Shedding light on a HIV blind spot: Factors associated with men’s HIV testing in five African countries

Fleming, Paul J.; Rosen, Joseph G.; Wong, Vincent; Carrasco, María

doi:10.1080/17441692.2019.1583266

Cited by 15 publications

(34 citation statements)

References 38 publications

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“…A comparative analysis of DHS survey results in 15 African countries found a majority of people living with HIV living in rural areas in nine countries, including Lesotho, Malawi, Rwanda and Zimbabwe. The report also shows that urban residence is a factor in prior testing among HIV-positive men [23]. Combined with our findings that men who never previously tested were more likely to reside in rural areas, this indicates an opportunity for HIV case finding in these locations.…”

Section: Discussionsupporting

confidence: 77%

“…Identifying the characteristics of men who do not go for HIV testing is needed to plan and implement testing services which can better reach them. Determinants of HIV testing among men has been studied in several reports [18][19][20][21][22][23][24][25], including analyses of Demographic and Health Surveys (DHS) [19,20,22,23]. Existing evidence shows that men who were younger [24,25], had less education [18,20,24,25], did not have an occupation [18], had stigmatising views of HIV [21,22] and who lacked HIV knowledge [22] were more likely to report never testing for HIV.…”

Section: Introductionmentioning

confidence: 99%

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Who are the missing men? Characterising men who never tested for HIV from population‐based surveys in six sub‐Saharan African countries

et al. 2019

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Introduction We sought to characterize men who had never tested for HIV, understand factors associated with not testing, and measure survey HIV test uptake among never testers. We analysed nationally representative Demographic and Health Surveys of six African countries from 2013 to 2016: Ethiopia, Malawi, Zimbabwe, Rwanda, Lesotho and Zambia. Methods Eligible men were household residents or overnight visitors aged 15 to 59 years. We analysed questionnaire responses on HIV testing, known behavioural risk factors, and corresponding HIV laboratory results. We used survey‐weighted logistic regression to identify factors associated with never testing for HIV. Results Approximately double the proportion of men had never tested for HIV compared to women (Malawi: 30% vs. 17%, p < 0.0001; Zimbabwe: 35% vs. 19%, p < 0.0001; Lesotho: 34% vs. 15%, p < 0.0001; Zambia: 36% vs. 20%, p < 0.0001); although, less of a differential existed in Ethiopia (54% vs. 56%, p = 0.12) and Rwanda (19% vs. 14%, p < 0.0001). When offered a test during the survey, 85% to 99% of sexually active men who reported never previously testing, accepted testing. HIV positivity ranged from <0.05% to 14% for never tested men. After adjusting for age, factors associated with never having tested for HIV were never being married (aOR range: 1.46 to 10.39), not having children (aOR: 1.36 to 3.59) and lower education (less than primary education aOR: 2.77 to 5.59). Conclusions Although higher proportions of men than women had never tested for HIV, 85% to 99% of men did accept a test when offered. Finding opportunities to offer HIV testing to single men without children, older men who have never tested, and those disadvantaged with less schooling and employment, alongside other facility and community‐based services, will be important in identifying those living with undiagnosed HIV and improving men's health.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Who are the missing men? Characterising men who never tested for HIV from population‐based surveys in six sub‐Saharan African countries

et al. 2019

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“…Fleming et al found that approximately 35% of men aged 15-49 endorsed stigmatizing views of people with HIV, and these men were significantly more likely to report never testing for HIV. The other three studies found stigma to be the among the most pervasive barriers to testing [36][37][38][39]. However, in Mozambique stigma was a robust barrier to HIV testing for women but not men, suggesting that other factors may impede testing for men over and above stigma, such as access to health services and masculinity [36,38].…”

Section: Mozambiquementioning

confidence: 97%

“…Only four studies examined barriers to HIV testing in Mozambique, and all found an association between low-testing rates and stigma [36][37][38][39]. Two studies were conducted exclusively in Mozambique, and the other two examined testing throughout several African countries, including Mozambique.…”

Section: Mozambiquementioning

confidence: 99%

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Falling Short of the First 90: HIV Stigma and HIV Testing Research in the 90–90–90 Era

et al. 2020

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Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa

et al. 2022

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Little is known about gender effects of alcohol and drug use (AOD) among people living with HIV (PLWH) in resource-limited settings. Using multilevel models, we tested whether gender moderated the effect of Khanya, a cognitive-behavioral therapy-based intervention addressing antiretroviral (ART) adherence and AOD reduction. We enrolled 61 participants from HIV care and examined outcomes at 3- and 6-months compared to enhanced treatment as usual (ETAU). Gender significantly moderated the effect of Khanya on ART adherence (measured using electronically-monitored and biomarker-confirmed adherence), such that women in Khanya had significantly lower ART adherence compared to men in Khanya; no gender differences were found for AOD outcomes. Exploratory trajectory analyses showed men in Khanya and both genders in ETAU had significant reductions in at least one AOD outcome; women in Khanya did not. More research is needed to understand whether a gender lens can support behavioral interventions for PLWH with AOD.Trial registry ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

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Shedding light on a HIV blind spot: Factors associated with men’s HIV testing in five African countries

Cited by 15 publications

References 38 publications

Who are the missing men? Characterising men who never tested for HIV from population‐based surveys in six sub‐Saharan African countries

Who are the missing men? Characterising men who never tested for HIV from population‐based surveys in six sub‐Saharan African countries

Falling Short of the First 90: HIV Stigma and HIV Testing Research in the 90–90–90 Era

Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa

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