XIX International AIDS Conference


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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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