title: HIV testing and tolerance to gender based violence: a cross-sectional study in Zambia.
abstract: This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia. We conducted a community-based cross-sectional study of 1716 randomly selected individuals. Associations were examined using mixed-effect multivariable logistic regression. A total of 264 men (64%) and 268 women (56%) had never tested for HIV. The strongest determinants for not being tested were disruptive couple relationships (OR = 2.48 95% CI = 1.00-6.19); tolerance to gender-based violence (OR = 2.10 95% CI = 1.05-4.32) and fear of social rejection (OR = 1.48 95% CI = 1.23-1.80). In the Zambian context, unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated. Policies, programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families.
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Gari
authors.forename: Jacob R S
authors.initials: JR
authors.lastname: Malungo
authors.forename: Adriane
authors.initials: A
authors.lastname: Martin-Hilber
authors.forename: Maurice
authors.initials: M
authors.lastname: Musheke
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Sonja
authors.initials: S
authors.lastname: Merten
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003657:Decision Making; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007398:Interpersonal Relations; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014754:Violence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology