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Non-Uptake of HIV Testing in Children at Risk in Two Urban and Rural Settings in Zambia: A Mixed-Methods Study
Sonja Merten1,2, Harriet Ntalasha3, Maurice Musheke4
1Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.
Insights
Caregivers feared family stigma and conflict, preventing HIV testing for at-risk children. Addressing social norms and household-level barriers is crucial for timely HIV diagnosis and care.
Area of Science:
- Public Health
- Social Sciences
- Pediatric HIV
Background:
- National policies aim to provide HIV testing and treatment for children.
- Household-level barriers impede access to essential pediatric HIV services.
Purpose of the Study:
- To investigate caregiver-reported reasons for not testing children at risk of HIV.
- To identify factors associated with delayed HIV testing in children.
Main Methods:
- Qualitative and quantitative data collection in Zambia (2010-11).
- Analysis of caregiver responses regarding HIV testing decisions for children.
Main Results:
- 12% of caregivers suspected HIV infection but did not test their children.
- Fears of family stigma and existing household conflicts were primary reasons for non-testing.
- Family conflict (aOR 1.35) and neighborhood stigma (aOR 1.69) significantly associated with not testing.
Conclusions:
- Household-level factors, including social norms and power dynamics, create significant barriers to pediatric HIV testing.
- Addressing stigma, family conflict, and gendered decision-making is essential to improve access to HIV care for children.
Abstract:
This article investigates reasons why children who were considered at risk of HIV were not taken for HIV testing by their caregivers. Qualitative and quantitative data collected in Zambia from 2010-11 revealed that twelve percent of caregivers who stated that they had been suspecting an HIV infection in a child in their custody had not had the child tested. Fears of negative reactions from the family were the most often stated reason for not testing a child. Experience of pre-existing conflicts between the couple or within the family (aOR 1.35, 95% CI 1.00-1.82) and observed stigmatisation of seropositive children in one's own neighbourhood (aOR 1.69, 95% CI1.20-2.39) showed significant associations for not testing a child perceived at risk of HIV. Although services for HIV testing and treatment of children have been made available through national policies and programmes, some women and children were denied access leading to delayed diagnosis and treatment-not on the side of the health system, but on the household level. Social norms, such as assigning the male household head the power to decide over the use of healthcare services by his wife and children, jeopardize women's bargaining power to claim their rights to healthcare, especially in a conflict-affected relationship. Social norms and customary and statutory regulations that disadvantage women and their children must be addressed at every level-including the community and household-in order to effectively decrease barriers to HIV related care.
