Article Text
Abstract
Objectives Increasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing.
Design and setting A cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique.
Participants Data were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731).
Measures Measures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates.
Results Significantly fewer men (38.3%) than women (47.6%; p<0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women.
Conclusions Men have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men’s engagement into the HIV care continuum in sub-Saharan Africa.
- HIV test
- Mozambique
- HIV care continuum
- gender
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Footnotes
Contributors LMVL, ECM, PD and ALW designed the study concept. JC and DP oversaw data collection. ALW, JHH and JC had full access to study data. JHH conducted statistical analysis and wrote the initial draft of the manuscript with oversight and support by ALW. All authors review and provided scientific input.
Funding This work was supported by funding from PEPFAR through the US Agency for International Development (Cooperative Agreement No AID-OAA-A-12-00058) to the Johns Hopkins Center for Communication Programs. This research has also been facilitated by the infrastructure and resources provided by the Johns Hopkins University Center for AIDS Research, an NIH-funded program (P30AI094189), which is supported by the following NIH cofunding and participating institutes and centres: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK and OAR.
Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Government, USAID, PEPFAR, the NIH or any other affiliate organisations or institutions.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board and the National Committee of Bioethics for Health (CNBS) in Mozambique.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.