Why are Testing Rates so Low in Sub-Saharan Africa? Misconceptions and Strategic Behaviors

Abstract

Voluntary testing and counseling (VTC) is a popular method for fighting the HIV/AIDS epidemic. The purpose of VTC is to reduce the incidence of the virus in a two-fold manner. First, testing provides access to health care and antiretroviral therapies that diminish the transmission rate of the virus. Second, counseling encourages safer behavior for not only individuals who test HIV-negative and wish to avoid HIV/AIDS infection but also altruistic individuals who test HIV-positive and wish to protect their partners from becoming infected by HIV. Surprisingly, DHS surveys that were conducted in sub-Saharan Africa provide empirical evidence that testing services are underutilized. Moreover, it is rare for both partners in a couple to be tested for HIV. This paper proposes a theoretical model that indicates how misperceptions about the HIV/AIDS virus may explain these puzzles. More specifically, this study demonstrates that individuals who are at risk of HIV infection may act strategically to avoid the cost of testing if they overestimate the risk of HIV transmission or believe that health care is not required if HIV is asymptomatic. The correction of false beliefs and the promotion of self-testing are expected to increase HIV testing rates.

Discrete Responses in Bivariate Generalized Additive Models

“…On the other hand, participation rates for HIV testing in national surveys are generally low, and ranges from 72% for men to 77% for women in the 2007 Zambia DHS (Hogan et al, 2012), although even lower peaks are recorded in the 2004 Malawi DHS (63% and 70%, respectively). There are potentially many reasons inducing this pattern, including concerns, lack of incentive to participate, survey fatigue or migration of those targeted for interview (Gersovitz, 2011;Sterck, 2013;McGovern et al, 2015); missing data on respondents' HIV status represent therefore a not necessarily less severe cause of bias than the ones already mentioned above. This case study focuses on refusal to be tested for HIV, which is commonly regarded as the main reason of missingness in surveys.…”

Recent updates on the possible reasons for the low incidence and morbidity of COVID-19 cases in Africa

“…In this regard, laboratory testing rate, genetic factors or immunological factors should be considered to understand low COVID-19 infection estimates in Africa. The data on testing of COVID-19 in Africa are scarce, but available sources suggest a low testing rate of COVID-19 in Africa (Sterck 2013 ; Ourworldindata 2021 ) could also account for the low number of reported cases. Therefore, analysis of excess death in 2020 should be conducted in Africa to find out whether those deaths may be attributable to COVID-19.…”

Soft and hard commitment devices to increase HIV testing

“…HIV prevalence among urban Malawian men is 11 percent (DHS 2016); if we assume that approximately half are already diagnosed, then our appointments treatment is selecting on men with average risk. However, our study is not well-powered for this analysis and we therefore cannot draw strong conclusions.29 Theoretically, these variables are expected to affect risky behaviors, including related to HIV testing(Sterck 2013(Sterck , 2014Kerwin 2020).30 The estrat command returns individual standard errors for each tercile, but not for the differences between them. We thus compute the standard errors of the differences as V ar(X) + V ar(Y ) − 2Cov(X, Y ).…”