Individual, household and community factors associated with HIV test refusal in rural Malawi.
OBJECTIVE
To investigate individual, household and community factors associated with HIV test refusal in a counselling and testing programme offered at population level in rural Malawi.


METHODS
HIV counselling and testing was offered to individuals aged 18-59 at their homes. Individual variables were collected by interviews and physical examinations. Household variables were determined as part of a previous census. Multivariate models allowing for household and community clustering were used to assess associations between HIV test refusal and explanatory variables.


RESULTS
Of 2303 eligible adults, 2129 were found and 1443 agreed to HIV testing. Test refusal was less likely by those who were never married [adjusted odds ratio (aOR) 0.50 for men (95% CI 0.32; 0.80) and 0.44 (0.21; 0.91) for women] and by farmers [aOR 0.70 (0.52; 0.96) for men and 0.59 (0.40; 0.87) for women]. A 10% increase in cluster refusal rates increased the odds of refusal by 1.48 (1.32; 1.66) in men and 1.68 (1.32; 2.12) in women. Women counsellors increased the odds of refusal by 1.39 (1.00; 1.92) in men. Predictors of HIV test refusal in women were refusal of the husband as head of household [aOR 15.08 (9.39; 24.21)] and living close to the main road [aOR 6.07 (1.76; 20.98)]. Common reasons for refusal were fear of testing positive, previous HIV test, knowledge of HIV serostatus and the need for more time to think.


CONCLUSIONS
Successful VCT strategies need to encourage couples counselling and should involve participation of men and communities.
Kranzer
Katharina
K
London School of Hygiene and Tropical Medicine, London, UK. katharina.kranzer@lshtm.ac.uk
McGrath
Nuala
N
Saul
Jacky
J
Crampin
Amelia C
AC
Jahn
Andreas
A
Malema
Simon
S
Mulawa
Dominic
D
Fine
Paul E M
PE
Zaba
Basia
B
Glynn
Judith R
JR
D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000592:standards*; D054541:Family Conflict / Q000208:ethnology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D045808:Refusal to Participate / Q000208:ethnology / Q000523:psychology*; D012423:Rural Health; D012931:Social Environment; D055815:Young Adult