Response to population -based voluntary counseling and testing for HIV in rural Malawi

This study examines three major aspects of response to population-based voluntary counseling and testing (VCT) for HIV (one of the strategies to stem the spread of the epidemic in sub-Saharan Africa) in rural Malawi. It uses longitudinal HIV survey data collected (in 2004 and 2006) from three sites in the country. The first aspect is a cross-sectional and longitudinal assessment of the effect of non-response to VCT on the HIV prevalence estimates and on the estimates of the relationships of the risk factors associated with the epidemic. Descriptive and sample selection analyses show that similar to existing studies, non-response did not exert significant bias in the cross-sectional estimates of HIV prevalence and of the risk factors associated with HIV/AIDS infection. It, however, did exert significant bias in the estimates for longitudinal participants. The second aspect involves examining whether the sex of the nurse or VCT counselor, informal indicators of HIV prevalence, and the study protocol were associated with participation in initial testing and obtaining the test results. The results show that: (i) informal indicators of HIV prevalence were significantly associated with the likelihood of participation in initial testing but not of obtaining the test results, and (ii) the chances of obtaining the test results were significantly higher under home-based than under clinic-based VCT for HIV. The final aspect is an examination of the reported vis-à-vis actual demand for VCT services with three important findings. First, there was no significant difference in the proportion of individuals who participated in the VCT program by whether they reported in the survey that they would or would not participate in such a program. Second, there was no systematic indication that the lowest proportion of individuals who obtained their test results were those who were at high risk of HIV infection which would be the case if there was reluctance to participate in VCT programs due to fear of knowing HIV status. Third, there were increased chances of reporting a demand for obtaining the test results and reduced chances of showing discrepancy between reported and actual demand for the same over time