Botswana’s policy of routinely offering an HIV test to all who seek medical care is widely supported by people in that country, and the majority of people believe that the policy will help to reduce stigma and violence against women, researchers from the University of California report this week in Public Library of Science Medicine.
The Botswana government introduced an opt-out policy for HIV testing in all medical facilities in 2004 after it became clear that reluctance to test for HIV was a major cause of the unexpectedly slow rate of enrollment to the country’s free antiretroviral treatment programme, the first in Africa.
The cross-sectional study, which recruited 1268 people from a cross-section of Batswana households for private, structured interviews at the end of 2004, found that 81% of people reported that they were either `extremely’ or very much in favour of routine testing, 60% thought that routine testing would reduce stigma and 55% thought it would reduce violence against women.
However, the survey also revealed some contradictory attitudes. Forty-three per cent thought that routine testing would discourage people from going to the doctor and 68% of the sample felt that they could not refuse a test.
Just under half of those questioned (48%) had undergone testing (a much higher proportion than seen in other African countries), and those with stigmatising attitudes towards people with AIDS were significantly less likely to have tested. But the key barriers to testing were the same as those the world over: fear of learning one’s HIV status, lack of perceived HIV risk and fear of having to change one’s sexual practices.
Among those not tested, 71% said that they planned to test within the next six months, and the factors most commonly cited as incentives to test among this group of people were the knowledge that HIV treatment would be available if they tested HIV-positive (67%) and being tested with their partner (64%). People who reported unprotected sex among the untested group were significantly more likely to say that they planned to test in the next six months (adjusted odds ratio 2.21).
The knowledge that treatment was available was a key factor in encouraging testing for two-thirds of those tested, as was the confidentiality of the test results, especially for men, but the national media advertising campaign was also very important in encouraging testing (69% said they were convinced by advertising messages of the need to test). However, only 15% of those who had tested were estimated to have done so as a result of the routine testing programme: the vast majority had undergone traditional voluntary testing and counselling. People who visited the doctor at least three times a year were significantly more likely to have tested.
The authors conclude that Botswana’s policy is well supported, but caution that “efforts to scale up HIV testing must also be accompanied by appropriate monitoring of testing practices to ensure that they are implemented in accordance with international guidelines on human rights and HIV/AIDS.”