Individual, household and community factors associated with HIV test refusal in rural Malawi

Kranzer, K., McGrath, N., Saul, J., Crampin, A. C. , Jahn, A., Malema, S., Mulawa, D., Fine, P. E.M., Zaba, B. and Glynn, J. R. (2008) Individual, household and community factors associated with HIV test refusal in rural Malawi. Tropical Medicine and International Health, 13(11), pp. 1341-1350. (doi: 10.1111/j.1365-3156.2008.02148.x) (PMID:18983282)

Abstract

Objective: To investigate individual, household and community factors associated with HIV test refusal in a counselling and testing programme offered at population level in rural Malawi. Methods: HIV counselling and testing was offered to individuals aged 18–59 at their homes. Individual variables were collected by interviews and physical examinations. Household variables were determined as part of a previous census. Multivariate models allowing for household and community clustering were used to assess associations between HIV test refusal and explanatory variables. Results: Of 2303 eligible adults, 2129 were found and 1443 agreed to HIV testing. Test refusal was less likely by those who were never married [adjusted odds ratio (aOR) 0.50 for men (95% CI 0.32; 0.80) and 0.44 (0.21; 0.91) for women] and by farmers [aOR 0.70 (0.52; 0.96) for men and 0.59 (0.40; 0.87) for women]. A 10% increase in cluster refusal rates increased the odds of refusal by 1.48 (1.32; 1.66) in men and 1.68 (1.32; 2.12) in women. Women counsellors increased the odds of refusal by 1.39 (1.00; 1.92) in men. Predictors of HIV test refusal in women were refusal of the husband as head of household [aOR 15.08 (9.39; 24.21)] and living close to the main road [aOR 6.07 (1.76; 20.98)]. Common reasons for refusal were fear of testing positive, previous HIV test, knowledge of HIV serostatus and the need for more time to think. Conclusion: Successful VCT strategies need to encourage couples counselling and should involve participation of men and communities.

• Item Type: Articles
• Additional Information: The Karonga Prevention Study issupported by the Wellcome Trust, UK, and the BritishLeprosy Relief Association (LEPRA). This study was supported by the World Health Organization (contract no.SANTE⁄2004⁄089-735, Second Generation Surveillanceon HIV⁄AIDS). J.R.G. was partly supported by the UK Department of Health.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Kranzer, K., McGrath, N., Saul, J., Crampin, A. C., Jahn, A., Malema, S., Mulawa, D., Fine, P. E.M., Zaba, B., and Glynn, J. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Tropical Medicine and International Health
• Publisher: Wiley
• ISSN: 1360-2276
• ISSN (Online): 1365-3156