TUAC0105 - Oral Abstract
The critical role of social cohesion on uptake of HIV testing and ART in Zambia
Presented by Sara Gari (Switzerland).
S. Gari1, M. Musheke1, H. Ntalasha2, J.R.S. Malungo2, S. Merten1
1Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Basel, Switzerland, 2University of Zambia, Department of Humanities and Social Sciences, Lusaka, Zambia
Background: It has been documented that being
HIV positive put the social safety net under strain preventing people from accessing
HIV care. Yet, to date, the scope of epidemiological research on this topic
remains limited. We tested the hypothesis that family and community cohesion were
associated with uptake of HIV testing and treatment.
Methods: This research uses
data from a randomized cross-sectional study of 2443 individuals sampled in communities
and ART clinics in rural and urban Zambia. Associations were examined using a
two step multivariable logistic regression approach. Initially independent
thematic models, adjusted for sociodemographic variables, were created to
examine the effect of social support, stigma, poverty and beliefs. Variables
with p< 0.2 in the thematic models were included in a comprehensive
multivariable model for each outcome.
Results: 978 participants (53% women and
44% men) in the community reported to be tested for HIV. A total of 691,
including those attending the clinics, reported to be on ART (64% women and 36%
men). In the final comprehensive models, adjusted for all covariates, the risk
of not being tested was associated with poor community engagement (OR= 1.5 95%
CI= 1.12-1.91), low attendance of religious services (OR= 1.3 95% CI=
1.08-1.47), problems with the neighbors (OR= 1.2 95% CI= 1.06-1.32) and living
in urban areas (OR= 2.8 95% CI= 2.06-3.61). Protective factors were being women
and married. The strongest predictors for non-uptake of ARVs were domestic
violence (OR= 1.3 95% CI=1.04-1.65) and trust in traditional medicines (OR= 1.8
95% CI= 1.33-.2.47). Being widowed or divorced showed a statistically
significant protective effect. Anticipated social stigma (OR=1.2 95% CI=
1.08-1.36) was a significant risk factor for testing in the thematic model but
the effect did not hold when adjusted to all covariates. Stigma was not associated
with uptake of ARVs.
Conclusions: Community engagement and community cohesion were important predictors
for uptake of HIV testing while family cohesion and trust in traditional
medicines played a bigger role for treatment initiation. Targeted community programs
to improve social cohesion on community and family levels can play a critical
role in increasing access to HIV/AIDS services.
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