Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns

Abstract

BackgroundThe Botswana government recently implemented a policy of routine or “opt-out” HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults.Methods and FindingsWe conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (AOR = 1.5, 95% CI = 1.1–1.9), higher education (AOR = 2.0, 95% CI = 1.5–2.7), more frequent healthcare visits (AOR = 1.9, 95% CI = 1.3–2.7), perceived access to HIV testing (AOR = 1.6, 95% CI = 1.1–2.5), and inconsistent condom use (AOR = 1.6, 95% CI = 1.2–2.1). Individuals with stigmatizing attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV/AIDS (AOR = 0.7, 95% CI = 0.5–0.9) or to have heard of routine testing (AOR = 0.59, 95% CI = 0.45–0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning one's status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%).ConclusionsRoutine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing.

An assessment of the understanding of the offer of routine HIV testing among pregnant women in rural Zimbabwe

“…Initially, HIV testing, as the entry point to PMTCT was based on the "opt-in" strategy. (Walmsley, 2003;Blott et al, 1999;Jayaraman et al, 2003;Chou et al, 2006;Walensky et al, 2005) and African countries ( Weiser et al, 2006;Homsy et al, 2006;Manzi et al, 2005;James, et al, 2000;Marum et al, 2006), the Zimbabwean Ministry of Health and Child Welfare (MoHCW) decided to review its policy to introduce a new HIV testing approach regardless of the individual's reason for presenting to the health facility (Ministry of Health and Child Welfare-Zimbabwe, 2005b). A survey evaluating the theoretical acceptability of routine offer of HIV testing in ANC services, in two rural districts of Zimbabwe, provided a solid rationale for applying this strategy in PMTCT programs (Perez et al, 2006).…”

Factors associated with HIV testing among female sex workers in Botswana

“…This could be because they have never collected their results for fear of knowing ones HIV status. Documented studies have shown that HIV-related stigma is a barrier to testing in Africa and elsewhere (Weiser, 2006;Arnott and Crago, 2009;Mtetwa et al, 2013;NACA, 2003). However, the results of this study showed social stigma and discrimination as an insignificant factor on having an HIV test.…”

“…The same findings were supported by Miller et al (1996) as they stated that "...having more than one sex partner and never using a condom in the past year were strong predictors of testing". Studies in different countries have shown that HIV testing among female sex workers is still poor (Matovu and Makumbi, 2007;Machekano et al, 2000;WHO/UNAIDS/UNICEF, 2007;Kalichman, 2003;Weiser et al,, 2006 (WHO, 2013) continued to point at stigma and discrimination, fear of receiving an HIV-positive status, lack of confidentiality, long distances to Voluntary Confidential HIV testing (VCT) sites, and long delays in returning HIV test results as factors discouraging people to access traditional VCT systems for testing, prevention and treatment, hence this fuels the cycle of new infections, especially among female sex workers. Babalola et al (2005) pointed out that among Nigerian female sex workers, readiness for testing was associated with knowledge of HIV, knowing a source of VCT, perceived risk and having discussed condom use for prevention.…”

Provider-initiated vs. client-initiated HIV testing in Autonomous Province of Vojvodina, Serbia, 2000-2008

“…Customizing HIV testing procedures to local environments may also be more efficient and effective [28]. Public health efforts in the AP Vojvodina with the goal of increasing HIV testing rates and thus early detection of HIV infection, can lead to continuous increase in testing rates, but have different limitations.…”