title: Knowledge of HIV status prior to a community HIV counseling and testing intervention in a rural district of south Africa: results of a community based survey.
abstract: BACKGROUND
  The low uptake of facility-based HIV counseling and testing (HCT) in South Africa, particularly amongst men and youth has hindered attempts to increase access to effective treatment and prevention strategies. Many barriers to HIV testing have been described including long waiting times, transport to reach facilities, fear of lack of confidentiality and health systems factors such as stock outs of HIV test kits. The aim of this study was to undertake a community survey to determine rates of HCT in a rural area in order to plan a community intervention.
  
  
  METHODS
  A community-based survey was undertaken in 16 communities in Sisonke district, KwaZulu-Natal between September and November 2008. A total of 5821 individuals participated in the survey of which 66% were females. Gender specific mixed effects logistic regression models were used to describe differences in socio-economic characteristics, and their association with HIV testing histories.
  
  
  RESULTS
  Overall 1833 (32%) individuals in this rural area knew their HIV status. Prior testing was higher amongst women (39%) than amongst men (17%). Older men (> 24 years) were more likely to report having tested for HIV previously, with the highest likelihood (adjusted OR = 4.02; 95% CI: 2.71-5.99) among men in age group, 35-49 years. For women, age group 25-34 years had the highest likelihood of having been previously tested (adjusted OR = 1.30; 95% CI: 1.05-1.66). Being currently pregnant (adjusted OR 3.31; 95% CI: 2.29-4.78) or having a child under five (adjusted OR 7.00; 95% CI: 5.84-8.39) were also associated with prior HIV testing amongst women.
  
  
  CONCLUSIONS
  Overall, knowledge of HIV status in this rural sub-district is low. The relatively higher uptake of HIV testing among women is encouraging as it shows that PMTCT services are well functioning. However, these data suggest that there is an urgent need for scaling up HIV testing services in rural communities specifically targeting men and youth.
authors.affiliation: Medical Research Council, Francie van Zyl Drive, Parrow, Cape Town, South Africa. hanani.tabana@mrc.ac.za
authors.forename: Hanani
authors.initials: H
authors.lastname: Tabana
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.forename: Sonja
authors.initials: S
authors.lastname: Swanevelder
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.forename: Wanga
authors.initials: W
authors.lastname: Zembe
authors.forename: Reshma
authors.initials: R
authors.lastname: Naik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population; D012737:Sex Factors; D012959:Socioeconomic Factors; D013019:South Africa; D055815:Young Adult