Munga Michael A, Urassa Janesta A, Kisoka William J, Mutalemwa Prince P
National Institute for Medical Research, Dar es Salaam, Tanzania.
Ardhi University, Dar es Salaam, Tanzania.
East Afr Health Res J. 2019;3(1):16-23. doi: 10.24248/EAHRJ-D-18-00020. Epub 2019 Jul 30.
Despite the ongoing efforts to promote HIV testing, the majority of adults in Tanzania remain untested, and many remain unwilling to know their HIV status. Understanding the underlying reasons for this unwillingness to test and know one's status will support the development of targeted interventions to promote the uptake of HIV testing. This paper explores the willingness of and barriers faced by self-perceived healthy individuals to test for HIV in selected districts of Tanzania.
A cross-sectional survey was conducted in urban and rural wards between October 2011 and March 2012. Structured questionnaires with closed- and open-ended questions were administered to heads of randomly selected households. Information collected included socioeconomic, demographics, rural/urban backgrounds and the perceived reasons which hinder household heads/members to access and utilise HIV-testing services. Regression analysis was conducted to assess the relationship between the same factors and participants' willingness to go for an HIV test in the near future.
There were 1,429 respondents from randomly selected households interviewed, and out of these, 57.1% were women, and 42.9% were men. The mean age of all respondents was 33.6 years; men were slightly older (mean age, 37 years) than women (mean age, 34 years). Almost one-third (n=433, 30.3%) of the respondents reported having ever tested for HIV, of whom 294 (61.8%) were women, and 139 (38.2%) were men. Being educated to at least the primary school level, being an urban resident, and being female increased the probability of HIV testing by 1.7% (<.001), 1.3% (<.005) and 0.2% (<.005) respectively. Further, for each year, one's age increased the probability of positive future intentions to test for HIV increased by 0.4 % (<.005). Education, residence and marital status were not significantly associated with future willingness to test. Fear of being stigmatised and discriminated was observed to be one of the important barriers for HIV testing among those who had never tested and those who were unwilling to test in the future.
In urban areas, knowledge of the benefits of HIV testing is higher than in rural areas. Overall stigma remains the most salient barrier to HIV testing and interventions that address this, and other structural drivers for stigma need to be addressed in order for people's willingness to test to increase. Finally, health systems need to be strengthened to further encourage testing and be ready to provide quality and non-discriminatory services once people's willingness to test becomes apparent.
尽管一直在努力推广艾滋病病毒检测，但坦桑尼亚的大多数成年人仍未接受检测，而且许多人仍不愿意了解自己的艾滋病病毒感染状况。了解这种不愿检测和了解自身状况的潜在原因，将有助于制定有针对性的干预措施，以促进艾滋病病毒检测的普及。本文探讨了坦桑尼亚部分地区自我感觉健康的个体进行艾滋病病毒检测的意愿及面临的障碍。
2011年10月至2012年3月期间，在城乡选区开展了一项横断面调查。向随机抽取的户主发放了包含封闭式和开放式问题的结构化问卷。收集的信息包括社会经济状况、人口统计学特征、城乡背景以及阻碍户主/家庭成员获得和利用艾滋病病毒检测服务的感知原因。进行回归分析以评估这些因素与参与者近期进行艾滋病病毒检测意愿之间的关系。
共采访了1429名来自随机抽取家庭的受访者，其中57.1%为女性，42.9%为男性。所有受访者的平均年龄为33.6岁；男性（平均年龄37岁）比女性（平均年龄34岁）略大。近三分之一（n = 433，30.3%）的受访者报告曾进行过艾滋病病毒检测，其中294人（61.8%）为女性，139人（38.2%）为男性。至少接受过小学教育、居住在城市以及女性进行艾滋病病毒检测的概率分别增加1.7%（<.001）、1.3%（<.005）和0.2%（<.005）。此外，年龄每增加一岁，未来进行艾滋病病毒检测的积极意愿概率增加0.4%（<.005）。教育程度、居住地点和婚姻状况与未来检测意愿无显著关联。对于从未检测过以及未来不愿检测的人来说，担心被污名化和歧视是艾滋病病毒检测的重要障碍之一。
在城市地区，对艾滋病病毒检测益处的了解高于农村地区。总体而言污名仍然是艾滋病病毒检测最突出的障碍，解决这一问题以及其他污名化的结构性驱动因素，才能提高人们的检测意愿。最后，需要加强卫生系统，以进一步鼓励检测，并在人们表现出检测意愿时准备好提供高质量且无歧视的服务。
