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

Area of Science:

• Public Health
• Epidemiology
• Social Sciences

Background:

• Understanding motivations for HIV testing is crucial for effective HIV prevention strategies.
• Despite accessible free HIV counseling and testing (CT) services in Brazil, HIV testing coverage remains insufficient.

Purpose of the Study:

• To identify individual and contextual factors associated with client-initiated HIV testing in urban Brazil.
• To explore gender-specific differences in seeking HIV testing.

Main Methods:

• A multilevel analysis of survey data from 4,760 urban respondents in Brazil.
• Examined individual factors (sociodemographics, sexual health, HIV knowledge, personal acquaintance with HIV+ individuals, discriminatory beliefs) and contextual factors (municipality HDI, HIV prevalence, CT service availability).
• Employed multilevel Poisson regression models with random intercepts to assess associated factors for client-initiated testing.

Main Results:

• Personal acquaintance with someone with HIV/AIDS and age were common predictors for both genders.
• Sexual and reproductive health factors and experiencing sexual violence showed gender-discordant associations with HIV testing.
• Availability of CT services and higher municipal Human Development Index (HDI) were associated with increased client-initiated testing among women.

Conclusions:

• Significant gender disparities exist in HIV testing behaviors in Brazil.
• Heterosexual men and married women represent key populations who do not spontaneously seek HIV testing, highlighting a gap in current prevention efforts.
• Targeted interventions may be necessary to increase HIV testing uptake in these under-tested groups.