Unmarried, childless and poorly educated men least likely to have an HIV test
An analysis finds that men who are unmarried, childless and only educated to primary level are least likely to have tested for HIV – but will take it up if offered.
Researchers analysed factors associated with men not testing across six countries, including Ethiopia, Malawi, Zimbabwe, Rwanda, Lesotho and Zambia. Using nationally representative Demographic and Health Surveys (DHS) conducted between 2013 and 2016, they sought to characterise and measure the proportion of men who had previously never tested for HIV and those who subsequently agreed to take an HIV test when offered one.
In each country, approximately double the proportion of men had never tested for HIV compared to women in Malawi (30% vs. 17%), Zimbabwe (35% vs. 19%), Lesotho (34% vs. 15%) and Zambia (36% vs. 20%). In Ethiopia and Rwanda, fewer men than women had tested for HIV, but there was less of a difference between the sexes (54% vs. 56% in Ethiopia, 19% vs. 14% in Rwanda).
After accounting for age, never being married, not having children and being educated to primary-level were associated with never having tested for HIV among men in every country. However, when asked to take an HIV test during the DHS, between 85% and 99% of previously untested men agreed. This suggests that men who have never tested before are willing to do so but may not have been offered an easy opportunity to test in the past.
Factors associated with non-testing were broadly similar across countries, for example, in five of the countries, 56% to 88% of men who had never tested lived in rural areas with the exception of Rwanda where only 16% lived in rural areas.
Similarly, men who hadn’t tested were more likely to be unemployed than men who had tested (unemployment ranging between 24% and 39% in non-tested men, compared to 9% to 27% among tested men), possibly reflecting lower educational levels. This was the case for all countries except Ethiopia, where both tested and never‐tested men reported low unemployment (10% vs. 5%).
Among men with jobs, never-tested men were more likely to be engaged in agricultural work and less likely to be in professional service-roles than men who had tested for HIV. In Ethiopia, Zimbabwe and Lesotho, men who never tested tended to have lower wages than men who had taken an HIV test.
The majority of never‐tested men had started having sex by the age of 19 (ranging from 46% to 83% across the six countries). Most never‐tested men reported two to five lifetime sex partners.
Between 3% and 58% of never-tested men reported not using condoms the last time they had sex. Between 2% and 22% of never-tested men had paid for sex (2% in Ethiopia and up to 22% in Zimbabwe).
Men who had tested for HIV were significantly more likely than never-tested men to be circumcised in all countries apart from Ethiopia. Circumcision coverage among non-tested men was 92% in Ethiopia, 69% in Lesotho, 22% in Malawi, 20% in Rwanda, 17% in Zambia and 6% in Zimbabwe.
High proportions of never‐tested men accepted HIV testing during the surveys (99% in Rwanda, 93% in Lesotho and Ethiopia, 91% in Zambia, 90% in Malawi and 85% in Zimbabwe). Fewer than 0.05% of previously untested men tested positive in Ethiopia, compared to 2% in Rwanda, 4% in Malawi, 8% in Zimbabwe and Zambia and 14% in Lesotho.
In most countries, never‐tested men had lower HIV positivity than previously-tested men, apart from in Rwanda where men aged 30 to 34 had significantly higher HIV positivity than men who had previously tested. Across all countries, HIV positivity was highest in men aged over 35, regardless of testing history.
These findings indicate that men who are not testing for HIV may be willing to do so if they are provided with a suitable testing scenario. By identifying the characteristics of men who do not go for HIV testing, interventions can be better designed to respond to the needs of men currently missing from testing programmes. For instance, the fact that men who do not test are more likely to be unemployed or in poorly-paid jobs may mean that helping to subsidise the costs associated with facility‐based testing, such as travel costs, could help more men to test.