HIV testing and the role of individual- and structural-level barriers and facilitators

Abstract

This study determined the overall prevalence of HIV testing within a community sample of heterosexual men and women at high risk for HIV infection, and analysed the gender-specific individual- and structural-level barriers and facilitators to testing. Data were collected through 1,643 personal interviews conducted in Philadelphia between 1999 and 2000. Overall, 79.4% of participants had ever taken an HIV test; women were significantly more likely to have tested than were men. Among the individual-level factors we examined, very few, including sexual and drug-using risk behaviours, were significantly associated with an increased likelihood of ever being tested for HIV. Structural-level factors were important correlates of HIV testing for both women and men. Results of this study indicate that there are gender-based similarities and differences in the correlates of testing, and that efforts to increase HIV testing must consider how structural factors, including access to health care, may deter or facilitate opportunities for HIV testing. In particular, efforts to improve the uptake of HIV testing by heterosexual men at high risk should focus on improving men's access to, and utilization of, routine health care.

A Multilevel Analysis of the Determinants of HIV Testing in Zimbabwe: Evidence from the Demographic and Health Surveys

“…Community level risky sexual behaviour and HIV awareness were not associated with HIV testing, consistent with findings from previous studies. 12,18,25 In the general population, it was living in the communities with higher proportions of individuals with HIV-related stigma and media exposure that were associated with HIV testing. Living in a community with higher levels of media exposure was positively associated with HIV testing.…”

“…31 The need factors pertain to the perceived and evaluated assessment of one's health status which may compel the need for seeking health care services. 18 For that reason, perceived/need factors such as whether an individual had engaged in risky behaviour such as having multiple sex partners, or had history of sexually transmitted diseases (STD) and whether one knew someone who had died of HIV were also considered in the framework. The conceptual framework in Figure 1 provides a schematic display of the perceived determinants of HIV testing in Zimbabwe.…”

“…32 At community level, the likelihood of HIV testing may increase for individuals who reside in communities with higher HIV prevalence, high poverty, high risk perception of HIV infection, or within easy access of HIV intervention programmes, compared to individuals living in other communities. 7,18,22,30 While HIV/AIDS stigma may exist within self as a result of imagined fear due to perceived risk of HIV infection based on self-assessment, 33 stigma can also be observed and exerted from the outside world (health care providers, family, community, and friends). Either form of stigma may lead to more people underutilising health care services.…”

“…Socio-economic challenges may also decrease the likelihood of HIV testing, due to lack of financial resources that would enable individuals to have access to health care services. [18][19][20][21] The effect of HIV/AIDS factors (e.g., stigma and discrimination, risk perception of HIV infection, risky behaviour, HIV awareness, or knowing someone who died of HIV/AIDS) on HIV testing may depend on an individual's predisposing factors such as age, education, marital status, social and economic status. 5,22 These interactions may lead to an increased risk perception of HIV infection which may in turn decrease the willingness to utilise health care services that are linked to HIV.…”

HIV/AIDS Among Immigrants in Portugal: Socio-Demographic and Behavioural Correlates of Preventive Practices

“…A growing body of literature indicates that factors such as socio-demographic (sex, age, country of origin, education, immigration status), behavioural (perceived risk for HIV, risk behaviours) and structural (utilization of health services) are associated with HIV testing (Bond et al, 2005;Stein & Nyamathi, 2000;Stolte et al, 2003;Wang et al, 2010).…”