HIV Testing Behaviors of At-Risk Populations in Kenya

In this study, I use data from the 2002 Kenya Behavioral Surveillance Surveys to examine the factors associated with having been tested for HIV and the acquisition of test results for female sex workers, low-income women, men in worksites, and policemen. With so many of the HIV/AIDS cases residing in sub-Saharan Africa, testing and counseling should be at the forefront of policies. But broad cultural norms surrounding gender and stigma affect the HIV testing and diagnosis-seeking behaviors of members of at-risk marginalized populations. Patriarchal ideologies support differential treatment and differential access to resources between women and men, and these differences are accentuated for men and women who are part of stigmatized, high risk populations. The current project contributes to scientific research on the demographic, cultural, and social-psychological factors that condition at-risk populations’ receptivity toward and pursuit of HIV testing and serostatus (HIV status) diagnosis. In the present study, I address two related questions concerning the research gap on HIV testing among at-risk populations. First, what factors influence the decision to be tested for HIV? Second, conditional on HIV testing having occurred, which factors influence the acquisition of test results for female sex workers and men in worksites? I explore these processes with rich data on vulnerable populations with unusually high HIV infection and transmission rates, using the gendered power perspective (Connell 1987; Wingood & DiClemente 2000) and Health Belief Model (Becker 1979; Strecher & Rosenstock 1997). For the first research question – predicting having been tested for HIV – five components of the Health Belief Model and several gendered culture variables are used. Two components of the Health Belief Model are significantly associated with having been tested for female sex workers and low-income women: perceived barriers (holding a high level of myths negatively predicts having been tested for HIV) and cues-to-action (having participated in HIV education programs is positively associated with having been tested for HIV). For men in worksites, two components of the Health Belief Model are significantly associated with having been tested for HIV: perceived barriers (believing that confidential testing is not available is negatively associated with having been tested for HIV) and cues-to-action (having participated in HIV education programs is positively associated with having been tested for HIV). None of the components of Health Belief Model is significantly associated with having been bested for HIV for policemen. For all four populations, none of the gendered culture variables is significantly related to having been tested for HIV. Results point to the importance of barriers and cues-to-action for having been tested for HIV. This underscores the need for accurate education on the transmission of HIV. For the second research question – predicting having acquired HIV test results, conditional on having been previously tested – five components of the Health Belief Model and several gendered culture variables are used. Only one component of the Health Belief Model is significantly associated with having acquired the HIV test results for female sex workers: perceived barriers (believing that no confidential testing is available and having been required to be tested for HIV are negatively related to having acquired HIV test results). For men in worksites, only one component of the Health Belief Model is significantly associated with having acquired the HIV test results: perceived barriers (having been required to be tested for HIV are negatively related to having acquired HIV test results). None of the gendered culture variables are significantly associated with having acquired HIV test results for female sex workers and..