Toward 90-90-90: identifying those who have never been tested for HIV and differences by sex in Lesotho

ABSTRACT

To reach HIV epidemic control it is important to ensure that those who have never been tested access HIV testing and counseling (HTC) particularly in the context of a generalized HIV epidemic. Using data from the 2014 Lesotho Demographic Health Survey bivariate and multivariate logistic regressions were conducted to determine the associations between never tested for HIV and key socio-cognitive characteristics by sex. Marginal probabilities at the means were calculated for the socio-cognitive variables for men and women to ascertain the magnitude of the differences in the likelihood of never being tested by sex. We stratified by gender and controlled for age, education, religion, marital status, place of residence, and years circumcised (for men only). Results indicate that more men than women have never been tested (χ²= 461.16, p < 0.001); and, among men, acceptance of gender based violence (Odds ratio [OR]: 1.44, p < 0.001), holding discriminatory attitudes (OR: 1.50, p < 0.001), and not having basic HIV prevention knowledge (OR: 1.53, p < 0.001) were significantly associated with never being tested. The likelihood of never being tested among those who had these three socio-cognitive characteristics was much higher among men (0.56, p < 0.001) than women (0.20, p < 0.001). Given the strong sex differential, there is an urgent need for strategies specifically targeting men in order to effectively promote HTC uptake among them. Additionally, results suggest that those strategies should integrate strategies to address GBV acceptance, HIV prevention knowledge, and HIV discrimination or link men to programs addressing these.

KEYWORDS:

• HIV testing and counseling
• sex
• HIV prevention
• 90-90-90 goals
• Lesotho

Acknowledgements

We would like to thank Trang Q. Nguyen for reviewing a draft of this paper. The views in this publication do not necessarily reflect the views of USAID or the United States Government.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

ORCID

Maria Augusta Carrasco http://orcid.org/0000-0002-7053-2462