title: The Differential Effects of an Opt-Out HIV Testing Policy for Pregnant Women in Ethiopia When Accounting for Stigma: Secondary Analysis of DHS Data.
abstract: Individual factors associated with HIV testing have been studied across multiple populations; however, testing is not just an individual-level phenomenon. This secondary analysis of 2005 and 2011 Ethiopia Demographic and Health Survey data was conducted to determine the extent to which the 2007 institution of an opt-out policy of HIV testing during antenatal care increased testing among women, and whether effects differed by women's stigmatizing beliefs about HIV. A logit model with interaction between pre-/post-policy year and policy exposure (birth in the past year) was used to estimate the increased probability of past-year testing, which may be attributable to the policy. Results suggested the policy contributed to a nine-point increase in the probability of testing (95% CI 0.06-0.13, p < 0.0001). A three-way interaction was used to compare the effects of exposure to the policy among women holding higher and lower HIV stigmatizing beliefs. The increase in the probability of past-year testing was 16 percentage points greater among women with lower stigmatizing beliefs (95% CI 0.06-0.27, p = 0.002). Women with higher stigmatizing beliefs were less likely to report attending antenatal care (ANC), testing at their last ANC visit, or being offered a test at their last ANC visit. We encourage researchers and practitioners to explore interventions that operate at multiple levels of socio-ecological spheres of influence, addressing both stigma and structural barriers to testing, in order to achieve the greatest results in preventing HIV.
authors.affiliation: Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 255, Baltimore, MD, 21205, USA. MichelleKaufman@jhu.edu.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Kaufman
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Mooney
authors.affiliation: Jimma University, Jimma, Ethiopia.
authors.forename: Lakew Abebe
authors.initials: LA
authors.lastname: Gebretsadik
authors.affiliation: Jimma University, Jimma, Ethiopia.
authors.forename: Morankar N
authors.initials: MN
authors.lastname: Sudhakar
authors.affiliation: Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 255, Baltimore, MD, 21205, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rieder
authors.affiliation: Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA.
authors.forename: Rupali J
authors.initials: RJ
authors.lastname: Limaye
authors.affiliation: Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Eshetu
authors.initials: E
authors.lastname: Girma
authors.affiliation: George Washington University, Washington, DC, USA.
authors.forename: Rajiv N
authors.initials: RN
authors.lastname: Rimal
mesh_terms: D000293:Adolescent; D000328:Adult; D003256:Community Participation; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006291:Health Policy; D006801:Humans; D011247:Pregnancy; D011295:Prenatal Care; D057545:Social Stigma; D013223:Statistics as Topic; D055815:Young Adult
keywords: Antenatal care; Ethiopia; HIV policy; HIV testing; Stigma