HIV testing remains below UNAIDS 90–90–90 goals in sub-Saharan Africa. The aim of this study was to understand gender-specific factors related to HIV testing in Kisarawe, Tanzania. Informed by Social Action Theory, we analyzed cross-sectional data from a population-based random sample using bivariate and multivariate logistic regression to identify the contextual, behavioral, and interpersonal factors associated with prior HIV testing – specifically, any prior testing and testing within the past year. Of 644 participants, 63.1% of men and 85.5% of women reported ever testing for HIV. Younger men and women (aged 18–25 years) had significantly lower odds of prior HIV testing compared with older participants. For men, low levels of anticipated stigma and having ever talked about HIV were both positively associated with any prior testing. Men who knew if a sexual partner had received an HIV test had almost three times the odds of receiving a recent HIV test compared to men with no knowledge of their partners’ testing status (aOR = 2.96, 95% CI: 1.22–7.17, p = 0.01). For women, knowing someone who is HIV-positive was associated with increased odds of any prior testing (aOR = 2.74, 95% CI: 1.24–6.07, p = 0.01). Gender-specific, proactive interventions are needed to increase testing uptake, especially for young people and men.
Joint United Nations Programme on HIV/AIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic.
Geneva:
UNAIDS, 2014.
2.
CohenMSChenYQMcCauleyM, et al.
Prevention of HIV-1 Infection with early antiretroviral therapy. N Engl J Med2011;
365: 493–505.
3.
UNAIDS. AIDS by the numbers.
Geneva:
UNAIDS, 2016.
4.
Tanzania Commission for AIDS (TACAIDS). Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of Chief Government Statistician(OCGS), ICF International. Tanzania HIV/AIDS and Malaria Indicator Survey 2011–12.
Dar es Salaam:
TACAIDS, ZAC, NBS, OCGS, and ICF International, 2013.
5.
Tanzania Commission for AIDS (TACAIDS). Global AIDS response country progress report.
Dar es Salaam:
UNAIDS, WHO, Ministry of Health and Social Welfare, 2014.
6.
GreigAPeacockDJewkesR, et al.
Gender and AIDS: time to act. AIDS2008;
22: S35–S43.
7.
WojcickiJM.Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: a systematic review. J Biosoc Sci2005;
37: 1–36.
8.
DunkleKLJewkesRKBrownHC, et al.
Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. The Lancet2004;
363: 1415–1421.
9.
MaganjaRKMamanSGrovesA, et al.
Skinning the goat and pulling the load: transactional sex among youth in Dar es Salaam, Tanzania. AIDS Care2007;
19: 974–981.
10.
TsaiACSubramanianS.Proximate context of gender-unequal norms and women’s HIV risk in sub-Saharan Africa. AIDS2012;
26: 381–386.
11.
ConnellR.Masculinities.
Berkeley:
University of California Press, 2005.
12.
MillsEJBeyrerCBirungiJ, et al.
Engaging men in prevention and care for HIV/AIDS in Africa. PLoS Med2012;
9: 159.
13.
ObermeyerCMSankaraABastienV, et al.
Gender and HIV testing in Burkina Faso: an exploratory study. Soc Sci Med2009;
69: 877–884.
14.
MuulaASNgulubeTJSiziyaS, et al.
Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review. BMC Public Health2007;
7: 63.
15.
KnightLMcGrathNvan RooyenH, et al.
Characteristics of sexually experienced HIV testers aged 18 to 32 in rural South Africa: baseline results from a community-based trial, NIMH Project Accept (HPTN 043). BMC Public Health2014;
14: 1164.
16.
VenkateshKKMadibaPDe BruynG, et al.
Who gets tested for HIV in a South African urban township? Implications for test and treat and gender-based prevention interventions. J Acquir Immune Defic Syndr2011;
56: 151–165.
17.
SiuGEWightDSeeleyJA.Masculinity, social context and HIV testing: an ethnographic study of men in Busia district, rural eastern Uganda. BMC Public Health2014;
14: 33.
18.
DiCarloALMantellJERemienRH, et al. ‘
Men usually say that HIV testing is for women’: gender dynamics and perceptions of HIV testing in Lesotho. Cult Health Sex2014;
16: 867–882.
19.
ParkerLPettiforAMamanS, et al.
Concerns about partner infidelity are a barrier to adoption of HIV-prevention strategies among young South African couples. Cult Health Sex2014;
16: 792–805.
20.
MushekeMNtalashaHGariS, et al.
A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in sub-Saharan Africa. BMC Public Health2013;
13: 220.
21.
CoatesTJKulichMCelentanoDD, et al.
Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. Lancet Global Health2014;
2: e267–e277.
22.
SweatMMorinSCelentanoD, et al.
Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. Lancet Infect Dis2011;
11: 525–532.
23.
EwartCK.Social action theory for a public health psychology. Am Psychol1991;
46: 931–946.
24.
TraubeDEHollowayIWSmithL.Theory development for HIV behavioral health: empirical validation of behavior health models specific to HIV risk. AIDS Care2011;
23: 663–670.
25.
HendriksenESHlubinkaDChariyalertsakS, et al.
Keep talking about it: HIV/AIDS-related communication and prior HIV testing in Tanzania, Zimbabwe, South Africa, and Thailand. AIDS Behav2009;
13: 1213–1221.
26.
StanglALBradyLFranzK. Measuring HIV stigma and discrimination.
Washington, DC:
International Center for Research on Women, 2012.
27.
PhakathiZVan RooyenHFritzK, et al.
The influence of antiretroviral treatment on willingness to test: a qualitative study in rural KwaZulu-Natal, South Africa. Afr J AIDS Res2011;
10: 173–180.
28.
PettiforAMacPhailCSuchindranS, et al.
Factors associated with HIV testing among public sector clinic attendees in Johannesburg, South Africa. AIDS Behav2010;
14: 913–921.
29.
YoungSDHlavkaZModibaP, et al.
HIV-related stigma, social norms and HIV testing in Soweto and Vulindlela, South Africa: NIMH Project Accept (HPTN 043). J Acquir Immune Defic Syndr2010;
55: 620.
30.
IsingoRWringeAToddJ, et al.
Trends in the uptake of voluntary counselling and testing for HIV in rural Tanzania in the context of the scale up of antiretroviral therapy. Trop Med Int Health2012;
17: e15–e25.
31.
MacPhersonEERichardsENamakhomaI, et al.
Gender equity and sexual and reproductive health in Eastern and Southern Africa: a critical overview of the literature. Glob Health Action2014;
7: 23717.
32.
SkovdalMCampbellCMadanhireC, et al.
Masculinity as a barrier to men’s use of HIV services in Zimbabwe. Global Health2011;
7: 13.
33.
IdelePGillespieAPorthT, et al.
Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr2014;
66: S144–S153.
34.
DellarRCDlaminiSKarimQA.Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc2015;
18: 19408.
35.
ZanoniBCElliottRJNeilanAM, et al.
Screening for HIV and linkage to care in adolescents: insights from a systematic review of recent interventions in high- versus low- and middle-income settings. Adolesc Health Med Ther2018;
9: 211–235.
36.
ShanaubeKSchaapAChailaMJ, et al.
Community intervention improves knowledge of HIV status of adolescents in Zambia: findings from HPTN 071-PopART for youth study. AIDS2017;
31: S221–S232.
37.
AbramsEJSimondsRJModiS, et al.
PEPFAR scale-up of pediatric HIV services: innovations, achievements, and challenges. J Acquir Immune Defic Syndr2012;
60: S105–S112.
38.
EvangeliMPadyKWroeAL.Which psychological factors are related to HIV testing? A quantitative systematic review of global studies. AIDS Behav2016;
20: 880–918.
39.
MatovuJKWanyenzeRKWabwire-MangenF, et al. “
Men are always scared to test with their partners … it is like taking them to the Police”: motivations for and barriers to couples’ HIV counselling and testing in Rakai, Uganda: a qualitative study. J Int AIDS Soc2014;
17: 19160.
40.
KalichmanSC.Social and structural HIV prevention in alcohol-serving establishments: review of international interventions across populations. Alcohol Res Health2010;
33: 184–194.
41.
KarneyBRHopsHReddingCA, et al.
A framework for incorporating dyads in models of HIV-prevention. AIDS Behav2010;
14: 189–203.
42.
MorfawFMbuagbawLThabaneL, et al.
Male involvement in prevention programs of mother to child transmission of HIV: a systematic review to identify barriers and facilitators. Syst Rev2013;
2: 5.
43.
NyondoALChokoATChimwazaAF, et al.
Invitation cards during pregnancy enhance male partner involvement in prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) in Blantyre, Malawi: a randomized controlled open label trial. PLoS One2015;
10: e0119273.
44.
BrownLBMillerWCKamangaG, et al.
HIV partner notification is effective and feasible in sub-Saharan Africa: opportunities for HIV treatment and prevention. J Acquir Immune Defic Syndr2011;
56: 437–442.
45.
HenleyCForgweiGWeltyT, et al.
Scale-up and case-finding effectiveness of an HIV partner services program in Cameroon: an innovative HIV prevention intervention for developing countries. Sex Transm Dis2013;
40: 909–914.
46.
JohnsonCCCorbettEL.HIV self-testing to scale up couples and partner testing. Lancet HIV2016; 3(6): e243–4.
47.
ThirumurthyHMastersSHMavedzengeSN, et al.
Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV2016; 3(6): e266–e274.
48.
MedleyABaggaleyRBachanasP, et al.
Maximizing the impact of HIV prevention efforts: interventions for couples. AIDS Care2013;
25: 1569–1580.
49.
KaufmanMRMasseyMTsangSW, et al.
An assessment of HIV testing in Tanzania to inform future strategies and interventions. AIDS Care2014;
27: 213–217.
50.
NtsepeYSimbayiLCShisanaO, et al.
Perceptions about the acceptability and prevalence of HIV testing and factors influencing them in different communities in South Africa. Sahara J2014;
11: 138–147.
