HIV This Week

Thierman S, Chi BH, et al. Individual-level predictors for HIV testing among antenatal attendees in Lusaka, Zambia. Am J Med Sci 2006;332:13-17.

Despite the availability of antiretroviral prophylaxis, roughly one-fifth of public-sector antenatal patients decline HIV testing in Lusaka, Zambia. Thierman and colleagues administered a survey to determine individual-level predictors of HIV testing. Of 1064 antenatal attendees approached after pre-test counselling, 1060 (>99%) participated. Of these, 686 (65%) agreed to HIV testing. On bivariate analysis controlling for clinic of attendance, women younger than 20 years old (RR 1.14), unmarried (RR 1.14), pregnant for the first time (RR 1.14), with lower educational attainment (RR 1.15), and with lower income (RR 1.14) were all more likely to undergo testing. When HIV risk was considered, women with low self-perceived risk were most likely to undergo HIV testing. As risk perception increased, likelihood for testing decreased (P for trend < 0.001). The authors conclude that although not statistically predictive, they identified prevalent community beliefs that may act as barriers to testing. Because individual-level characteristics were only weakly predictive of HIV testing, they recommend that future work should concentrate on community-level factors.