A multilevel analysis of the determinants of HIV testing in Zimbabwe: evidence from the demographic and health surveys

Abstract

Introduction Zimbabwe is still burdened with HIV epidemic and the government has an ambitious aim in the post-2015 era to end the AIDS epidemic by 2030. To achieve this, the government has set up the 90-90-90 strategic milestones to be achieved by 2020. It is daunting task to increase HIV testing uptake from current estimate of 56%to 90% to meet these targets. The current government's initiative requires an understanding of determinants of HIV testing. Objectives The specific objectives of this study are to: (i) identify the individual and community-level determinants of HIV testing, focussing on predisposing, enabling and perceived need factors (PREP); and (ii) establish gender differences. Material and Methods We applied multilevel logistic regression models to nationally-representative samples of 17,797women and 14,587 men from the 2005/6 and 2010/11 Zimbabwe Demographic and Health Surveys to examine the determinants of HIV testing. Results HIV testing uptake increased significantly between 2005/6 and 2010/11, especially for women (females OR=5.60; males OR=2.57). Most PREP factors associated with HIV testing are largely consistent with patterns in Southern Africa (e.g. higher uptake by women and those who are wealthier), but unique patterns have also emerged. In particular, results reveal important gender differences: rural residence is associated with lower uptake of HIV testing for women (OR=0.74) but higher for men (OR=1.16); community wealth is a more important factor in enabling HIV testing than household wealth for women, but the converse is true for men; and individual-level, rather than community-level stigma is important for women, while for men, it is community-level stigma that is important. Conclusion Observed gender disparities in determinants of HIV testing calls for gender specific response. Couple-oriented HIV counselling and testing services where men accompany their spouse to HIV screening during pregnancy may help increase HIV testing uptake for males and reduce gender disparities.