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BACKGROUND

The critical role of social cohesion on uptake of HIV testing and ART in Zambia Swiss Tropical and Public Health Institute University of Zambia. BACKGROUND. >14% HIV prevalence among adults 15-49 Despite free access to HIV related services:

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BACKGROUND

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  1. The critical role of social cohesion on uptake of HIV testing and ART in ZambiaSwiss Tropical and Public Health InstituteUniversity of Zambia

  2. BACKGROUND • >14% HIV prevalence among adults 15-49 • Despite free access to HIV related services: • only 35% of women and 20% of men have been tested and received their results; • up to one third treated with ARVs dropped out of the programs. • Reasons? • health system constraints, poverty, gender inequality, stigma, beliefs… • dynamics of decision-making?

  3. METHOD Ethnographicstudy Systematicreview Cross sectional study (part of a larger mixed-method study) QUESTIONNAIRE SD, SES, FS, K&B, STG, Healthriskbehav. , Socialrelationships SURVEY Randomcommunity sample NestedFacility-based sample

  4. STUDYPOPULATION • Foursites • urban : LUSAKA and MAZABUKA • rural: MBEZA and CHIVUNA • Inclusion criteria • being over the age of 18 • living in the area for at least six months • Exclusion criteria • having participated in the community-based survey

  5. STATISTICAL ANALYSIS • Scales • Mokken Scale analysis for polytomous items, implemented in STATA modules mspand Loevh(Non-parametric IRT) • Estimated effects : • Logistic regression analysis • 3 steps: univariable – focal models – multivariable • Retention in model if P-value<0.02

  6. RESPONDENTS’ CHARACTERISTICS

  7. Top 10 reasons for not testing

  8. Top 10 reasons for not initiating ART

  9. Risk of not testing *significant, p=0,005 1 combines "people in this neighbourhood don't get along with each other; People around here are willing to help their neighbours".

  10. Risk of not initiating ART *significant, p=0,005. 1 combines "in times of crisis I can turn to my spouse/partner for support; My spouse/partner and I get along well together; I trust my partner; Feel supported by people of my household". 2 combines "if someone in the household misuses money it is acceptable to beat him/her; In my household if a wife comes home late without the permission of the husband she will be beaten". 3 combines "traditional medicine better relieves symptoms compared to ARV’s; traditional medicine cures; is easier to apply; easier to access; HIV may be caused by witchcraft; ARV’s are against black people; African people used as guinea pigs".

  11. Conclusions • Less cohesive communitiesput individuals at higher risk of non-accessing HIV services. • For the initiation of ART, family cohesion and trust in traditional medicines play a bigger role. • Not only enacted violence adds to the burden of HIV but its tolerance within families also jeopardizes access to treatment. • LIMITATIONS • design does not allow establishing a temporal relationship; • self reported rates (recall bias).

  12. Recommendations • Interventions should target community and family in addition to individual and/or couple. • Promote community participation and collective action. • (Acknowledgetraditional relationship systems) • For future research longitudinal studies need to clarify the causal links between social cohesion and HIV testing and to confirm replicability in other contexts.

  13. Acknowledgments • Wesincerelythankthecontribution of: • Respondentswhosharedtheir time withus • Collaborators: Virginia Bond (Zambia AIDS Related Tuberculosis, Lusaka, Zambia) • We gratefully acknowledge the support of: • Local authorities and the Ministry of Health, Zambia • SNSF, AECID

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