HIV/AIDS-Related Communication and Prior HIV Testing in Tanzania, South Africa, Zimbabwe, and Thailand

Transcription

1 HIV/AIDS-Related Communication and Prior HIV Testing in Tanzania, South Africa, Zimbabwe, and Thailand Ellen Setsuko Hendriksen 1, Daniel Hbulinka 2, Suwat Chariyalertsak 3 Alfred Chingono 4, Glenda Gray 5, Jessie Mbwambo 6 Linda Richter 7, Michal Kulich 2, Thomas J. Coates 8 1 Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts 2 Charles University, Prague, Czech Republic 3 Chiang Mai University, Chiang Mai, Thailand 4 University of Zimbabwe, School of Medicine, Harare, Zimbabwe 5 Chris Hani Baragwanath Hospital/University of the Witswatersrand, Johannesburg, South Africa 6 College of Health Sciences, Muhimbili University, Dar Es Salaam, Tanzania 7 Human Sciences Research Council, Durban, South Africa 8 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California

2 Communication and HIV Communication about sex, HIV & AIDS, testing necessary to teach and learn about HIV and its prevention and treatment Informal, interpersonal communication about HIV and AIDS has been shown to affect: HIV knowledge (e.g., Hutchinson et al., 2007) Stigma (e.g., Hutchinson et al., 2007) Possibly even risk behaviors (e.g., Stoneburner & Low-Beer, 2004)

3 Voluntary Counseling and Testing VCT is an effective strategy for HIV prevention VCT promotes reduction of risky behavior based (VCT) knowledge of status Plan for Tomorrow -- Get HIV Tested Today

4 Uptake of VCT Uptake varies across communities 1. Availability and logistical barriers (e.g., Morin et al., 2006) 2. Community climate of social norms 3. Stigma (Chesney & Smith, 1999; Ogden & Nyblade, 2005)

5 Research Question Is constructive communication about HIV and AIDS associated with VCT uptake?

6 Spiral of Silence Theory Noelle-Neumann s Spiral of Silence Theory (1974, 1977) Individual perception of public opinion, gleaned from social interactions, affects further communication Vocal supporters seem more prevalent Appearance of popularity self-fulfilling prophecy

7 Spiral of Silence and HIV Spiral of silence can be applied to HIV-related conversations may perpetuate a highly stigmatized environment may inhibit people coming forward for VCT Possibility to work in reverse? Facilitates tolerant environment and increased VCT uptake?

8 NIMH Project Accept 23 matched pairs of communities in 5 locations (46 communities total) Thailand, Zimbabwe, Tanzania, Soweto SA, Vulindlela SA 8 in each African region 14 in Thailand

9 Method Baseline assessment questionnaire administered in all 46 communities Demographics & behavioral topics In-person but no identifying info collected Local language (translated/back translated) Two-stage probability sample 1. Households randomly sampled in each community 2. One individual age randomly sampled from each selected household N= 14,818

10 Measures Outcome = past HIV testing Ever been voluntarily tested for HIV? never tested, tested only due to pregnancy, tested once, involuntary, and repeated testing. IV = Conversations about HIV and AIDS To whom have you talked about HIV and AIDS in the last 6 months 9 categories of people Coded into three ordinal factors: Never, some conversations, common conversations

11 Additional measures Demographics Self-reported HIV status Social norms around HIV testing HIV stigma Sexual risk behavior over the past 6 months

12 Results: Description of the Sample Sample 55.2% women Mean age: 25 for women, 24 years for men History of voluntary testing Women: 55.5% never tested 28.5% due to pregnancy 15.6% voluntarily once or more 0.5% involuntary Men 80.3% never tested 19% voluntarily once or more

13 Results: Description, cont. Conversations about HIV None: 50.1% of women, 46.3% of men Some: 24.7% of women, 31.7% of men, Common: 25.3% of women, 22.1% of men. Variation across sites Thailand--common 12.8% for women, 10.9% for men Soweto--common 38.2% of women and 31.5% of men Knowledge of HIV status Don t know: 58.8% of women, 82.1% of men Sexual risk Women: 4.4 / Men: 3.2 occasions/month unprotected sex over last 6 months

14 Results: Logistic Regression Only common conversations about HIV was significantly and consistently associated with past HIV testing at every site Thailand OR= [1.426,2.922] p<.001 Soweto OR= [2.239,4.249] p<.001 Vulindlela OR=2.474 [1.572,3.895] p<.001 Tanzania OR= [1.310,2.916] p<.01 Zimbabwe OR= [1.094,3.248] p<.05

15 Results: Logistic Regression, cont. Some conversations also significant in Soweto, Vulindlela, Tanzania Gender--more likely to be women Thailand OR= [1.116, 7.153] Soweto OR= [3.145, 7.856] Vulindlela OR= [1.133, 3.572] Tanzania OR= [1.084, 5.832] Stigma--lower likelihood of testing Thailand OR [0.290,0.642] Sexual risk--higher likelihood of testing Thailand OR=1.076 [1.055, 1.098] Soweto OR= [1.008,1.054]

16 Discussion Only variable significantly and consistently associated with past HIV testing was common conversations about HIV Particularly notable given diversity of sites

17 Interpretations Cross-sectional data Increased communication greater acceptance and uptake of VCT? Testers are more vocal Increased communication?

18 Limitations Cross-sectional design Focus of HIV-related conversations Attempted to screen out speculation/gossip Unclear whether conversations focused on HIV as a general social issue or personal

19 Future research More closely examine with whom conversations occurs and impact on VCT Impact of prevalence Conversation and testing become more salient as prevalence rises Prevalence itself may drive testing and conversation

20 Conclusions Accumulated over a community, higher numbers of conversations about HIV are associated with past voluntary HIV testing Self-fulfilling prophecy illustrated by the spiral of silence theory might also work in reverse, moving towards a tolerant environment for PLWHA and increasing VCT uptake.