title: Factors Associated with HIV Prevalence and HIV Testing in Sierra Leone: Findings from the 2008 Demographic Health Survey.
abstract: BACKGROUND
  The Sierra Leone Demographic Health Survey 2008 found an HIV prevalence of 1.5%. This study investigates associations with HIV infection and HIV testing.
  
  
  METHODS
  Households were selected using stratified multi-stage sampling. In all selected households women aged 15-49 were eligible. In every second household men aged 15-59 were also eligible. Participants were asked to consent for anonymous HIV testing. All participants interviewed and tested were analysed. Multiple logistic regression identified associations with HIV infection, undiagnosed infection and with ever having a voluntary HIV test among sexually active participants.
  
  
  RESULTS
  Of 7495 invited 86% (6,475) agreed to an interview and HIV test. Among 96 HIV positive participants, 78% had never taken a voluntary HIV test so were unaware of their serostatus, and 86% were sexually active in the last 12 months among whom 96% did not use a condom at last intercourse. 11% of all participants had previously voluntarily tested. Among women who had tested, 60% did so in antenatal care. We found that those living in an urban area, and those previously married, were more likely to be HIV infected. Voluntary HIV testing was more common in those aged 25-44, living in an urban area, females, having secondary or higher education, having first sexual intercourse at age 17 years or older, and using condoms at last sex. Although 82% of men and 69% of women had heard of HIV, only 35% and 29% respectively had heard of antiretroviral therapy.
  
  
  CONCLUSIONS
  The HIV prevalence in Sierra Leone has been stable. HIV testing, however, is uncommon and most infected individuals are unaware of their serostatus. This could allow the epidemic to escalate as individuals with undiagnosed infection are unlikely to change their behaviour or access treatment. Improving knowledge and increasing testing need to remain central to HIV prevention interventions in Sierra Leone.
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Brima
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom; Royal Free London NHS Foundation Trust, University College London, London, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Burns
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Ibidun
authors.initials: I
authors.lastname: Fakoya
authors.affiliation: Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors.forename: Brima
authors.initials: B
authors.lastname: Kargbo
authors.affiliation: National AIDS Control Program, Freetown, Sierra Leone.
authors.forename: Suleiman
authors.initials: S
authors.lastname: Conteh
authors.affiliation: Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Copas
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012807:Sierra Leone / Q000453:epidemiology; D055815:Young Adult