Prevalence, associated factors and perspectives of HIV testing among men in Uganda

Abstract

Background Despite overall increase in HIV testing, more men than women remain untested. In 2018, 92% of Ugandan women but only 67% of men had tested for HIV. Understanding men's needs and concerns for testing could guide delivery of HIV testing services (HTS) to them. We assessed the prevalence of testing, associated factors and men's perspectives on HIV testing in urban and peri-urban communities in Central Uganda. Methods and findings We conducted a parallel-convergent mixed-methods study among men in Kampala and Mpigi districts from August to September 2018. Using two-stage sampling, we selected 1340 men from Mpigi. We administered a structured questionnaire to collect data on HIV testing history, socio-demographics, self-reported HIV risk-related behaviors, barriers and facilitators to HIV testing. We also conducted 10 focus-groups with men from both districts to learn their perspectives on HIV testing. We used modified Poisson regression to assess factors associated with HIV testing and inductive thematic analysis to identify barriers and facilitators. Though 84.0% of men reported having tested for HIV, only 65.7% had tested in the past 12-months despite nearly all (96.7%) engaging in at least one HIV risk-related behavior. Men were more likely to have tested if aged 25-49 years, Catholic, with secondary or higher education and circumcised. Being married was associated with ever-testing while being widowed or divorced was associated with testing in past 12-months. Men who engaged in HIV

Socio-economic and demographic factors associated with never having tested for HIV among sexually active men across the four administrative regions of Uganda

“…Specifically, we found that amid variations in effect, an increase in education level (primary, secondary, and higher vs no education) was associated with reduced odds of never to have tested for HIV among respondents across regions. Our study agrees with findings in Uganda, and elsewhere that found increase in education level associated with HIV testing status [ 12 , 32 , 49 , 63 , 70 , 71 ]. The most conceivable reason for this association could be that possessing secondary or higher education level can influence an individual’s desire for health, knowledge on access and uptake of health care services, including HIV testing services [ 71 – 78 ].…”

“…In Uganda, the proportion of men who have never tested for HIV is high (27%), yet over 80% of all men across the country have knowledge on where to obtain HIV testing services [ 37 , 38 ] amidst availability of free HIV testing [ 39 , 40 ]. Men’s HIV testing coverage in the country is a major hindrance to HIV decline [ 32 , 41 ], and achievement of the global commitment to reduce and end the epidemic by 2030 [ 42 , 43 ]. Consequently, emphasis ought to be placed in understanding the challenges men face in testing for HIV.…”

“…Consequently, emphasis ought to be placed in understanding the challenges men face in testing for HIV. Studies on drivers of never having tested for HIV among men in Uganda indicate among others; fear of being tested, older age, fear of knowing HIV status, absence of testing interest, men’s view of clinics as places for females, culture, facilities, fear of testing-related gossip, distrust of HIV testing methods, peer and economic influence [ 10 , 32 , 44 – 56 ], without examining determinants of never having tested for HIV among sexually active men (15 -54 years) across regions of Uganda. In Uganda, regional differences in never having tested for HIV among men exist, for instance; highest in Karamoja region (60%), trailed by Bukedi region (42%) and lowest in Greater Kampala (14%), betwixt availability of HIV testing services [ 20 , 57 ].…”

HIV Testing Uptake and Late Diagnosis among Urban Population of Ethiopia: A Multilevel Modeling Approach

“…This is consistent with evidence from Zimbabwe, which showed a significant difference between male and female testing uptake [16]. In contrast, a study conducted in Uganda reported a lower proportion of males (16%) than females was never tested [24]. Other studies have shown that women are more likely to report having ever been tested than men [5,4,7,8].…”

Factors associated with HIV testing among traditional healers and their clients in rural Uganda: Results from a cross-sectional study

“…2 The relatively high rates of testing in our sample of adults receiving care from traditional healers may be attributable to availability of HIV testing facilities located throughout the District. 24 In our sample, clients of healers generally received HIV testing at biomedical facilities, rather than from mobile or community-based testing outreach. It has been suggested that scale-up of routine antenatal screening and provider-initiated HIV testing has improved uptake of facility-based HIV testing.…”