Spatial and social inequities in HIV testing utilization in the context of rapid scale-up of HIV/AIDS services in rural Mozambique.
The massive scale-up of HIV counseling, testing, and treatment services in resource-limited sub-Saharan settings with high HIV prevalence has significant implications for the course of the HIV/AIDS epidemic. It also offers important broader policy lessons for improving access to critical health services. Applying GIS-based methods and multilevel regression analysis to unique longitudinal three-wave survey data from rural Mozambique, this study investigates the impact of a rapid expansion of HIV-related services on access to and utilization of HIV testing. The results illustrate the declining importance of spatial barriers to utilization of HIV testing services as these services expanded. In addition, the expansion of HIV-related services decreased the spatial variability of HIV testing among the survey respondents. At the same time, some important non-spatial variation, such as that in educational level, persisted despite the expansion of services. These results illustrate the process and consequences of health service diffusion.
Centre for GeoInformatics, School of Geography and Geosciences, University of St Andrews, St Andrews, Fife KY16 9AL, Scotland, UK. Electronic address: jing.yao@st-andrews.ac.uk.
Jing
J
Yao
Center for Population Dynamics, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287, USA. Electronic address: victor.agadjanian@asu.edu.
Victor
V
Agadjanian
GeoDa Center for Geospatial Analysis and Computation, School of Geographical Sciences and Urban Planning, Arizona State University, AZ 85287, USA. Electronic address: atmurray@asu.edu.
Alan T
AT
Murray
D000163:Acquired Immunodeficiency Syndrome; D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D040362:Geographic Information Systems; D015658:HIV Infections / Q000175:diagnosis*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009073:Mozambique; D055361:Multilevel Analysis; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D055815:Young Adult
Access; GIS; HIV/AIDS; Health care; Utilization