massive scale-up of HIV counseling, testing, and treatment services in resource-limited sub-Saharan settings with high HIV prevalence has significant implications for the course of the HIV/AIDS epidemic. It also offers important broader policy lessons for improving access to critical health services. Applying GIS-based methods and multilevel regression analysis to unique longitudinal three-wave survey data from rural Mozambique, this study investigates the impact of a rapid expansion of HIV-related services on access to and utilization of HIV testing. The results illustrate the declining importance of spatial barriers to utilization of HIV testing services as these services expanded. In addition, the expansion of HIV-related services decreased the spatial variability of HIV testing among the survey respondents. At the same time, some important non-spatial variation, such as that in educational level, persisted despite the expansion of services. These results illustrate the process and consequences of health service diffusion.

A Qualitative Study of Barriers to the Utilization of HIV Testing Services Among Rural African American Cocaine Users

This qualitative study is about barriers to the utilization of HIV testing as perceived by African Americans who have recently used cocaine and who live in the rural Delta region of Arkansas. Affordability, physical accessibility, and geographic availability were not perceived as barriers to HIV testing in this sample, yet acceptability was still perceived as poor. Acceptability due to social mores and norms was a major barrier. Many said testing was unacceptable because of fear of social costs. Many were confident of being HIV-negative based on risky assumptions about testing and the notification process. Small-town social and sexual networks added to concerns about reputation and risk. System approaches may fail if they focus solely on improving access to HIV services but do not take into consideration deeply internalized experiences of rural African Americans as well as involvement of the community in developing programs and services.

Determinants for refusal of HIV testing among women attending for antenatal care in Gambella Region, Ethiopia

BackgroundIn Gambella region, inhabitants owe socio-cultural factors that might favor refusal for HIV testing service utilization among Antenatal Care attendees.ObjectiveTo assess determinants for refusal of HIV testing service utilization among ANC attendees in Gambella Region.MethodsA comparative cross sectional study was conducted among ANC attendees from March 2008 to May 2008 in four selected health facilities of Gambella region. Sample size of 332 participants (83 who refused HIV testing and 249 who accepted HIV testing) were taken for the study. The study was supplemented with four focus group discussions. Multivariate binary logistic regression was employed to control for confounding factors.ResultsWhen adjusted with other factors pregnant women with 2–3 live births in the past; who claimed divorce as a perceived response of their husband following HIV positive test result; who had not sought agreement from their husband for testing; disclosure of test for husband and being from certain ethnic group (E.g. Mejenger) were independent predictors for refusal of HIV testing among ANC attendees.Conclusion and recommendationBased on the findings, the following recommendations were forwarded: Provision of innovative information and education on the pre-test session for those pregnant women having two or more children; community involvement to tackle stigma; women empowerment; designing couple friendly counseling service; and fighting harmful traditional practices related with decision of HIV testing.

HIV Risk Behavior and Access to Services: What Predicts HIV Testing among Heterosexually Active Homeless Men?

HIV is a serious epidemic among homeless persons, where rates of infection are estimated to be three times higher than in the general population. HIV testing is an effective tool for reducing HIV transmission and for combating poor HIV/AIDS health outcomes that disproportionately affect homeless persons, however, little is known about the HIV testing behavior of homeless men. This study examined the association between individual (HIV risk) and structural (service access) factors and past year HIV testing. Participants were a representative sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles. Logistic regression examined the association between past year HIV testing and demographic characteristics, HIV risk behavior, and access to other services in the Skid Row area in the past 30 days. Despite high rates of past year HIV testing, study participants also reported high rates of HIV risk behavior, suggesting there is still significant unmet need for HIV prevention among homeless men. Having recently used medical/dental services in the Skid Row area (OR: 1.91; CI: 1.09, 3.35), and being a military veteran (OR: 2.10; CI: 1.01-4.37) were significantly associated with HIV testing service utilization. HIV testing was not associated with HIV risk behavior, but rather with access to services and veteran status, the latter of which prior research has linked to increased service access. We suggest that programs encouraging general medical service access may be important for disseminating HIV testing services to this high-risk, vulnerable population.