Individual- and contextual-level factors associated with client-initiated HIV testing

Barros, Claudia Renata dos Santos; Zucchi, Eliana Miura; Schraiber, Lilia Blima; França, Ivan

doi:10.1590/1980-5497201700030004

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 20 (03) • Jul-Sep 2017 • https://doi.org/10.1590/1980-5497201700030004 copy

Individual- and contextual-level factors associated with client-initiated HIV testing

Fatores individuais e contextuais associados à realização do teste anti-HIV por busca espontânea

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Background:

Knowing the reasons for seeking HIV testing is central for HIV prevention. Despite the availability of free HIV counseling and testing in Brazil, coverage remains lacking.

Methods:

Survey of 4,760 respondents from urban areas was analyzed. Individual-level variables included sociodemographic characteristics; sexual and reproductive health; HIV/AIDS treatment knowledge and beliefs; being personally acquainted with a person with HIV/AIDS; and holding discriminatory ideas about people living with HIV. Contextual-level variables included the Human Development Index (HDI) of the municipality; prevalence of HIV/AIDS; and availability of local HIV counseling and testing (CT) services. The dependent variable was client-initiated testing. Multilevel Poisson regression models with random intercepts were used to assess associated factors.

Results:

Common individual-level variables among men and women included being personally acquainted with a person with HIV/AIDS and age; whereas discordant variables included those related to sexual and reproductive health and experiencing sexual violence. Among contextual-level factors, availability of CT services was variable associated with client-initiated testing among women only. The contextual-level variable “HDI of the municipality” was associated with client-initiated testing among women.

Conclusion:

Thus, marked gender differences in HIV testing were found, with a lack of HIV testing among married women and heterosexual men, groups that do not spontaneously seek testing.

Keywords:
AIDS serodiagnosis HIV testing; Vulnerability; Gender

Variables	Bivariate analysis		Model 1		Model 2
Individual	PR	95%CI	PR	95%CI	PR	95%CI
Age (years)
56 - 65	1		1		1
46 - 55	1.85	(1.0 - 3.3)	1.5	(0.8 - 2.7)	1.6	(0.8 - 2.9)
36 - 45	2.8	(1.6 - 4.9)	1.87	(1.0 - 3.3)	2.06	(1.2 - 3.6)
26 - 35	4.55	(2.6 - 7.8)	2.51	(1.4 - 4.5)	2.99	(1.7 - 5.3)
16 - 25	3.4	(1.9 - 5.9)	2.18	(1.1 - 4.2)	2.48	(1.3 - 4.7)
Skin color
White	1		ns		ns
Brown	0.74	(0.5 - 0.9)	ns	ns	ns	ns
Black	0.96	(0.6 - 1.6)	ns	ns	ns	ns
Others	0.96	(0.5 - 1.9)	ns	ns	ns	ns
Marital status
Married / partner	1
Single	1.91	(1.4 - 2.6)	ns		ns
Separated / widowed	1.69	(1.2 - 2.3)	ns	ns	ns	ns
Religion
None/do not know	1		ns		ns
Catholic	0.61	(0.4 - 0.9)	ns	ns	ns	ns
Traditional Evangelical	0.57	(0.3 - 1.1)	ns	ns	ns	ns
Pentecostal	0.67	(0.3 - 1.1)	ns	ns	ns	ns
Spiritist	1.12	(0.6 - 1.9)	ns	ns	ns	ns
Schooling level
Illiterate	1		1		ns
Elementary	1.87	(0.9 - 3.9)	1.29	(0.6 - 2.7)	ns	ns
High	3.53	(1.7 - 7.3)	1.67	(0.8 - 3.5)	ns	ns
College or higher	4.67	(2.2 - 9.8)	2.36	(1.1 - 5.1)	ns	ns
Age at first intercourse
Do not know	1		ns		ns
≤ 15 and unforced	2.13	(0.7 - 6.9)	ns	ns	ns	ns
≤ 15 and forced	2.27	(0.6 - 7.8)	ns	ns	ns	ns
> 15 and unforced	1.21	(0.4 - 3.8)	ns	ns	ns	ns
> 15 and forced	1.52	(0.4 - 5.1)	ns	ns	ns	ns
Condom use during first intercourse
No / non-steady partner	1		ns		ns
No / steady partner	0.48	(0.3 - 0.8)	ns	ns	ns	ns
Yes / non-steady partner	0.91	(0.3 - 2.5)	ns	ns	ns	ns
Yes / steady partner	0.87	(0.5 - 1.5)	ns	ns	ns	ns
Condom use during last intercourse
Not applicable	1		ns		ns
No	1.46	(1.0 - 2.1)	ns	ns	ns	ns
Yes	2.34	(1.6 - 3.4)	ns	ns	ns	ns
Number of sexual partners in lifetime
1	1		1		1
2	1.69	(1.1 - 2.5)	1.53	(1.0 - 2.3)	1.58	(1.0 - 2.4)
3 - 5	2.63	(1.9 - 3.7)	1.9	(1.4 - 2.7)	1.97	(1.4 - 2.8)
> 5	3.56	(2.5 - 5.1)	2.36	(1.6 - 3.4)	2.47	(1.7 - 3.6)
Type of sexual partnership
Homosexual / bisexual	1		ns		ns
Heterosexual	0.32	(0.1 - 0.7)	ns	ns	ns	ns
History of STIs
No / do not know	1		ns		ns
Yes	1.49	(1.1 - 2.0)	ns	ns	ns	ns
Children
No	1		1
Yes. ≤ 6 years	1.48	(1.0 - 2.1)	1.67	(1.1 - 2.4)	1.56	(1.1 - 2.2)
Yes. > 6 years	0.67	(0.5 - 0.9)	1.15	(0.8 - 1.7)	1.02	(0.7 - 1.5)
Sexual violence
No	1		1		1
Yes. before the age of 15 years	2.61	(1.7 - 4.0)	1.68	(1.1 - 2.6)	1.57	(1.0 - 2.4)
Yes. after the age of 15 years	1.33	(0.9 - 1.9)	1.09	(0.8 - 1.6)	1.03	(0.7 - 1.5)
Perceived risk
No	1		1		ns
Yes	1.88	(1.4 - 2.4)	1.17	(0.9 - 1.5)	ns	ns
Personally acquainted with a person with HIV/AIDS
No	1		1		1
Yes, family	2.8	(1.8 - 4.3)	2.24	(1.4 - 3.5)	2.17	(1.4 - 3.3)
Yes, friends / acquaintances	2.16	(1.6 - 2.8)	1.75	(1.3 - 2.3)	1.81	(1.4 - 2.4)
HIV/AIDS treatment
No	1		1		1
Yes, it makes no difference	1.69	(0.6 - 4.8)	1.34	(0.5 - 3.8)	1.18	(0.4 - 3.3)
Yes, it cures	2.1	(0.9 - 5.1)	2.17	(0.9 - 5.3)	1.91	(0.8 - 4.7)
Yes, it improves health	3.19	(1.8 - 5.6)	2.15	(1.2 - 3.8)	2.28	(1.3 - 4.0)
Discriminatory ideas
Yes	1		ns		ns
No	1.63	(1.2 - 2.1)	ns	ns	ns	ns
HDI
Low-medium	1				1
High	1.69	(1.2 - 2.3)			1.59	(1.2 - 2.1)
HIV/AIDS prevalence
Low	1				ns
High	1.34	(0.9 - 1.9)			ns	ns
CT services
No	1				1
Yes	2.08	(1.4 - 3.0)			1.64	(1.1 - 2.4)

Variables	Bivariate analysis		Multiple analysis
Sociodemographic	PR	95%CI	PR	95%CI
Age (years)
56 - 65	1		1
46 - 55	1.71	(0.9 - 3.1)	1.52	(0.8 - 2.7)
36 - 45	1.72	(0.9 - 3.1)	1.53	(0.9 - 2.6)
26 - 35	2.3	(1.3 - 3.9)	1.98	(1.2 - 3.4)
16 - 25	0.89	(0.5 - 1.7)	0.72	(0.4 - 1.4)
Skin color/ethnicity
White	1		1
Brown	0.71	(0.5 - 0.9)	0.87	(0.6 - 1.2)
Black	1.29	(0.9 - 1.9)	1.51	(0.9 - 2.3)
Others	1.87	(0.9 - 3.6)	2.34	(1.4 - 3.9)
Schooling level
Illiterate	1		1
Elementary school	1.85	(0.7 - 4.9)	1.67	(0.6 - 4.4)
High school	2.93	(1.1 - 7.8)	2.72	(1.0 - 7.2)
College or higher	4.83	(1.8 - 13.1)	4.17	(1.6 - 11.0)
Number of sexual partners in lifetime
1	1		ns
2	1.52	(0.6 - 3.9)	ns	ns
3 - 5	1.36	(0.6 - 2.8)	ns	ns
> 5	1.85	(0.9 - 3.6)	ns	ns
Type of sexual partnership
Homosexual / bisexual	1		1
Heterosexual	0.33	(0.2 - 0.5)	0.46	(0.3 - 0.7)
History of STIs
No / do not know	1		ns
Yes	1.44	(1.0 - 2.1)	ns	ns
Sexual violence
No	1		ns
Yes, before the age of 15 years either repeated or not thereafter	1.82	(0.9 - 3.8)	ns	ns
Yes, after the age of 15 years	1.56	(1.0 - 2.4)	ns	ns
Perceived risk
No	1		ns
Yes	1.38	(1.1 - 1.8)	ns	ns
Personally acquainted with a person with HIV/AIDS
No	1		1
Yes, family	2.99	(1.6 - 5.5)	2.04	(1.2 - 3.4)
Yes, friends / acquaintances	2.12	(1.6 - 2.8)	1.79	(1.3 - 2.4)
HIV/AIDS treatment knowledge and beliefs
No	1		ns
Yes, it makes no difference	1.37	(0.6 - 3.3)	ns	ns
Yes, it cures	1.99	(0.8 - 4.7)	ns	ns
Yes, it improves health	1.94	(1.2 - 3.2)	ns	ns
Discriminatory ideas about people with HIV/AIDS
Yes	1		ns
No	1.55	(1.2 - 2.0)	ns	ns

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[1] Corresponding author: Cláudia Renata dos Santos Barros. Universidade Católica de Santos. Avenida Conselheiro Nébias, 300, Vila Mathias, CEP: 11015-002, Santos, SP, Brasil. E-mails: claudia.barros@unisantos.br; barros.crs3@gmail.com