Factors that affect HIV testing and counseling services among heterosexuals in Canada and the United Kingdom: an integrated review

Nurses' clinical practices reducing the impact of HIV-related stigmatisation in non-HIV-specialised healthcare settings: a protocol for a realist synthesis

INTRODUCTION

Despite tremendous progress in care, people living with HIV (PLHIV) continue to experience HIV-related stigmatisation by nurses in non-HIV-specialised healthcare settings. This has consequences for the health of PLHIV and the spread of the virus. In the province of Quebec (Canada), only four interventions aimed at reducing the impact of HIV-related stigmatisation by nurses have been implemented since the beginning of the HIV pandemic. While mentoring and persuasion could be promising strategies, expression of fears of HIV could have deleterious effects on nurses' attitudes towards PLHIV. In literature reviews on stigma reduction interventions, the contextual elements in which these interventions have been implemented is not considered. In order to develop new interventions, we need to understand how the mechanisms (M) by which interventions (I) interact with contexts (C) produce their outcomes (O).

METHODS AND ANALYSIS

Realist synthesis (RS) was selected to formulate a programme theory that will rely on CIMO configuration to describe (1) nursing practices that may influence stigmatisation experiences by PLHIV in non-HIV-specialised healthcare settings, and (2) interventions that may promote the adoption of such practices by nurses. The RS will draw on the steps recommended by Pawson: clarify the scope of the review; search for evidence; appraise primary studies and extract data; synthesise evidence and draw conclusions. To allow an acute interpretation of the disparities between HIV-related stigmatisation experiences depending on people's serological status, an initial version of the programme theory will be formulated from data gathered from scientific and grey literature, and then consolidated through realist interviews with various stakeholders (PLHIV, nurses, community workers and researchers).

ETHICS AND DISSEMINATION

Ethical approval for realist interviews will be sought following the initial programme theory design. We intend to share the final programme theory with intervention developers via scientific publications and recommendations to community organisations that counter HIV-related stigmatisation.

Factors associated with HIV testing and counselling services among women and men in Nepal: a cross-sectional study using data from a nationally representative survey

OBJECTIVES

This study is set up to explore the factors associated with Human Immunodeficiency Virus (HIV) testing among women and men in Nepal.

STUDY DESIGN

Nepal Demographic and Health Survey, 2016 adopts a cross-sectional design.

SETTING

Nepal.

PARTICIPANTS

Women and men of age 15-49 years.

PRIMARY OUTCOME MEASURES

Our primary outcome was ever tested for HIV. We used multivariable analysis at a 95% level of significance to measure the effect in outcome variables.

RESULTS

About one in 10 women (10.8%) and one in five men (20.5%) ever tested for HIV. Women who had media exposure at least once a week ((adjusted odds ratio (aOR)=2.8; 95% CI: 1.4 to 5.3) were more likely to get tested for HIV compared with those who had no media exposure at all. Similarly, those who had their recent delivery in the health facility (aOR=3.9; 95% CI: 2.4 to 6.3) were more likely to get tests for HIV compared with those delivered elsewhere. Likewise, among men, compared with adolescents (15-19 years), those from older age groups were more likely to get tested for HIV. Compared with no education, secondary (aOR=2.3; 95% CI: 1.4 to 3.6) and higher education (aOR=1.7; 95% CI: 1.0 to 2.8) had higher odds of getting tested for HIV. Similarly, wealth quintiles in richer and richest groups were more likely to get tested for HIV compared with the poorest quintile. Other characteristics like media exposure, paid sex and 2+ sexual partners were positively associated with being tested for HIV.

CONCLUSIONS

HIV testing is not widespread and more men than women are accessing HIV services. More than two-thirds of women who delivered at health facilities never tested for HIV. It is imperative to reach out to people engaging in risky sexual behaviour, people with lower educational attainment, and those in the lower wealth quintile for achieving 95-95-95 targets by 2030.

Prevalence and associated factors of HIV testing among reproductive-age women in eastern Africa: multilevel analysis of demographic and health surveys

BACKGROUND

Despite efforts made to reduce the spread of the human immune-deficiency virus (HIV), its testing coverage remains low in low and middle-income countries (LMIC). Besides, information on factors associated with HIV counseling and testing among reproductive-age women is not sufficiently available. Therefore, this study was aimed to determine the pooled prevalence and factors associated with HIV testing among reproductive-age women in eastern Africa.

METHODS

Secondary data analysis was conducted based on the Demographic and Health Surveys (DHS) data conducted in East African countries. We pooled the most recent DHS surveys done in 11 East African countries. A total weighted sample of 183,411 reproductive-age women was included for this study. Both bivariable and multivariable multilevel logistic regression models were fitted. Variables with a p-value ≤0.2 in the bivariable analysis were selected for multivariable analysis. Finally, in the multivariable analysis, variables with a p-value ≤0.05 were considered as significant factors affecting HIV testing.

RESULTS

The pooled prevalence of HIV testing in eastern Africa was 66.92% (95%CI: 66.70, 67.13%). In the multivariable multilevel analysis factors such as the age of respondent, marital status, educational level, HIV knowledge, HIV stigma indicator, risky sexual behavior and women who visit a health facility were positively associated with HIV testing coverage among reproductive-age women. While women from rich and richest households, having multiple sexual partners, being from rural dwellers, late initiation of sex and higher community illiteracy level had a lower chance of being tested for HIV.

CONCLUSION

The pooled prevalence of HIV testing in eastern Africa was higher than most previous studies. Age of respondent, residence, wealth index, marital status, educational level, HIV knowledge, stigma indicator, risky sexual behavior, women who visit a health facility, multiple sexual partnerships, early initiation of sex and community illiteracy level were significantly associated with HIV testing. There should be an integrated strategic plan to give education about methods of HIV transmission and the implication of HIV testing and counseling. So all the stakeholders should have an integrated approach by giving special attention to the factors that hinder HIV testing to increase awareness regarding the benefit of HIV testing and counseling to control the spread of HIV/AIDS.

Understanding barriers and facilitators to HIV testing in Canada from 2009-2019: A systematic mixed studies review

BACKGROUND

HIV testing is a core pillar of Canada's approach to sexually transmitted and blood-borne infection (STBBI) prevention and treatment and is critical to achieving the first Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target. Despite progress toward this goal, many Canadians remain unaware of their status and testing varies across populations and jurisdictions. An understanding of drivers of HIV testing is essential to improve access to HIV testing and reach the undiagnosed.

OBJECTIVE

To examine current barriers and facilitators of HIV testing across key populations and jurisdictions in Canada.

METHODS

A systematic mixed studies review of peer-reviewed and grey literature was conducted identifying quantitative and qualitative studies of barriers and facilitators to HIV testing in Canada published from 2009 to 2019. Studies were screened for inclusion and identified barriers and facilitators were extracted. The quality of included studies was assessed and results were summarized.

RESULTS

Forty-three relevant studies were identified. Common barriers emerge across key populations and jurisdictions, including difficulties accessing testing services, fear and stigma surrounding HIV, low risk perception, insufficient patient confidentiality and lack of resources for testing. Innovative practices that could facilitate HIV testing were identified, such as new testing settings (dental care, pharmacies, mobile units, emergency departments), new modalities (oral testing, peer counselling) and personalized sex/gender and age-based interventions and approaches. Key populations also face unique sociocultural, structural and legislative barriers to HIV testing. Many studies identified the need to offer a broad range of testing options and integrate testing within routine healthcare practices.

CONCLUSION

Efforts to improve access to HIV testing should consider barriers and facilitators at the level of the individual, healthcare provider and policy and should focus on the accessibility, inclusivity, convenience and confidentiality of testing services. In addition, testing services must be adapted to the unique needs and contexts of key populations.

'I think they might just go to the doctor': qualitatively examining the (un)acceptability of newer HIV testing approaches among Vietnamese-born migrants in greater-Brisbane, Queensland, Australia

Background In high-income countries (HICs), migrants often have higher rates of late diagnosis of HIV than the host population. Timely HIV testing has significant implications for HIV prevention and management. Newer HIV testing approaches, namely provider-initiated testing and counselling (PITC), HIV rapid testing (HIV RT) and HIV self-testing (HIV ST), aim to reach those populations most at risk and, particularly, those who have not previously tested for HIV.

METHODS

This study used semi-structured interviews to examine the (un)acceptability, barriers and facilitators to newer HIV testing approaches (i.e. PITC, HIV RT and HIV ST) among Vietnamese-born migrants (n = 10) in greater-Brisbane, Queensland, Australia.

RESULTS

Vietnamese-born migrants had mixed perspectives on the (un)acceptability of newer HIV testing approaches. PITC was largely viewed by participants as a facilitator to HIV testing for Vietnamese-born migrants. Likewise, HIV RT (undertaken by a doctor in a medical setting, as opposed to a trained community member in a community setting) was generally considered to facilitate HIV testing. HIV ST was largely not considered acceptable to Vietnamese-born migrants and they would prefer to go to a doctor for HIV testing. Several factors were identified that either facilitate or act as barriers to newer HIV testing approaches, including privacy; cost of (accessing) HIV testing; comfort and convenience; healthcare provider relationship; risk perception; symptoms; and technical and emotional support.

CONCLUSIONS

There is a need to understand migrants' HIV testing preferences if poorer HIV-related outcomes are to be overcome. The findings from this study show a preference for doctor-centred HIV testing, due to enhanced privacy, accuracy and support.

Factores psicosociales asociados a la realización de la prueba diagnóstica del VIH en estudiantes universitarios colombianos

Los objetivos de esta investigación fueron: (a) relacionar el riesgo sexual, los conocimientos y las actitudes hacia la prueba del VIH con su realización en estudiantes universitarios colombianos; y (b) describir las barreras percibidas en aquellos que no sela habían realizado, identificando las diferencias según el sexo. Se llevó a cabo un estudio transversal en el que particip- aron 1057 estudiantes colombianos, y en el que se utilizó el Cuestionario Confidencial sobre Vida Sexual Activa (CCVSA), el test Barreras Hacia la Prueba del VIH, la Escala de Actitudes hacia el VIH-Sida y un cuestionario ad hoc de conocimien- tos sobre la prueba. Los estudiantes que se realizaron la prueba (n = 214) reportaron una edad inferior de iniciación sexual (p < .01), un número superior de parejas sexuales (p = .01) y un menor uso de condón en la primera (p = .02) y la última (p = .04) relación sexual, así como mayores conocimientos sobre la prueba del VIH (p < .001). Las principales barreras estuvieron relacionadas con la baja percepción del riesgo de la enfermedad (29.8 %), la confianza en las parejas sexuales (29.2 %) y la falta de ofrecimiento de la prueba (25.2 %). En conclusión, la realización de la prueba está relacionada con la exposición a conductas sexuales de riesgo y con los conocimientos, mas no con las actitudes hacia la prueba. La identi- ficación de los factores psicosociales vinculados podría contribuir al diseño de intervenciones orientadas a la prevención y al tratamiento oportuno de la enfermedad.

Individual- and contextual-level factors associated with client-initiated HIV testing

ABSTRACT: Background: Knowing the reasons for seeking HIV testing is central for HIV prevention. Despite the availability of free HIV counseling and testing in Brazil, coverage remains lacking. Methods: Survey of 4,760 respondents from urban areas was analyzed. Individual-level variables included sociodemographic characteristics; sexual and reproductive health; HIV/AIDS treatment knowledge and beliefs; being personally acquainted with a person with HIV/AIDS; and holding discriminatory ideas about people living with HIV. Contextual-level variables included the Human Development Index (HDI) of the municipality; prevalence of HIV/AIDS; and availability of local HIV counseling and testing (CT) services. The dependent variable was client-initiated testing. Multilevel Poisson regression models with random intercepts were used to assess associated factors. Results: Common individual-level variables among men and women included being personally acquainted with a person with HIV/AIDS and age; whereas discordant variables included those related to sexual and reproductive health and experiencing sexual violence. Among contextual-level factors, availability of CT services was variable associated with client-initiated testing among women only. The contextual-level variable “HDI of the municipality” was associated with client-initiated testing among women. Conclusion: Thus, marked gender differences in HIV testing were found, with a lack of HIV testing among married women and heterosexual men, groups that do not spontaneously seek testing.

Use of GetCheckedOnline, a Comprehensive Web-based Testing Service for Sexually Transmitted and Blood-Borne Infections

Background

The British Columbia Centre for Disease Control implemented a comprehensive Web-based testing service GetCheckedOnline (GCO) in September 2014 in Vancouver, Canada. GCO’s objectives are to increase testing for sexually transmitted and blood-borne infections (STBBIs), reach high-prevalence populations facing testing barriers, and increase clinical STI service capacity. GCO was promoted through email invitations to provincial STI clinic clients, access codes to clients unable to access immediate clinic-based testing (deferred testers), and a campaign to gay, bisexual, and other men who have sex with men (MSM).

Objective

The objective of the study was to report on characteristics of GCO users, use and test outcomes (overall and by promotional strategy) during this pilot phase.

Methods

We used GCO program data, website metrics, and provincial STI clinic records to describe temporal trends, progression through the service pathway, and demographic, risk, and testing outcomes for individuals creating GCO accounts during the first 15 months of implementation.

Results

Of 868 clients creating accounts, 318 (36.6%) submitted specimens, of whom 96 (30.2%) tested more than once and 10 (3.1%) had a positive STI diagnosis. The proportion of clients submitting specimens increased steadily over the course of the pilot phase following introduction of deferred tester codes. Clients were diverse with respect to age, gender, and ethnicity, although youth and individuals of nonwhite ethnicity were underrepresented. Of the 506 clients completing risk assessments, 215 (42.5%) were MSM, 89 (17.6%) were symptomatic, 47 (9.3%) were STI contacts, 232 (45.8%) reported condomless sex, 146 (28.9%) reported ≥4 partners in the past 3 months, and 76 (15.0%) reported a recent STI. A total of 63 (12.5%) GCO clients were testing for the first time. For 868 accounts created, 337 (38.8%) were by clinic invitations (0 diagnoses), 298 (34.3%) were by deferred testers (6 diagnoses), 194 (22.4%) were by promotional campaign (3 diagnoses), and 39 (4.5%) were by other means (1 diagnosis).

Conclusions

Our evaluation suggests that GCO is an acceptable and feasible approach to engage individuals in testing. Use by first-time testers, repeated use, and STI diagnosis of individuals unable to access immediate clinic-based testing suggest GCO may facilitate uptake of STBBI testing and earlier diagnosis. Use by MSM and individuals reporting sexual risk suggests GCO may reach populations with a higher risk of STI. Motivation to test (eg, unable to access clinical services immediately) appears a key factor underlying GCO use. These findings identify areas for refinement of the testing model, further promotion, and future research (including understanding reasons for drop-off through the service pathway and more comprehensive evaluation of effectiveness). Increased uptake and diagnosis corresponding with expansion of the service within British Columbia will permit future evaluation of this service across varying populations and settings.

Engaging African-Caribbean, Asian, and Latino community leaders to address HIV stigma in Toronto

Purpose

Racialized minority and newcomer communities are over-represented in positive HIV cases in Canada. Stigma has been identified as one of the barriers to HIV prevention, testing, and treatment. Faith, media, and social justice sectors have historically served a vital role in promoting health issues in these communities. However, they have been relatively inactive in addressing HIV-related issues. The purpose of this paper is to report on the results of an exploratory study that engaged faith, media, and social justice leaders in the African-Caribbean, Asian, and Latino communities in Toronto.

Design/methodology/approach

This study used a qualitative interpretive design and focus groups to explore the challenges and opportunities in addressing HIV stigma. A total of 23 people living with HIV and 22 community leaders took part in seven focus groups. Intersectionality was used as an analytical lens to examine the social processes that perpetuate HIV stigma.

Findings

This paper focuses on the perspectives of community leaders. Five themes were identified: misconception of HIV as a gay disease; moralistic religious discourses perpetuate HIV stigma; invisibility of HIV reinforces community denial; need to promote awareness and compassion for people with HIV; and the power of collective community efforts within and across different sectors.

Originality/value

Although affected communities are faced with many challenges related to HIV stigma, effective change may be possible through concerted efforts championed by people living with HIV and community leaders. One important strategy identified by the participants is to build strategic alliances among the HIV, media, faith, social justice, and other sectors. Such alliances can develop public education and HIV champion activities to promote public awareness and positive emotional connections with HIV issues, challenge HIV stigma and related systems of oppression, and engage young people in HIV championship.

Explaining the Presence of "Heterosexual" Female Clients of a Rapid HIV Testing Site Located in the Gay Village of Montreal, Quebec

BACKGROUND

Increasing access and uptake of HIV testing among at-risk women is needed. Examining women's motives for visiting a community-based rapid HIV testing site (Actuel sur Rue-AsR) oriented to men who have sex with men (MSM) could offer suggestions.

OBJECTIVE

To compare the "heterosexual" female and male clients of AsR, located in Montreal's (Canada) gay village, to better understand the women's particular HIV prevention and sexual health service needs.

METHODS

This cross-sectional pilot study analyzed questionnaire data provided by AsR clients and staff (nurse and community agent teams) between July 2012 and November 2013. Women and men reporting only opposite-sex partners were compared with chi-square, Fisher's exact, and Kruskal-Wallis tests, as appropriate, on sociodemographics, HIV-related behaviors, motives for visiting AsR, and health service provision.

RESULTS

AsR received 1901 clients. Among these, 55 women and 147 men reported only opposite-sex partners. Women were significantly younger. Significantly greater proportions of women visited AsR because no appointment was necessary (67% vs. 48%), sought testing for condom failure (18% vs. 5%), and had no regular doctor (44% vs. 27%). Both groups mainly chose AsR for the rapid test results (80% and 77%), visited it to receive the rapid HIV test (71% and 76%), and sought testing due to unprotected vaginal sex (44% and 43%). Similar proportions saw the nurse (91% and 89%), received the rapid HIV test (44% and 35%), and were linked to a medical clinic (49% and 52%), especially, to receive complete sexually transmitted infection testing (50% and 44%).

CONCLUSIONS

The results of this innovative study highlight the draw of rapid HIV testing for "heterosexual" users of a site mainly targeting MSM. They also suggest that further research is warranted into the importance for this group of women clients of drop-in and linkage services, particularly given their possible lesser access to regular care.

Predictors of Standard Follow-Up Completion after Sexual Exposure to HIV: Five-Year Retrospective Analysis in a French HIV-Infection Care Center

Objectives

The care of exposed individuals to HIV remains a challenge regarding follow-up completion and HIV-testing of the partner. Identifying patients with risk of not fulfilling HIV-testing follow-up completion (FC), among patients demanding non-occupational post-exposure prophylaxis (nPEP), may improve clinical practice.

Methods

A retrospective chart review was conducted in a single French HIV-infection care center. FC predictors were assessed in a multivariate logistic regression model (Likelihood ratios test).

Results

Between 2009 and 2013, 646 sexual exposures to HIV were evaluated for nPEP, of which 507 effectively received nPEP (78%). FC rate was 30% (194/646). In the multivariate analysis, FC rates rose with age of exposed individuals (OR, 1.04 [0.25–4.28]; p<0.001) and decreased with the year of sexual exposure (OR, 0.74 [0.65–0.85]; p<0.001). FC was associated with sexual encounter with a sex worker (OR, 4.07 [0.98–16.82]; p<0.001) and nPEP use (OR, 2.69 [2.37–3.06]; p<0.001). nPEP early discontinuation was associated with decreased FC rates (OR, 0.18 [0.08–0.39]; p<0.001). No documented nPEP failure was identified. However, five Men who have Sex with Men (MSM) nPEP recipients for unprotected anal receptive intercourse subsequently seroconverted to HIV more than 6 months after nPEP. Seroconversion to HIV was associated with the lack of FC (p = 0.04) and multiple presentations for nPEP over the study period (p = 0.002).

Conclusions

We identified significant predictors of not fulfilling sequential HIV-testing. They appear to be linked with a self-perceived HIV risk, especially in young adults recently exposed. Enhanced counseling in targeted individuals with high risk behaviors and using smartphone and internet-based strategies may be interesting retention in care options.

Factors associated with antiretroviral treatment uptake and adherence: a review. Perspectives from Australia, Canada, and the United Kingdom

International focus on reducing onward HIV transmission emphasizes the need for routine HIV testing and early uptake of antiretroviral treatment (ART). Strategic targets have been set for 2020 to achieve the goal of 90% of people infected with HIV diagnosed, 90% of identified cases on treatment, and 90% of persons on treatment virally suppressed (90-90-90). It is vital to understand the complexity of factors influencing a person's treatment decisions over time and the context which may enable better adherence. In this paper we present findings from the review of published and gray literature (2003-2013) on the documented factors associated with treatment initiation and adherence in the general adult population of Australia, Canada, and the UK. A framework developed by Begley, McLaws, Ross, and Gold [2008. Cognitive and behavioural correlates of non-adherence to HIV anti-retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology. Clinical Psychologist, 12(1), 9-17] in Australia was adapted to summarize the findings. A systematic database search using keywords and a set of inclusion criteria yielded 17 studies (Australia = 6; Canada = 8; UK = 3). In addition 11 reports were included in the review. We found that a person's abilities and motivations (intrapersonal factors, reported in 7 studies) to start and continue ART are influenced by a host of interconnected factors spanning relationship (interpersonal, 3 studies) and broader structural (extrapersonal, 15 studies) factors that are situated within social determinants of health. People therefore evaluate various costs and benefits of starting and staying on treatment, in which biomedical concerns play an important yet often subsidiary role. In this review the economic barriers to care were found to be significant and under-reported, highlighting the persistent health inequities in terms of access to services. Our understanding of the context around people's use of ART remains poor. Qualitative social research within HIV-positive communities is urgently needed to capture people's lived experiences and may address some of this deficit in understanding.

Reaching the unreached: treatment as prevention as a workable strategy to mitigate HIV and its consequences in high-risk groups

While there have been significant advances in curbing the HIV disease epidemic worldwide, there continues to be significant number of incident cases with 2.3 million new infections in the year 2012 alone. Treatment as prevention (TasP), which involves the use of antiretroviral drugs to decrease the likelihood of HIV illness, death and transmission from infected individuals to their noninfected sexual and /or drug paraphernalia-sharing injecting partners, must be incorporated into any HIV prevention strategy that is going to be successful on a large scale. Especially in resource-limited settings, the focus of the prevention approach should be on high-risk groups who contribute disproportionately to community HIV transmission, including people who inject drugs (PWID), men who have sex with men (MSM) and sex workers. Innovative strategies including integrated care services adapted to different patient care settings have to and can be employed to reach these at-risk populations.

Factors impacting HIV testing: a review--perspectives from Australia, Canada, and the UK

With the current global focus on strengthening HIV prevention through greater testing and treatment uptake, it is increasingly salient to identify and address barriers to testing. A review of the published, peer-reviewed literature and national reports from Australia, Canada, and the UK (2003-2013) on barriers to HIV testing was conducted to provide new information relevant to Australia and to complement earlier reviews from Canada and the UK. A systematic database search using keywords and a set of inclusion criteria yielded 36 studies (Australia = 13; Canada = 6; and the UK = 17). In addition 17 unpublished reports were included in the review. Our study uses a novel, comprehensive framework to describe barriers to HIV testing, and thus contributes to moving beyond the traditional patient-provider-system categorization. Within that framework, barriers are categorized as either intrapersonal (reported in 15 studies), interpersonal (21), or extrapersonal (16) and conceptualized within wider sociocultural and structural contexts. People's abilities and motivations to test (intrapersonal factors) are influenced by a host of interconnected factors spanning relationship (interpersonal) and broader socioeconomic, political and cultural (extrapersonal) factors. We suggest that the relative effects of interventions targeting barriers to HIV testing at the intrapersonal and interpersonal levels are limited by the extent to which the social determinants of health are addressed. The framework may also lend itself to thinking about the enabling factors for HIV testing, and future research may investigate the application of that framework for strategizing the most effective response. Future studies should also capture the lived experiences of barriers to HIV testing experienced by patients, especially in populations which are hard to reach based on social and geographic distance. Context-specific studies to evaluate the feasibility and effectiveness of various interventions proposed in the literature to address barriers to HIV testing are needed.

Individual and jurisdictional factors associated with voluntary HIV testing in Canada: Results of a national survey, 2011

OBJECTIVE

HIV testing remains a central strategy for HIV prevention for its ability to link those who test positive to treatment and support. In Canada, national guidelines have recently changed as part of standard primary care to recommend voluntary HIV testing for those aged 16-64 years. Using results from a nationally representative survey, we examined individual and jurisdictional factors associated with voluntary testing.

METHODS

A total of 2,139 participants were sampled using a regionally stratified, two-stage recruitment process. English or French interviews (by phone or online) were conducted during May 2011. Voluntary testing was defined as testing at least once for reasons other than blood donation, insurance purposes, immigration screening or research participation. Weighted logistic regression analysis (including socio-demographic, sexual activity, HIV/AIDS knowledge and jurisdictional factors of HIV prevalence and anonymous testing availability) were conducted for the overall sample, and stratified by sex.

RESULTS

Twenty-nine percent (29%) of survey participants reported at least one lifetime voluntary HIV test. For the full-sample model, the following were associated with increased odds of testing: age &lt;60 years, female sex, sexual minority status, perceived HIV knowledge, casual sex partner in previous year, and living in a higher-prevalence jurisdiction. For men, the strongest factor related to testing was sexual minority status (OR = 5.15, p &lt; 0.001); for women, it was having a casual sex partner in the previous year (OR = 2.57, p = 0.001). For both men and women, residing in a jurisdiction with lower HIV prevalence decreased odds of testing.

DISCUSSION

Sex differences should be considered when designing interventions to increase testing uptake. Jurisdictional factors, including HIV prevalence and testing modality, should be investigated further.

A systematic review of HIV testing among Canadian populations

OBJECTIVE

Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care can prevent disease progression in the individual and prevent onwards transmission within the community. This review describes HIV testing coverage in populations disproportionately affected by HIV and in the general population in Canada.

METHODS

A search of published and grey literature on HIV testing uptake in Canada was conducted. Studies reporting quantitative data on testing practices (ever tested, recent testing, and regular testing), published in either English or French from 2008-2012, were included. Studies that involved testing for immigration or prenatal purposes, and post-intervention studies, were excluded. Included studies were assessed using a modified version of the Public Health Agency of Canada's Descriptive Study Critical Appraisal Tool. Pooled prevalence for percent ever tested was calculated for subpopulations and heterogeneity was estimated using the I2 statistic.

SYNTHESIS

A total of 26 studies were included in the review. The highest rates of ever having been tested were among people who inject drugs (90.6%) and inmates (90.4%); followed by men who have sex with men (83.0%); Aboriginal peoples (55.5%); and the general population (32.8%). Limited information was available on regular and recent testing.

CONCLUSION

HIV testing can reduce the number of undiagnosed cases in Canada. Future research should focus on testing coverage in certain populations, and on the extent to which populations engage in regular testing.