Fylkesnes K, Haworth A, Rosensvärd C, Kwapa P M
Institute of Community Medicine, Faculty of Medicine, University of Tromsø, Norway.
AIDS. 1999 Dec 3;13(17):2469-74. doi: 10.1097/00002030-199912030-00019.
To examine factors affecting the readiness for HIV-related voluntary confidential counselling and testing (VCT).
In a population-based HIV survey in selected urban and rural areas in Zambia, adults aged > or = 15 years were selected by stratified random cluster sampling. The participants were asked to provide a saliva sample for anonymous HIV testing (n=4812, consent rate 93.5%) and, as a part of an interview, were asked about previous HIV testing experience and if they wished to be counselled and tested for HIV. Those indicating interest (initially willing) were provided with an invitation letter to see a counsellor. In rural areas, VCT was provided by personnel brought in from outside the local community, whereas in urban areas it was provided by locally recruited staff.
The overall HIV test rate was 6.5%, but rates appeared to be considerably biased towards higher educational groups. The proportion initially willing was 37% while 3.6% actually came for counselling and were tested (9.3% of those initially willing), of which 47% returned for the result. Actual use was four to five times higher in rural compared with urban areas. Self-perceived risk and high-risk behaviour were positively associated with initial willingness but not with actual use.
The readiness for VCT in the general population was found to be very low. Provision factors such as concerns about confidentiality and length of time waiting for the test result contributed to the low utilization rate. Results of this study contrast sharply with reported VCT acceptance rates of 70-90% among women attending antenatal care in Zambian and in other African populations, suggesting an urgent need to evaluate testing policy and practice of antenatal VCT in particular.
探讨影响艾滋病病毒（HIV）相关自愿咨询检测（VCT）接受意愿的因素。
在赞比亚部分城乡地区开展的一项基于人群的HIV调查中，采用分层随机整群抽样法选取年龄大于或等于15岁的成年人。参与者被要求提供唾液样本进行匿名HIV检测（n = 4812，同意率93.5%），并在访谈中被问及既往HIV检测经历以及是否希望接受HIV咨询和检测。表示感兴趣（最初愿意）的人会收到一封去见咨询师的邀请函。在农村地区，VCT由从当地社区以外引入的人员提供，而在城市地区则由当地招聘的工作人员提供。
总体HIV检测率为6.5%，但该比率似乎严重偏向高学历人群。最初愿意接受检测的比例为37%，而实际前来咨询并接受检测的比例为3.6%（占最初愿意者的9.3%），其中47%回来获取检测结果。农村地区的实际使用率比城市地区高四到五倍。自我感知风险和高危行为与最初意愿呈正相关，但与实际使用率无关。
发现普通人群对VCT的接受意愿非常低。诸如对保密性的担忧以及等待检测结果的时间长度等提供服务方面的因素导致了低利用率。本研究结果与报道的赞比亚及其他非洲人群中接受产前护理的妇女70 - 90%的VCT接受率形成鲜明对比，这表明迫切需要特别评估产前VCT的检测政策和实践。
