South Africans who have ever tested for HIV are more likely than others to have discussed HIV and sexual health issues with others, researchers report in the April issue of Sexually Transmitted Infections. However those who tested HIV-positive were no more likely than those testing HIV-negative to do so.
South Africa is currently nearing the end of a major campaign to increase the number of its citizens who regularly test for HIV. As a result of the campaign, more than six million have tested in the past year. While the campaign’s principal aim is to increase access to HIV treatment for those who need it, the authors of the new study suggest that it could also “have an added benefit of increasing sexual health communication.”
Nonetheless, the researchers do acknowledge that their research methods are unsuited to identifying causal relationships. It is plausible that people who discuss sexual health issues are more willing to be tested for HIV - rather than the other way round.
A study conducted in South Africa, Zimbabwe, Tanzania and Thailand has previously found a similar relationship between HIV-related communication and HIV testing. Researchers have also found that South Africans with fewer stigmatising views about HIV are more likely to test for HIV.
For the current study, Lori Scott-Sheldon and colleagues recruited 1284 residents of Gugelethu township outside Cape Town in 2008 and 2009 (before the testing campaign began). Participants were approached on the street or in shebeens (venues selling alcohol) and asked to complete a cross-sectional survey.
Participants were mostly in their twenties or thirties; more men than women were recruited. A third reported having two or more sexual partners in the past month.
Just under two thirds (63%) of participants had ever been tested for HIV. Testing was somewhat more common in women, people with more education and people in employment.
Testing was associated with communication about HIV with community members. The following results are from logistic regression analyses which take into account potentially confounding factors and are statistically significant.
People who had tested were more likely to talk to other about HIV testing (odds ratio 2.24), talk about HIV and AIDS (odds ratio 1.57) and advise someone to use a condom (odds ratio 1.86).
Although there was a trend for people who had tested to be more likely to discuss condom use with sexual partners, this was not statistically significant.
Comparing people who had tested HIV-positive with those who had tested HIV-negative, there were no statistically significant differences in people’s likelihood of discussing HIV with community members. However when it came to discussing condom use with sexual partners, those who had tested positive were more likely to do so.
While these findings show an association between HIV testing and HIV communication, they cannot demonstrate which came first. As the authors acknowledge: “The cross-sectional nature of these studies prevents strong inferences regarding the directionality of the association between HIV testing and communication. It is possible that increased interpersonal communication prompts individuals to seek HIV testing.”
The authors say that an alternative research method, following individuals over a period of time, would be required in order to demonstrate causality.
Nonetheless they believe that increasing uptake of HIV testing in South Africa may lead to increasing communication around HIV and sexual health.
Scott-Sheldon LAJ et al. Impact of HIV testing on sexual health communication in South Africa. Sexually Transmitted Infections 87: 242-247, 2011.
