Knowledge, attitude and practice towards voluntary counseling and testing among university students in North West Ethiopia: a cross sectional study

HIV preventive practice and its associated factors among street dwellers in Ethiopia: Application of health belief model

Street dwelling is the use of public space as a place of residence and nourishment for children, adolescents, and young people, revealing a complex and multifactorial situation. Moreover, homelessness facilitates HIV transmission and its progression due to the risky lifestyle of individuals. To the best of our knowledge, there is no study conducted in the study area on HIV preventive practices among street dwellers. The aim of this study was to assess HIV prevention practices and associated factors among street dwellers. A community-based cross-sectional study was conducted in Bahir Dar City from March 12, 2023 to April 30, 2023. By using the simple random sampling technique, 424 street dwellers were recruited. Bivariable and multivariable logistic regression were used for analysis. The magnitude of HIV preventive practice among street dwellers was 35.9%. Being male (AOR = 0.23, 95% CI: 0.10, 0.55), educational status (AOR = 7.53, 95% CI: 2.20, 25.6), practice of sex to earn money (AOR = 0.18, 95% CI: 0.08, 0.44), good knowledge about HIV preventive practice (AOR = 2.83, 95% CI: 1.46, 5.49), perceived susceptibility for HIV (AOR = 0.90, 95% CI: 0.81, 0.99), and perceived benefit of using HIV preventive practice (AOR = 1.09, 95% CI: 1.02, 1.17), were factors associated with HIV preventive practice. The magnitude of HIV preventive practice was low. Being male, the ability to read and write, the practice of sex to earn money, good knowledge about HIV preventive practice, perceived susceptibility to HIV, and the perceived benefit of using HIV preventive practice were significantly associated with HIV preventive practice. Therefore, responsible organizations, both governmental and non-governmental, should design inclusive strategies to improve HIV preventive practice among street dwellers by focusing on regular demand creation activities, awareness creation about HIV preventive practice, and sustainable condom distribution in the city.

A Serious Video Game Targeting HIV Testing and Counseling: A Randomized Controlled Trial

PURPOSE

Adolescents are the age group that is least likely to know their HIV status and may unknowingly transmit the virus to others. A randomized controlled trial was conducted to evaluate the impact of the original video game intervention, PlayTest!, on behavioral antecedents for HIV testing and counseling (HTC).

METHODS

Participants (N = 287 adolescents) were recruited between 2018 and 2020 and were 48% female, aged 14-18 years (mean age = 15.4 years), and 76% racial minorities. Participants were randomized 1:1 and assigned to either play PlayTest! or a set of control games, ∼one session per week for an hour per session over 4-6 weeks (gameplay) after school. The primary outcome measure was participants' attitudes around HTC at 6 months, with intentions, knowledge, self-efficacy, and behaviors assessed as secondary outcomes.

RESULTS

Two hundred and ninety-six participants were enrolled/randomized; nine were withdrawn due to incomplete parental consent forms, leaving 287 participants: 145 were randomized to PlayTest! and 142 to the control condition. Mixed between-within subjects ANOVAs assessed the impact of the study conditions on outcomes. Improvements were seen in the PlayTest! group in HTC attitudes (p < .001), intentions (p < .001), knowledge (p < .001), and self-efficacy (p = .002) at all time-points. At 6 months, for those who had access to HTC (N = 134; prior to COVID-19) and for those who did not have access to HTC (N = 261; during COVID-19), there were no differences in self-reported HTC between the two groups (p = .289 and p = .074, respectively).

DISCUSSION

PlayTest! impacted important behavioral antecedents related to HTC and has the potential to broadly increase HTC rates in adolescents.

Determination of knowledge, attitude and practice of voluntary counseling testing on HIV among youths from Tepi Town, Ethiopia

Objective

Voluntary counseling and testing (VCT) is an integral component of HIV prevention and care strategies worldwide. VCT is considered as an effective strategy in risk reduction among sexually active youth. There is a high burden of HIV in Ethiopia despite a considerable scale up of comprehensive HIV interventions. Hence, the aim of this study was to assess the level of knowledge, attitude and practice of VCT uptake towards HIV among youth of rural part of Tepi town, Ethiopia.

Method

A cross sectional study was carried out from May to August 2020. Total numbers of 127 youths in the age group of 15-24 years were recruited in a self-administered questionnaire with 100% response rate. Descriptive analysis was referred to describe the data. Binary logistic regression analysis was used to measure the effect of different variables by computing odds ratio. Multivariable analyses were utilized to determine the relative effect of explanatory variables.

Results

The study showed that out of 127 total youth respondents, 111 (87.4%) of the respondents have good knowledge and 99 (78%) had a positive attitude towards VCT. Whereas, 86 (67.7%) of the respondents are aware of practicing VCT on HIV in the past.

Conclusions

The findings revel that gender and father's educational status were among the socio-demographic variables that showed statistically significant association with one or more variables affecting youths' knowledge towards VCT uptake. As such, perceived risk of HIV infection, educational level, gender and marital status were statistically responsible for VCT uptake.

Determinants of Voluntary Counseling and Testing Service Uptake Among Adult Sub-Saharan Africans: A Systematic Review and Meta-Analysis

Objective: To examine the major determinants of VCT service uptake among adults in SSA.

Methods: Electronic databases were searched to identify eligible English language publications. Reporting of the study selection procedure was done according to PRISMA and the selected articles were also critically appraised.

Results: We found 8 significant determinants of VCT uptake among adults in SSA, such as less physical access [OR (Odds ratio): 0.77 (95% CI (Confidence interval): 0.62–0.96), p < 0.01], older age [OR: 1.36 (95% CI: 1.08–1.73), p < 0.01], higher education level [OR: 1.60 (95% CI: 1.24–2.05), p < 0.01], high knowledge of HIV and VCT awareness [OR: 1.40 (95% CI: 1.03–1.90), p < 0.01], unprotected sexual practices [OR: 1.75 (95% CI: 1.18–2.58), p < 0.01], discussion on HIV among partners and others [OR: 1.76 (95% CI: 1.10–2.81), p < 0.01], other STIs [OR: 1.40 (95% CI: 1.00–1.98), p < 0.01], and divorced/separated [OR: 1.39 (95% CI: 1.12–1.72), p < 0.01].

Conclusion: This study showed that 8 determinants were significantly associated with VCT service uptake in SSA. Thus, HIV interventions and policy initiatives should be tailored to these determinants to ensure scale-up of VCT service uptake in SSA.

Utilization of Voluntary Counseling and Testing Experience among Mizan-Tepi University Students in Southwestern Ethiopia

Background

Voluntary counseling and testing (VCT) is the primary gateway to HIV prevention, caution, and handling, where people learn whether they are infected. This study was aimed to assess the determinants of voluntary counseling and testing experience among students.

Methods

An institution-based cross-sectional study was conducted between November and January, 2020. A simple random sampling procedure was used to select participants from the target group. The Chi-square test, descriptive analysis, and a binary logistic regression analysis were used to identify the factors associated with VCT experience among students.

Results

Out of 398 participants, 42.5% experienced VCT services. From 59.5% of female participants in the study, only 22.9% experienced VCT services. The logistic regression results revealed that male participants less likely experienced VCT (AOR = 0.549; 95%CI: 0.330, 0.910; p=0.020) compared to female students. Students who had VCT service access in their surroundings (AOR = 2.348; 95%CI: 1.371, 4.020; p=0.002), a sexual partner (AOR = 3.795; 95%CI: 1.214, 11.868; p=0.022), and media access (AOR = 2.374; 95%CI: 1.059, 5.320; p=0.036) were more likely to utilize VCT services than their reference categories.

Conclusions

VCT utilization among students remains limited. In this study, sex, age, region, the education of mother and father, having boy/girlfriend, the source of information, service access, media access, and attitude were the identified factors of VCT utilization. To enhance the usage of VCT services, the facilities should be publicized, and all information regarding VCT should be made available to teenagers.

Factors Affecting HIV Voluntary Counseling and Testing Uptake among Usndergraduate Students of Khartoum, Sudan

Background:

HIV Voluntary Counseling and Testing (VCT) services provide an importatnt start to HIV/AIDS prevention and care. The literature showed that the uptake of VCT is very low, and it is affected by many factors among university students, which are considered as high-risk group for HIV/AIDS infection.

Objective:

The objective of this study is to identify the factors that affect the uptake of voluntary counseling and testing among the undergraduate students.

Methodology:

A descriptive cross-sectional study was conducted among the undergraduate students from the faculty of sciences at the Khartoum university with a sample size of 192. The students were selected by systematic random technique. A structured questionnaire was used for data collection, and data were entered and analyzed by using the SPSS (computer program). IRB approval was obtained from the University of Science and Technology, and informed consent was taken from all participants.

Results:

A total of 192 students participated in this study 107 (55.7%) male and 85 (44.3%) female. Out of these, 100 (52.1%) were in the age group of 15-20, while 92 (47.9%) were in the age group of 21-25. Regarding the knowledge about VCT; 149 (78%) students had good knowledge. The study revealed that about 17 (9%) of the students took the HIV test, and 118 (62%) expressed their willingness to uptake VCT in the future. Reasons that hindered HIV testing during this study include: 1) Some students did not consider themselves at risk (84 i.e. 44%), some students did not know the place where the test is provided (74 i.e. 38.%), some of them did not hear about VCT (32 i.e. 17%) and some were afraid of the test results (17 i.e. 32%). The study found that VCT uptake is positively associated with age, sexual intercourse, and considering themselves self at

risk of HIV infection (p=0.05,0.00.0.03 respectively). Moreover, the study also found an association between willingness to uptake VCT in the future with sexual intercourse and considering themselves at risk of HIV of HIV infection (p = 0.03, 0.00 respectively).

Conclusion:

The uptake of VCT is very low among university students, and it is associated with age and risk perception and sexual intercourse. The most important factors include not considering themselves at risk or not knowing the place of testing or no knowledge about the test or the fear of being positive. On the other hand, willingness to uptake the test was considerably high.

Prevalence of Voluntary Counseling and Testing Utilization and Its Associated Factors Among Merawi Preparatory School Students in Merawi Town, West Gojjam, Ethiopia

Purpose

HIV/AIDS is a major public health problem in many parts of the world. Voluntary counseling and testing (VCT) is one of the essential strategies for its prevention and an entry point to AIDS care. Nevertheless, utilization of VCT is low in Ethiopia. Hence, the aim of this study was to assess the prevalence of VCT utilization and associated factors among Merawi preparatory school students, West Gojjam, Ethiopia.

Methods

An institution-based cross-sectional study was conducted from December 2 to 20, 2019 using a stratified random sampling method to enroll 365 participants. Data were collected using pretested structured self-administered questionnaires, entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. A logistic regression was used to determine an association between a number of independent variables and dependent variables. Adjusted odds ratios were calculated at 95% CI and considered significant with a p value of ≤ 0.05.

Results

The mean age of participants was 20.2 ± 2.6 years and more than half (52.6%) of the respondents were male. From the study participants, 77.5% had good knowledge of VCT, 75% had a positive attitude towards VCT for HIV and 31.5% had undergone VCT for HIV. According to the multivariable logistic regression, having a boyfriend or girlfriend (AOR = 10.49; 95% CI: 5.48, 20.09), discussing with parents about HIV (AOR = 3.63; 95% CI: 1.97, 6.68), good knowledge (AOR: 3.9; 95% CI: 1.80, 8.46) and positive attitude (AOR: 3.14; 95% CI:1.45, 6.82) were significantly associated with VCT utilization.

Conclusion

The majority of the respondents had good knowledge and a positive attitude towards VCT; however, its utilization was low. Having a boyfriend or girlfriend, discussion with parents about HIV, good knowledge and positive attitude towards VCT were significantly associated with VCT utilization. Therefore, a health education program aimed at bringing behavioral change should be planned and implemented.

Factors Affecting Voluntary HIV/AIDS Counseling and Testing Service Utilization Among Youth in Gondar City, Northwest Ethiopia

BACKGROUND

Voluntary counseling and testing (VCT) is a vital response to human immunodeficiency virus (HIV) infection among adolescents in sub-Saharan Africa. Determining the status of VCT services is important to link HIV care and antiretroviral therapy.

METHODS

An institutional cross-sectional study design was conducted among 841 young students at Gondar College of Teachers' Education. A self-administered questionnaire was used to gather the data. Descriptive statistics were performed. Bivariate and multivariable binary logistic regressions were used to identify factors associated with the use of VCTs. The adjusted odds ratio (AOR) with 95% confidence was used to report statistical significance.

RESULTS

The majority (71%) were aware of VCT services. More than one-third (37.8%, 95% CI: 34.6-41.2) participants had used VCT services. Having peer groups used VCT (AOR=2.04, 95% CI: 1.31-3.20), having partner (AOR: =1.6, 95% CI: 1.04-2.45), desiring to have VCT in the future (AOR=3.58, 95% CI: 1.98-6.50), being aware of VCT (AOR= 1.98, 95% CI: 1.20-3.34), knew infected/dead individuals with HIV/AIDS (AOR=1.67, 95% CI: 1.07-2.61), know test sites (AOR=2.01, 95% CI: 1.29-3.13) were positively associated, whereas being married (AOR=0.36, 95% CI: 0.20-0.63) and fear of confidentiality (AOR=0.23, 95% CI: 0.10-0.52) were major barriers to use.

CONCLUSION

Low use of VCTs, which was far away from the 90:90:90 WHO goal, has been noted. The use of VCT services was associated with having peer groups that used VCT, having a partner, wanting to have VCT in the future, knowing the infected/dead individual with HIV/AIDS, fear of confidentiality of results, knowing the test sites, and having awareness of VCT. Efforts are needed to strengthen the health system that also needs to pay attention to education about HIV and VCT.

Health beliefs and barriers related to HIV prevention and screening among students of the University of Vlora: a cross-sectional study

Background

Previous researchers have found that young university students can have a high level of knowledge about HIV/AIDS infection, but they are still not utilizing the existing HIV prevention methods. As a result there is a need to determine which factors and barriers influence the use of existing HIV screening and prevention methods among students of the University of Vlora in Albania.

Methods

This was a cross-sectional study conducted among university students in the district of Vlora, Albania from April to June 2018. Stratified, multi-stage sampling technique was used to select randomly study subjects. A structured, self-administered questionnaire was used for data collection. Bivariate and multivariate logistic regression analysis was employed to reflect the relationship between variables.

Results

The mean age of the participants (710) was 20.85 ± 2.1 years. 38% of them believe that chances of getting HIV would not stop them to have sexual intercourse with more than one partner, 69% report that using a condom seems like an insult to their partner. 78% of the students with sexual experience didn’t used Voluntary Counseling and Testing services. The students from the rural area (AOR = 0.50, 95% CI [0.30–0.82]) and those of first academic year (AOR second/first year =2.31, 95% CI [1.33–3.99], AOR third/first year =1.18, 95% CI [0.65–2.13]) were less likely to use HIV service.

Conclusions

The findings reveal that health beliefs and barriers are good predictors of the preventive behaviours toward HIV infection. The survey has provided evidence to suggest that creating awareness about HIV prevention among student community, especially those from non-health sciences and rural areas could contribute to increased uptake of the VCT services, the condom use and to reduce the identified stigmatizing barriers.

Uptake of HIV testing and counseling among tertiary institution students in the Hohoe Municipality, Ghana

HIV Testing and Counselling (HTC) is a critical strategy to reduce the rate of new HIV infections and the key entry point to HIV treatment, care and support services. This study aimed to determine the uptake of HTC among students of tertiary institutions in the Hohoe Municipality of Ghana. This was a quantitative cross-sectional study. A structured questionnaire was used to collect data among a proportionate stratified sample of students from tertiary institutions. Chi-square and Logistic regression analyses were performed using Stata version 12.0 at the 0.05 level of significance. Only 30.6% of the total respondents had ever tested for HIV/AIDS of which, only 22.9% tested less than 6 months before the current study. Students above twenty-four years of age were 3 times more likely to go for HTC than those below 20 years [OR=2.56 (95% CI: 1.07-6.11; p=0.034)]; those in the fourth year of study were 3 times more likely get HTC than those in the first year [OR=3.05 (95%CI: 1.10-8.49; p=0.033)]; and those attending THERESCO, the Midwifery training college and UHAS were more than 2 times more likely to get tested for HIV than those attending FRANCO [OR =2.67 (95% CI: 1.14-6.15; p=0.024)], [OR=2.40 (95% CI: 1.04-5.54; p=0.040)] and [OR=2.63 (95% CI: 1.13-6.13; p=0.026)] respectively. The uptake of HTC among tertiary institution students in Hohoe municipality was considerably low. Policymakers should design programs and interventions that would increase uptake of HTC among tertiary students, with focus on those aged less than 20 years, those at the lower level of study and those in the non-health related institutions.

Videogame intervention to encourage HIV testing and counseling among adolescents

BACKGROUND

Adolescents in the United States account for one-fifth of new HIV cases, and have the highest rate of undiagnosed HIV, with more than half (51%) not knowing their status. It is a crucial public health concern to help equip youth with the information and autonomy to minimize their risk and know their status. Serious videogames are emerging as valuable tools for health and behavior change in adolescents, and have potential to engage this population and increase their use of HIV testing and counseling (HTC). The purpose of this study was to: (I) modify an original serious game targeting risk reduction and HIV prevention developed by the play2PREVENT Lab and create a new serious game that focuses on HTC; (II) evaluate its feasibility and acceptability; (III) pilot-test the assessment measures that are subsequently being used in a large randomized controlled trial.

METHODS

Three focus groups with adolescents, aged 14-17 (n=13, mean age =15), informed artwork and storylines for PlayTest! After the game was completed, a pilot test was conducted using a one-group pretest-posttest design to collect data on: (I) participants' gameplay satisfaction and experience; (II) the validity of the project's assessments. Twenty-six participants, aged 15-16 were enrolled from a local after-school program. Participants played PlayTest! twice weekly for three weeks. Data were collected on behavior, intentions, knowledge, perceived susceptibility, and attitudes related to HTC at baseline, post-gameplay (three weeks), and follow-up (six weeks).

RESULTS

For the focus groups used in the game development, four major themes emerged: (I) adolescents have strong misperceptions about HTC, including who should get tested and what the test entails; (II) adolescents have incorrect knowledge about how HIV is contracted, spread, and treated; (III) adolescents are supportive of their peers getting tested for HIV, but are not likely to get tested themselves; (IV) while the majority of adolescents know where to get tested for HIV, social stigma, misperceptions around HTC, and fear of having a positive diagnosis keep them from seeking it. For the pilot study, overall, participant experience with the game was highly favorable. The assessments were sensitive enough to capture changes in our target variables: intentions (P=0.037) and knowledge (P=0.025) related to HTC at follow-up.

CONCLUSIONS

The PlayTest! game provides promising results regarding using an engaging and evidence-informed videogame intervention to promote HTC in adolescents.

Knowledge, Attitude, and Practice of Postexposure Prophylaxis against HIV Infection among Healthcare Workers in Hiwot Fana Specialized University Hospital, Eastern Ethiopia

Background

Postexposure chemoprophylaxis can prevent human immunodeficiency virus (HIV) infection in risk health care workers; however routine adoption of these practices by the workers has been limited.

Methods

A cross-sectional study was conducted on 311 health care workers of Hiwot Fana Specialized University Hospital between February and March 2016. Data was collected using a structured self-administered questionnaire and analysed using STATA 12.

Results

In all, 83% of the participants had adequate knowledge of postexposure prophylaxis for HIV. All the respondents had heard about postexposure prophylaxis for HIV; however, only 37 (22.4%) workers know the definition of the postexposure prophylaxis. Among study participants, the majority of them, 272 (87.5%), knew the preferable time to initiate postexposure chemoprophylaxis. A significant number of the workers (43.4%) had an unfavorable attitude towards postexposure prophylaxis. Among 53 workers with a potential exposure to HIV, 38 (71.7%) took postexposure chemoprophylaxis and only 26 (44.8%) completed taking postexposure prophylaxis correctly.

Conclusion

In all, most of the health care workers had adequate knowledge about postexposure prophylaxis against HIV/AIDS. The result shows that a significant number of individuals had a negative attitude and poor practice with regard to postexposure prophylaxis. Therefore, formal training that aims to improve attitudes and support to improve postexposure prophylaxis implementation and completion are needed. We would recommend the establishment of appropriate guidelines and the supply chain to ensure the availability of postexposure prophylaxis drugs for the protection of healthcare workers with potential high risk exposure to HIV.

Discordance, Disclosure and Normative Gender Roles: Barriers to Couple Testing Within a Community-Level HIV Self-Testing Intervention in Urban Blantyre, Malawi

A community-based HIV self-testing study in Blantyre, Malawi demonstrated that not all individuals living in couples tested with their partner. We describe factors dissuading individuals in couples from self-testing with their partner. Data were drawn from qualitative study exploring consequences of HIV self-testing within couples. In-depth interviews were conducted with 33 individuals living in couples who tested alone. Participants expressed fear of dealing with HIV-discordant relationships. Failure to self-test with a partner was correlated with gender, with more men than women overtly declining or unconsciously unable to have joint HIV self-test. Men feared exposure of infidelity and were often not available at home for economic reasons. Barriers to uptake of couple HIV self-testing seemed to be shaped by gendered dichotomies of social-relationships. To help achieve the first 90% of the UNAIDS 90:90:90 goals, it is important to overcome structural barriers to realise the full potential of HIV self-testing.

Knowledge and awareness of HIV/AIDS among students of a technical institution

BACKGROUND

Acquired immunodeficiency syndrome (AIDS) is a major health problem worldwide. The number of infected people is increasing daily. Knowledge and awareness toward prevention and control of the disease is necessary among both educated and illiterate people.

OBJECTIVE

This study is aimed at assessing the knowledge and awareness about human immunodeficiency virus (HIV)/AIDS among undergraduate students studying in a technical institute in Gorakhpur, Uttar Pradesh, India.

METHODS

A community-based cross-sectional study was conducted among youths aged 15-30 years studying in a technical institution in Gorakhpur. Data were collected using a semistructured questionnaire developed with the help of existing literature, from 250 participants (students).

RESULTS

The main source of information was the television; knowledge about the difference between HIV/AIDS was satisfactory. The findings showed that the knowledge about modes of prevention (blood checkup, needle/syringe sterilization) was satisfactory. There were several misconceptions about the modes of transmission of the disease, such as through mosquito bites, eating/drinking, and kissing.

CONCLUSION

The knowledge of the study population was satisfactory, and there is a need for innovation and comprehensive education to impart better knowledge and understanding about HIV/AIDS.

Uptake of HIV testing and counseling, risk perception and linkage to HIV care among Thai university students

Background

HIV testing and counseling (HTC) with linkage to care after known infection are key components for HIV transmission prevention. This study was conducted to assess HTC uptake, HIV risk perception and linkage to care among Thai university students.

Methods

An outreach HTC program was conducted in a large public university in Thailand from January 2013 to December 2014. The program consisted of brief HIV knowledge assessment, free HTC, HIV risk assessment and education provided by the healthcare personnel. Students were categorized into low, moderate and high-risk groups according to the pre-defined HIV risk characteristics.

Results

One-thousand-eight-hundred-one students participated in the program, 494 (27 %) underwent HTC. Independent characteristics associated with no HTC uptake included female sex (P < 0.001), lower HIV knowledge score (P < 0.001), younger age (P < 0.001) and students from non-health science faculties (P = 0.02). Among the 494 students undergoing HTC, 141 (29 %) were categorized into moderate or high-risk group, of whom 45/141 (32 %) had false perception of low HIV risk. Being heterosexual was independently associated with false perception of low HIV risk (P = 0.04). The rate of new HIV infection diagnosis was 4/494 (0.8 %). Of these 4 HIV-infected students, 3 (75 %) were men who have sex with men and only 2 of the 4 students (50 %) showed up for HIV continuity care.

Conclusions

An outreach HIV prevention program with HTC was feasible and beneficial in detecting HIV risk and infection among the university students. However, interventions to improve HTC uptake, HIV risk perception and linkage to care are needed.

Prevalence and Correlates of HIV Testing among Young People Enrolled in Non-Formal Education Centers in Urban Chiang Mai, Thailand: A Cross-Sectional Study

BACKGROUND

HIV testing is the gateway to HIV prevention, treatment, and care. Despite the established vulnerability of young Thai people to HIV infection, studies examining the prevalence and correlates of HIV testing among the general population of Thai youth are still very limited. This study investigates socio-demographic, behavioral, and psychosocial factors associated with HIV testing among young Thai people enrolled in Non-formal Education Centers (NFEC) in urban Chiang Mai, Northern Thailand.

METHODS

This was a cross-sectional quantitative study conducted among young unmarried Thai youth--between the ages of 15 and 24--who were enrolled in NFEC in urban Chiang Mai. Multiple logistic regressions were used to identify correlates of "ever tested for HIV" among the sexually active participants.

FINDINGS

Of the 295 sexually active participants, 27.3% reported "ever tested for HIV;" 65.4% "did not consistently use condom;" and 61.7% "had at least 2 lifetime partners." We found that "self-efficacy" (AOR, 4.92; CI, 1.22-19.73); "perception that it is easy to find a location nearby to test for HIV" (AOR, 4.67; CI, 1.21-18.06); "having at least 2 lifetime sexual partners" (AOR, 2.05; CI, 1.09-3.85); and "ever been pregnant or made someone pregnant" (AOR, 4.06; CI, 2.69-9.15); were associated with increased odds of having ever been tested. On the other hand, "fear of HIV test results" (AOR, 0.21; CI, 0.08-0.57) was associated with lower odds of ever having been tested for HIV.

CONCLUSION

The main finding is that a substantially high proportion of Thai youth is engaged in risky sexual behaviors--yet reports low rates of ever having been tested for HIV. This highlights an urgent need to develop appropriate interventions--based on the identified correlates of HIV testing. There is also an urgent need to enhance HIV testing and to promote safer sexual behaviors among young Thai people--particularly those who are out-of-school.

Mobilization for HIV Voluntary Counseling and Testing Services in Vietnam: Clients' Risk Behaviors, Attitudes and Willingness to Pay

A multi-site survey was conducted on a sample of 365 clients to assess their willingness to pay for HIV voluntary counseling and testing (VCT) services in Ha Noi and Nam Dinh province, two epicenters of Vietnam. By using contingent valuation technique, the results showed that most of respondents (95.1 %) were willing to pay averagely 155 (95 % CI 132-177) thousands Vietnam Dong (~US $7.75, 2013) for a VCT service. Clients who were female, had middle income level, and current opioid users were willing to pay less; meanwhile clients who had university level of education were willing to pay more for a VCT service. The results highlighted the high rate of willingness to pay for the service at a high amount by VCT clients. These findings contribute to the implementation of co-payment scheme for VCT services toward the financial sustainability of HIV/AIDS programs in Vietnam.

"Students want HIV testing in schools" a formative evaluation of the acceptability of HIV testing and counselling at schools in Gauteng and North West provinces in South Africa

Background

The proposal by the South African Health Ministry to implement HIV testing and counselling (HTC) at schools in 2011 generated debates about the appropriateness of such testing. However, the debate has been between the Ministries of Education and Health, with little considerations of the students. The main aim of the study was to assess the students’ opinions and uptake of HIV testing and counselling in general, and the acceptability of the provision of HIV testing and counselling in schools. The study also determined the association between socio-demographic characteristics, sexual behaviour, and HIV testing behaviour of the students.

Methods

A survey was conducted among grade 10–12 high school students in North West and Gauteng provinces, South Africa. Seventeen high schools (nine rural and eight urban) were randomly selected for the administration of a researcher-assisted, self-administered, semi-structured questionnaire.

Results

A total of 2970 students aged 14–27 years participated in the study; 1632 (55%) were girls, 1810 (61%) ever had sex, and 1271 (49.8%) had more than one sex partner. The mean age of first sexual activity was 15.6. Half (n = 1494, 50.1%) had been tested for HIV. Having multiple sexual partners, age, and gender were significantly associated with increased odds of having had a HIV test. Fear, being un-informed about HTC, and low HIV risk perceptions were the reasons for not getting tested. The acceptability of HTC at school was high (n = 2282, 76.9%) and 2129 (71.8%) were willing to be tested at school. Appropriateness, privacy, and secrecy were the main arguments for and against HTC at school. One-third (n = 860, 29%) had intentions to disclose their HIV status to students versus 1258 (42.5%) for teachers. Stigma, discrimination and secrecy were the primary reasons students did not intend to disclose.

Conclusions

A high acceptability of HTC and willingness to be tested at school suggest that HIV prevention programs tailored to youth have a high potential of success given the readiness of students to uptake HTC. Bringing HIV testing to the school setting will increase the uptake of HTC among youth and contribute towards efforts to scale up HTC in South Africa.

Predictors of Intention to Use HIV Testing Service Among Sexually Experienced Youth in Thailand

This study examined the predictors of intention to use HIV counseling and testing (HCT) services among those who had never used HCT services in a sample of 2,536 Thai youth in Bangkok (ages 15-24). Web-based questionnaires included assessments of HIV knowledge, HIV testing attitude, AIDS stigma, and youth-friendly HCT (YFHCT) service expectation. More than 80% of the sexually experienced youth had never used HCT services but among this group 74.06% reported having intentions to do so. The significant predictors consisted of favorable expectations of YFHCT services (p < .001), positive attitude toward HIV testing (p < .005), perceived high risk for HIV infection (p < .01), having multiple sex partners while also using condoms consistently (p < .01), willingness to pay (p < .001), and being informed about HCT and knowing service locations (p < .001). Policy makers, as well as health promotion program developers and researchers can use these findings to increase intention and use of HCT services among at-risk youth.

Attitudes of adolescents towards sexual health in three cities from Croatia and Bosnia and Herzegovina

AIM

This study aimed to determine the attitudes of adolescents towards sexual health and to assess their understanding of contraception use and knowledge about sexually transmitted infections in three ethnically different areas of Croatia and Bosnia and Herzegovina.

METHODS

A total of 146 adolescent high school students between 17 and 19 years of age from three different cities were enrolled in this cross-sectional study. The participants completed two anonymous questionnaires: one that measured attitudes towards safe sex practice and another that measured contraception and general sexual health knowledge.

RESULTS

Shame was identified as the main factor why adolescents did not seek information about sexual health and contraception. On average, respondents correctly answered only 35% of questions regarding sexual health. Adolescents from East Mostar, with a predominantly Bosniak population, had more positive attitudes towards safe sex and showed less contraception knowledge in comparison to their colleagues from two cities in Croatia.

LIMITATIONS

Our study design might be burdened by socially desirable reporting and other biases inherent to the survey design.

CONCLUSION

Adolescents from Croatia and Bosnia and Herzegovina, countries that experienced war and are still undergoing post-communist socio-economic transition, generally did not have adequate knowledge with respect to safe sex lifestyles. Respondents had major problems identifying sexually transmitted infections and their knowledge about contraception was insufficient.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Providing care for adolescent populations should address specificities in local ethnical and socio-economical circumstances. There is a need for further studies to determine social, cultural and religious factors influencing the knowledge and attitudes towards sexual health in order to provide most effective interventions for specific adolescent populations.

Low uptake of HIV testing and no HIV positivity in stable serodiscordant heterosexual partners of long-term treated HIV-infected Thais

The objective of this study was to characterize HIV-serodiscordant heterosexual couples and to evaluate acceptance for HIV testing and HIV prevalence in nonindex partners. We conducted a cross-sectional study with quantitative and qualitative components. Two cohorts of 1767 HIV-positive people were screened to identify heterosexual HIV-serodiscordant couples. HIV-positive partners (index) were administered a questionnaire; CD4, viral load (VL), and antiretroviral therapy (ART) history were gathered from clinical records. HIV-negative/unknown status partners (nonindex) were invited for a similar questionnaire and HIV testing. In-depth interviews with three HIV-serodiscordant couples were conducted. Two hundred and ninety-seven index partners agreed to enroll in this study. The median duration of the relationship was 10 years, and 81% were sexually active. All but two index partners were on ART, and 98% had VL < 1000 copies/mL. Only 111 (37%) nonindex partners came for HIV testing, and all of them tested HIV-negative. In addition, only 41% of nonindex partners had HIV testing in the last one year. The main reasons for the nonindex partners not to come for HIV testing were "no interest" (n = 117, 63%) and "nondisclosure of HIV status" (n = 46, 25%). The latter was substantiated and explained by the qualitative outcome of this study, suggesting relation to stigma against HIV-positive people. Our results support the WHO recommendation for starting ART for treatment and prevention in HIV-serodiscordant couples at any CD4 count. Furthermore, we recommend the dissemination of data showing that no HIV transmission in heterosexual couples through sex practice has been observed provided VL is suppressed. This could be a powerful tool for effective fight against stigma and self-stigma in people living with HIV.

Attitudes Towards (Psychotherapy) Groups: Results of a Survey in a Representative Sample

Based upon observations indicating decreasing attractiveness of groups within and outside the clinical field, the present study aimed to determine attitudes toward, and expectations of, groups in a representative sample of 2512 German citizens. The survey also included questions specifically related to group psychotherapy and its acceptance. In addition, psychological characteristics of respondents (measures of narcissism, psychological impairment, and emotion regulation) and socio-demographic variables were assessed to examine their potential association with group-related attitudes. In total, the survey revealed a relatively positive picture of attitudes and expectations toward groups in general and psychotherapy groups in particular. Those with more open attitudes towards groups were comparatively less distressed, anxious, and depressed; they favored emotional reappraisal instead of suppression as the dominant strategy to regulate their emotions. Contrary to prediction, narcissism did not influence attitudes towards groups. The results are related to current discussions of the attractiveness of groups and to implications for the practice of group psychotherapy.

Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group - results from the ANRS-VESPA2 Study, France

Correlates of late presentation (LP) for HIV infection in Metropolitan France and French overseas departments (FODs) were assessed among HIV-infected patients recently diagnosed, using data from a large cross-sectional survey, representative of the French HIV-infected population, conducted in 2011. LP was defined as presentation with either clinical AIDS events within the calendar year of diagnosis or CD4 < 350/mm(3) and presentation with advanced disease (PAD) was defined as presentation with either clinical AIDS events or CD4 < 200/mm(3). Correlates of LP/PAD were assessed through logistic modelling, separately in Metropolitan France and FODs. In Metropolitan France, 47.7% of participants were late presenters and 29.3% presented with advanced disease. LP was more frequent among male and female migrants from sub-Saharan Africa (SSA; 58.5% and 56.4%) and non-African heterosexual males (61.8%) than among men who have sex with men (34.8%). In FODs, 53.2% of participants were late presenters and 36.8% presented with an advanced disease. LP was more frequent among men than women (60.6% vs. 45.3%) and among those with a lower level of education (56.6% vs. 47.5%). A consistent positive association was found in adjusted analyses between LP/PAD and increasing age at diagnosis among all subpopulations, in both settings. In Metropolitan France, among men who have sex with men, those self-declaring as bisexual were at higher risk of LP/PAD; among non-African heterosexual males and females, religiosity was associated with increased risk of LP/PAD; and among SSA migrants, those diagnosed within the year following their arrival in France were at higher risk of LP/PAD. Older age at diagnosis is a major risk factor for LP/PAD independently of any other socio-demographic characteristics. Promotion of HIV testing should be renewed to target each subgroup at risk while paying a particular attention to middle-aged or older adults whose attitudes and beliefs towards HIV/AIDS might prevent them from seeking testing.

HIV and hepatitis C virus test uptake at methadone clinics in Southern China: opportunities for expanding detection of bloodborne infections

Background

HIV and hepatitis C (HCV) co-infection is highly common among Chinese injection drug users but it is difficult to reach IDUs at traditional VCT (Voluntary HIV counseling treatment) clinics. A new national model integrating HIV/HCV testing with methadone maintenance treatment was started in 2006. The purpose of this study was to investigate HIV and HCV test uptake and associated factors at methadone clinics in Guangdong Province, China.

Methods

A cross-sectional design using routine surveillance data and laboratory testing confirmation was applied to determine rates of HIV and HCV test uptake. Multi-level modeling was used to examine individual-level and clinic-level correlates of increased test uptake.

Results

45 out of 49 methadone clinics in Guangdong Province agreed to participate in the study. Among all 13,270 individuals, 10,046 (75.7%) had HIV test uptake and 10,404 (78.4%) had HCV uptake. At the individual level, methadone clients 30 years or older were more likely to have HIV and HCV test uptake (p <0.001 for both). At the clinic level, methadone clinics with greater health care personnel were more likely to have HIV (p =0.01) and HCV (p = 0.044) test uptake. HIV test uptake significantly correlated with HCV test uptake (correlation coefficient=0.64).

Conclusion

Methadone clinics provide an opportunity for routine integrated HIV and HCV screening among drug users in China. Increased test uptake in young drug users and increased health care personnel at clinics may further improve screening.