Factors Associated with HIV Prevalence and HIV Testing in Sierra Leone: Findings from the 2008 Demographic Health Survey

Abstract

BackgroundThe Sierra Leone Demographic Health Survey 2008 found an HIV prevalence of 1.5%. This study investigates associations with HIV infection and HIV testing.MethodsHouseholds were selected using stratified multi-stage sampling. In all selected households women aged 15–49 were eligible. In every second household men aged 15–59 were also eligible. Participants were asked to consent for anonymous HIV testing. All participants interviewed and tested were analysed. Multiple logistic regression identified associations with HIV infection, undiagnosed infection and with ever having a voluntary HIV test among sexually active participants.ResultsOf 7495 invited 86% (6,475) agreed to an interview and HIV test. Among 96 HIV positive participants, 78% had never taken a voluntary HIV test so were unaware of their serostatus, and 86% were sexually active in the last 12 months among whom 96% did not use a condom at last intercourse. 11% of all participants had previously voluntarily tested. Among women who had tested, 60% did so in antenatal care. We found that those living in an urban area, and those previously married, were more likely to be HIV infected. Voluntary HIV testing was more common in those aged 25–44, living in an urban area, females, having secondary or higher education, having first sexual intercourse at age 17 years or older, and using condoms at last sex. Although 82% of men and 69% of women had heard of HIV, only 35% and 29% respectively had heard of antiretroviral therapy.ConclusionsThe HIV prevalence in Sierra Leone has been stable. HIV testing, however, is uncommon and most infected individuals are unaware of their serostatus. This could allow the epidemic to escalate as individuals with undiagnosed infection are unlikely to change their behaviour or access treatment. Improving knowledge and increasing testing need to remain central to HIV prevention interventions in Sierra Leone.

Predictors of Health-Seeking Behavior: HIV Test Experiences among Youth Aged 15-24 Years in Cameroon and Gabon

“…The result of this study coincides with findings of other many studies [2,3,[13][14][15]31,40,41]. Studies found that the reason for HIV testing uptake among females was accepting testing when it is offered, while among males it was voluntary testing [31] and significantly determined by the individual's economic status, behavior and knowledge of HIV/AIDS [42].…”

“…Though similar data was not available in the DHS data files of Gabon, the main reasons for HIV test uptake among Cameroonian youth were found to be asked for the test, offered and accepted, and required which indicates their low awareness, as they did not do it voluntarily. However, a welcoming achievement was found in receiving results of HIV testing which is higher than in many African countries [3]. The causes for the decreased awareness and HIV test uptake among youth can be many, for example, their own lack of knowledge and information about HIV/AIDS [38], limitations of the countries to provide the services due to some shortages like human, financial, material and technical resources and others like inadequate involvement of community volunteers or spiritual (1) knowing that both condom use and limiting sex partners to one uninfected faithful partner are HIV prevention methods, (2) being aware that a healthy looking person can have the AIDS virus, and (3) rejecting two most common local misconceptions (the two most common local misconceptions in Cameroon and Gabon were; that the AIDS virus can be transmitted through mosquito bites, and by supernatural means).…”

“…HIV testing is believed to be a cornerstone in the prevention and reduction of the HIV epidemic and is a critical measure for HIV prevention programs and services [1,2] as the major sources of HIV transmission are people living with HIV/AIDS who have not yet tested and don't know their serostatus but yet continue to have unprotected sex [3]. A study based on a mathematical model suggested that a massive coverage of HIV testing coupled with immediate initiation of anti-retroviral treatments (ART) might help to halt the HIV epidemic [4].…”

“…HIV testing remains as a strategic intervention to prevent transmission and stop the epidemic especially in countries with high HIV prevalence. Of all the Western African countries, Cameroon was the first highly HIV prevalent country followed by Gabon in 2014 [3,4]. In spite of the decrease of the new infection by 41% in subSaharan Africa between 2000 and 2014, the prevalence of HIV/ AIDS has increased from 4.3% in 2011 to 4.8% in Cameroon, and a minimal decrease in Gabon from 4.1% in 2012 to 3.9% in 2014 [18][19][20][21][22].…”

“…Advancing HIV test centers and making them more accessible and visible encourages HIV testing uptake among youth. Moreover, understanding of the determining factors to predict HIV testing is the cornerstone to advance the coverage of HIV testing thereby to control the HIV transmission [2,3]. Studies from other countries revealed that age, type of residence, education, marital status, HIV-related stigma, occupation, low socioeconomic status, and HIV/AIDS knowledge as the main determining factors to predict HIV testing [1,2,13,14,[29][30][31][32].…”