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Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns

BACKGROUND: The Botswana government recently implemented a policy of routine or “opt-out” HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. METHODS AND FINDINGS: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in B...

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Autores principales: Weiser, Sheri D, Heisler, Michele, Leiter, Karen, Percy-de Korte, Fiona, Tlou, Sheila, DeMonner, Sonya, Phaladze, Nthabiseng, Bangsberg, David R, Iacopino, Vincent
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1502152/
https://www.ncbi.nlm.nih.gov/pubmed/16834458
http://dx.doi.org/10.1371/journal.pmed.0030261
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author Weiser, Sheri D
Heisler, Michele
Leiter, Karen
Percy-de Korte, Fiona
Tlou, Sheila
DeMonner, Sonya
Phaladze, Nthabiseng
Bangsberg, David R
Iacopino, Vincent
author_facet Weiser, Sheri D
Heisler, Michele
Leiter, Karen
Percy-de Korte, Fiona
Tlou, Sheila
DeMonner, Sonya
Phaladze, Nthabiseng
Bangsberg, David R
Iacopino, Vincent
author_sort Weiser, Sheri D
collection PubMed
description BACKGROUND: The Botswana government recently implemented a policy of routine or “opt-out” HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. METHODS AND FINDINGS: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (AOR = 1.5, 95% CI = 1.1–1.9), higher education (AOR = 2.0, 95% CI = 1.5–2.7), more frequent healthcare visits (AOR = 1.9, 95% CI = 1.3–2.7), perceived access to HIV testing (AOR = 1.6, 95% CI = 1.1–2.5), and inconsistent condom use (AOR = 1.6, 95% CI = 1.2–2.1). Individuals with stigmatizing attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV/AIDS (AOR = 0.7, 95% CI = 0.5–0.9) or to have heard of routine testing (AOR = 0.59, 95% CI = 0.45–0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning one's status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%). CONCLUSIONS: Routine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing.
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spelling pubmed-15021522006-07-18 Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns Weiser, Sheri D Heisler, Michele Leiter, Karen Percy-de Korte, Fiona Tlou, Sheila DeMonner, Sonya Phaladze, Nthabiseng Bangsberg, David R Iacopino, Vincent PLoS Med Research Article BACKGROUND: The Botswana government recently implemented a policy of routine or “opt-out” HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. METHODS AND FINDINGS: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (AOR = 1.5, 95% CI = 1.1–1.9), higher education (AOR = 2.0, 95% CI = 1.5–2.7), more frequent healthcare visits (AOR = 1.9, 95% CI = 1.3–2.7), perceived access to HIV testing (AOR = 1.6, 95% CI = 1.1–2.5), and inconsistent condom use (AOR = 1.6, 95% CI = 1.2–2.1). Individuals with stigmatizing attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV/AIDS (AOR = 0.7, 95% CI = 0.5–0.9) or to have heard of routine testing (AOR = 0.59, 95% CI = 0.45–0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning one's status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%). CONCLUSIONS: Routine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing. Public Library of Science 2006-07 2006-07-18 /pmc/articles/PMC1502152/ /pubmed/16834458 http://dx.doi.org/10.1371/journal.pmed.0030261 Text en Copyright: © 2006 Weiser et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Weiser, Sheri D
Heisler, Michele
Leiter, Karen
Percy-de Korte, Fiona
Tlou, Sheila
DeMonner, Sonya
Phaladze, Nthabiseng
Bangsberg, David R
Iacopino, Vincent
Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns
title Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns
title_full Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns
title_fullStr Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns
title_full_unstemmed Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns
title_short Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns
title_sort routine hiv testing in botswana: a population-based study on attitudes, practices, and human rights concerns
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1502152/
https://www.ncbi.nlm.nih.gov/pubmed/16834458
http://dx.doi.org/10.1371/journal.pmed.0030261
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