Most people living with HIV/AIDS are in developing countries and these seropositive individuals are unaware of their serological status. Many are diagnosed late after developing at least one AIDS-defining illness. And even after diagnosis, there is no guarantee that these people will access health services for treatment. In Brazil, there is a policy focused on free testing in all federal units, with the implementation of Testing and Counseling Centers (CTA), since the beginning of the 90s, with decentralization to municipalities in the interior of the country. The increase in the proportion of anti-HIV tests should accompany the success of the policy of universal access to treatment, but studies show that the search for anti-HIV tests remains low and the highest proportion of cases with the first late test resides in the region Northeast (SOUZA JR, SZWARCWALD E CASTILHO et al., 2007; FRANÇA-JR, 2008). We aimed to relate the performance of HIV tests with a CD4 T-lymphocyte count, with a retrospective cohort, of all patients with HIV and/or AIDS treated in 02 referral services in the state of Pernambuco, in the entire period from 2009 to 2013, totaling 1,356 cases. The study shows that the CD4 T-cell count was presented as an indicator of late presentation. Since approximately half of the cases had a count of less than 350 cells/mm3 (more than 30%, it was less than 200 cells/mm3). As for the place where the test was performed, the majority occurred in public health units (40.4%) and in the Test Centers Anonymous (36.6%). Most of the cases (79.4%) performed a rapid test, and among the reasons for the test, although in 990 of the cases, there is no record in the medical record, it is noteworthy that the patient was ill (35.8%), and having a mate or partner with HIV/AIDS (26.8%), only 18.9% decided to take the test spontaneously. The results of this study can support the elaboration and/or update of the recommendations of attention to the society vulnerable to HIV and AIDS, reorienting the policies of health promotion, prevention and therapeutic strategies in this area, both for the country and for other regions with similar characteristics the behavior of the epidemic.
Souza Júnior, J. G. S., has completed his master of science (focus in Public Health) from Oswaldo Cruz Foundation, in Pernambuco, Ministry of Health – Brazil. He is a member of the Technical Chamber of Health Care of the Federal Nursing Council and General Coordinator of the Graduate Nucleus of Nursing of the Institute of Educational Development, Coordinator of the Post-Graduation in Hospital Infection Control Committee and Infectology of IDE/Centro Universitário Redentor.
Background HIV counseling and testing (HCT) is widely considered an integral part of HIV prevention and treatment strategies in Kenya. However, recent studies have shown that slum youth are a highly vulnerable group due to factors such as environmental (security and shelter), economic (poverty), and social (risky behavior and lack of amenities). The youth in urban slums of Kenya is a group at substantial risk for HIV infection, especially women. In this paper I examine: the correlates of access to HIV testing, whether or not a variation exists in these associations based on the context under which a person gets tested; and the motivations for getting an HIV test (or lack thereof). Methods Drawing on data collected by the Kenya National Aids Control Council (NACC) in 2013 from 6042 (51% female) youth (12-22 years) living in Mukuru and Viwandani slum settlements in Nairobi (Kenya), I explored the correlates of and motivations for HIV testing (or lack thereof) using the Health Belief Model (HBM) as a theoretical framework. HBM, a social learning theory (recently relabelled social cognitive theory) is applied in this study to problems of explaining, predicting, and influencing behavior; on self-efficacy, and locus of control with respect to motivations for HIV testing (or lack thereof). Bivariate analyses were employed to assess reasons for or against testing. Results Thirty two percent of males and 41% of females had been tested. Among the slum youth tested, 67% of males and 58% of females requested to take the most recent HIV test while 31% of males and 43% of females reported that their most recent HIV test was mandatory (they were required to take the test). About 70% of sexually active females gave the reason for taking an received an HIV test as pregnancy. My findings pointed towards perceived risk for HIV infection as a possible motivation to HIV testing among the slum youth. For instance, more than half of the sexually active slum youth who had never been tested for HIV reported that they had not been tested because they believed they were not at risk. Conclusions Testing services such as Voluntary Testing Centres and other targeted interventions may help young people to accurately assess their HIV infection risk levels while also increasing awareness of the potential value of HIV testing, which may in turn, enhance the motivation to use HIV testing services. Mainstreaming of the policy on Prevention of Mother-to-Child Transmission (PMTCT) services has helped increase (mandatory) HIV testing rates among females. HIV Testing provider-initiated routine testing and counseling among all clients visiting medical facilities may provide an important avenue to increase HIV status awareness among the general population and especially among male slum youth. Keywords Social Learning Theory and the Health Belief Model PMTCT Service Kenya AIDS Indicator Survey National Aids Control Council Urban Slum Settlement
Purity Cathleen Nyawira has worked with Women Fighting AIDS in Kenya (WOFAK) since 2013. WOFAK is a national non-profit that strives to contribute significantly to national efforts aimed at prevention and to provide comprehensive care and support to women and children living with and affected by HIV and AIDS to enable them lead more wholesome lives. Wanyoike supports community based research and implementation of the HIV management activities in Mukuru and Viwandani slum settlements in Nairobi Nairobi county of Kenya. She also undertakes community mobilization, education and sensitization sessions, and dissemination of health information and materials.