Situation analysis of HIV testing among family health international mobile service units (MSU) clients in four provinces of South Africa.
Background. The study objective was to determine how the population located in five remote rural areas responded to HIV testing offered by mobile clinics operating under Family Health International, an international NGO that provides health services, especially HIV prevention and family planning. The study sought to identify how different segments of the population, classified according to their socio-demographic characteristics, responded to HIV testing. The analysis is based on secondary data, collected between October 2009 and September 2010, on clients who came to seek health services at mobile clinics. The population is geographically located in five districts: OR Tambo in Eastern Cape, Amajuba in KwaZulu-Natal, Gert Sibande and Ehlanzeni in Mpumalanga, and Sekhukhune in Limpopo. Although these mobile clincs provided comprehensive health services, HIV prevention and family planning were the main focus of attention. Methods. A total number of 9015 individuals aged 18 years and older visited the mobile clinics during the period October 2009 to September 2010. Eight socio-demographic characteristics were collected and used to determine the association between HIV testing and the aforementioned eight variables. The association between the independent variables (sex, age, level of education, marital status, occupation, number of living children, district of residence and area of residence) and HIV testing (the dependent variables) was first investigated using a descriptive analysis and then performing a logistic regression. Results. More than 88% of individuals aged 18 years and older who visited the mobile clinics in the areas covered by the FHI project are from rural areas. HIV testing is still low in these areas, even though the services are provided close to their homes by the mobile clinics. It was found that only 34.7% of the mobile clinic’s clients tested for HIV during the period from October 2009 to September 2010. Out of eight independent variables included in the logistic regression model, five were found to have a statistically significant association with HIV testing, being: sex, age, education, occupation and area of residence Although the majority of these mobile clinics’ clients are females (77.1%), males tested in higher proportion than females accross all areas. The results showed that HIV testing decreases with age, with the age category 18 - 24 years testing for HIV in higher proportion than the age group 25 - 34 years and decreasing further when people become older. Individuals are more likely to take an HIV test when their level of education is higher than matric and tend to respond the same to a HIV testing offer when they have no education, primary or secondary level. Employment was found to be an enabling factor to test for HIV. People who are employed tested for HIV in a higher proportion than people who were unemployed or still in school. The area of residence (classified as rural, semi-urban and urban) showed that HIV testing is higher in urban than in semi-urban areas, and low in rural areas. The analysis by sex showed that education is important for women because women who had either primary, secondary or a higher level of education tested for HIV better than women who do not have any level of education. For males, education was not statistically significant regarding HIV testing. The different age groups showed the same pattern for both sexes regarding HIV testing, but young males in the category 18-24 years showed higher odds of testing for HIV than females in the same age category. With occupation variable, females who are either students or employed tested for HIV almost in the same proportion and their odds of testing for HIV were double that of unemployed females. Employed males showed a notably higher difference in testing for HIV than males who were either in school or unemployed. The area of residence showed the same pattern for males and females, with both testing in higher proportions in urban and semi-urban areas than in rural areas. Conclusion. Women from rural areas, with no education, were found to test for HIV less than any other individual in the areas under study. Women tested better when they had been exposed to any form of education. The provision of education to women in the form of an extensive and aggressive door to door HIV awareness campaign should therefore make a difference in increasing the uptake of HIV testing in the five areas covered by the mobile clinics.
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