Summaryobjectives To examine factors affecting readiness for and acceptability of voluntary HIV counselling and testing (VCT).methods Participants in a population-based HIV survey conducted in an urban population in Zambia in 1996 were offered VCT. Although 29% of them expressed interest in being tested (readiness), only 4% of this group used the services (i.e. acceptability). When the survey was repeated 3 years later, VCT was designed differently to assess acceptability. At the cluster level the participants were randomly allocated to VCT either at the local clinic (similar to 1996, n ¼ 1102) or at an optional location (n ¼ 1343).results Readiness varied significantly by age group (47% in age group 20-24 years vs. 18% in age group 40-49 years). There were contrasts between young (15-24 years) and older age groups (25-49 years) regarding the main factors associated with readiness. Whereas self-perceived risk of being HIV infected was the only significant factor among the young, poor self-rated health and ever HIV tested were important factors among the older. The acceptability was 11.8% among the group allocated to VCT at the local clinic compared with 55.8% for the group allocated to an optional location (RR, 4.7).conclusions Perceived risk of HIV infection had a major influence on VCT readiness among young people, whereas declining general health status, as indicated by self-rated health, was most evident among those of older age. A strong effect of placement on acceptability of VCT was demonstrated, indicating this barrier to be important in explaining low demands for VCT in the past. Differences in perceptions of how confidentiality is handled at the two locations might be an important underlying factor.

The results suggested a dominant declining trend in HIV prevalence that corresponds to declines in incidence since the early 1990s attributable to behavioural changes. Efforts to sustain the ongoing process of change in the well-educated segments of the population should not be undervalued, but the modest change in behaviour identified among the most deprived groups represents the major preventive challenge.

The findings suggested a shift in the association between educational attainment and HIV infection between 1995 and 2003. The most convincing sign was the risk reduction among more educated younger groups where most infections can be assumed to be recent. The changes in older groups are probably largely influenced by differential mortality rates. The stable risk among groups with lower education might also indicate limitations in past preventive efforts.

BackgroundVoluntary HIV counselling and testing (VCT) is one of the key strategies in the HIV/AIDS prevention and control programmes in Ethiopia. However, utilization of this service among adults is very low. The aim of the present study was to investigate factors associated with VCT utilization among adult men since men are less likely than women to be offered and accept routine HIV testing.MethodsThe study utilized data from the Ethiopian Demographic Health Survey (EDHS) 2005, which is a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 6,778 men aged 15–59 years were selected from all the eleven administrative regions in Ethiopia. Logistic regression was used to analyze potential factors associated with VCT utilization.ResultsOverall, 21.9% of urban men and 2.6% of rural men had ever tested for HIV through VCT and most of them had learned their HIV test result. Having no stigmatizing attitudes toward people living with HIV/AIDS was found to be strongly and positively associated with VCT utilization in both urban and rural strata. In rural areas HIV test rates were higher among younger men (aged ≤44 years) and those of higher socio-economic position (SEP). Among urban men, risky sexual behaviour was positively associated with VCT utilization whereas being Muslim was found to be inversely associated with utilization of VCT. Area of residence as well as SEP strongly affected men’s level of stigmatizing attitudes toward people living with HIV/AIDS.ConclusionsVCT utilization among men in Ethiopia was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma. Targeting rural men with low SEP should be given first priority when designing, expanding, and implementing VCT services in the country.

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The readiness for VCT in the general population was found to be very low. Provision factors such as concerns about confidentiality and length of time waiting for the test result contributed to the low utilization rate. Results of this study contrast sharply with reported VCT acceptance rates of 70-90% among women attending antenatal care in Zambian and in other African populations, suggesting an urgent need to evaluate testing policy and practice of antenatal VCT in particular.

This study explores determinants of I) general practitioner (GP) visits and II) referrals (outpatient and hospitalization). The analyses were performed with regression models on a set of data from a comprehensive population study of 3533 men and 3578 women aged 40-42 in a county in Northern Norway. Among the various health status dimensions included, self-rated health was found to be the most important determinant, regardless of type of service. Factors, other than health status aspects affecting GP visits, were preoccupation with health and help seeking attitude. Volume of resources (GP per population), socio-demographic characteristics and social networks did not appear as important. Several inequitable effects were revealed on referrals: First, higher rate of referral of patients with higher educational achievement indicates a bias towards higher social status groups. Second, high GP/population ratio and residence in municipalities with referral care facilities were both found to be associated with higher probability of referral.