Routine HIV testing in Botswana

A population-based study on attitudes, practices, and human rights concerns

Sheri D. Weiser, Michele Heisler, Karen Leiter, Fiona Percy-De Korte, Sheila Tlou, Sonya DeMonner, Nthabiseng Phaladze, David Bangsberg, Vincent Iacopino

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1013-1022
Number of pages10
JournalPLoS Medicine
Volume3
Issue number7
DOIs
StatePublished - 2006
Externally publishedYes

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Botswana
HIV
Population
Violence
Fear
Acquired Immunodeficiency Syndrome
Condoms
Informed Consent
HIV Infections

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Weiser, S. D., Heisler, M., Leiter, K., Percy-De Korte, F., Tlou, S., DeMonner, S., ... Iacopino, V. (2006). Routine HIV testing in Botswana: A population-based study on attitudes, practices, and human rights concerns. PLoS Medicine, 3(7), 1013-1022. https://doi.org/10.1371/journal.pmed.0030261

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; Iacopino, Vincent.

In: PLoS Medicine, Vol. 3, No. 7, 2006, p. 1013-1022.

Research output: Contribution to journalArticle

Weiser, SD, Heisler, M, Leiter, K, Percy-De Korte, F, Tlou, S, DeMonner, S, Phaladze, N, Bangsberg, D & Iacopino, V 2006, 'Routine HIV testing in Botswana: A population-based study on attitudes, practices, and human rights concerns', PLoS Medicine, vol. 3, no. 7, pp. 1013-1022. https://doi.org/10.1371/journal.pmed.0030261
Weiser, Sheri D. ; Heisler, Michele ; Leiter, Karen ; Percy-De Korte, Fiona ; Tlou, Sheila ; DeMonner, Sonya ; Phaladze, Nthabiseng ; Bangsberg, David ; Iacopino, Vincent. / Routine HIV testing in Botswana : A population-based study on attitudes, practices, and human rights concerns. In: PLoS Medicine. 2006 ; Vol. 3, No. 7. pp. 1013-1022.
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N2 - 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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