HIV testing rates still low in Soweto

HIV testing programmes need to be scaled-up in South African townships, according to a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Most of the study’s participants had never been tested for HIV, and especially low levels of screening were observed in younger men and those of lower socio-economic status.

 “It is of great concern that about half the participants remained unaware of their HIV status in a hyperendemic setting,” comment the investigators. They hope that their study could “assist in the development of future test and treat strategies.”

Increasing the number of individuals who have been tested for HIV is a priority for both prevention and treatment programmes in many settings.

South Africa has an especially high HIV prevalence and the majority of the population have never been tested for the virus. In March 2010 the South African health minister announced a drive to test 15 million people within a year; by December 1st 2010 4.6 million people had taken a test.

Investigators wished to determine the proportion of young men and women in Soweto who had been screened for HIV, and see if there were any socio-economic characteristics associated with testing.

“The current study utilizing a large representative sample of the general population can inform programs aimed at expanded testing and linkage of HIV-infected individuals to care and treatment,” suggest the authors.

Between July and October 2007a total of 3416 men and women were interviewed in their homes about their testing history. The majority of the participants (55%) were women and all were aged between 18 and 32.

Only 49% reported ever having an HIV test. Women were significantly more likely than men to have ever tested (65% vs. 29%, p < 0.001).

Of the individuals who had ever tested, 58% said that they had had at least one repeat test. Again, repeat testing was more common in women than men (61% vs. 50%, p < 0.0001).

A recent HIV test – within the previous year – was reported by 17% of men and 44% of women.

For those who had never tested for HIV, the main reasons included not thinking that they were at risk (37%) and being worried about the possible result (17%).

A number of factors were associated with testing.

For men, they included being aged over 23 (p < 0.0001), greater wealth (p = 0.008), being married (p < 0.001), and having children (p < 0.001).

Men who were sexually active were also more likely to report that they had ever had an HIV test (p < 0.001).

Factors associated with testing among women included age over 23 (p < 0.001), being married (p < 0.001), and having children (p < 0.001). Being sexually active was also associated with testing.

Experiencing violence in childhood was associated with testing for both men and women (p = 0.025), as was talking about HIV (p < 0.001), and having heard about antiretroviral therapy (p < 0.001).

“Increased communication about HIV may lead to greater acceptance and uptake of testing,” comment the investigators. They call for “further studies…to elucidate with whom these conversations occur, the context of these conversations, and the impact on HIV testing.”

Women were more likely than men to have had a repeat HIV test (p < 0.001). Other factors associated with repeat testing included age over 23 (p < 0.001), being married (p < 0.001), being sexually active (p < 0.001), and caring for children (p < 0.001).

“These data suggest that there is still a great need for scaling-up HIV testing in this hyperendemic urban setting,” write the authors. They conclude, “given the continued high prevalence of HIV and plans to expand voluntary counselling and testing in South Africa, the current study is timely in emphasizing the need for further targeted efforts to expand HIV testing.”