|A Multilevel Analysis of the Determinants of HIV Testing in Zimbabwe: Evidence from the Demographic and Health Surveys|
||Martin Marufu Gazimbi, and Monica Akinyi Magadi
||HIV/AIDS Research and Treatment, 4(1): 14-31. doi: 10.17140/HARTOJ-4-124
||Introduction: Zimbabwe is still burdened with HIV epidemic and the government has an ambitious
aim in the post-2015 era to end the AIDS epidemic by 2030. To achieve this, the government
has set up the 90-90-90 strategic milestones to be achieved by 2020. It is a daunting task
to increase HIV testing uptake from the current estimate of 56% to 90% to meet these targets.
The current government’s initiative requires an understanding of determinants of HIV testing.
Objectives: The specific objectives of this study are to: (i) identify the individual and communitylevel
determinants of HIV testing, focussing on predisposing, enabling and perceived need
factors (PREP); and (ii) establish gender differences.
Materials and Methods: We applied multilevel logistic regression models to nationally-representative
samples of 17,797 women and 14,587 men from the 2005/2006 and 2010/2011 Zimbabwe
Demographic and Health Surveys (ZDHS) to examine the determinants of HIV testing.
Results: HIV testing uptake increased significantly between 2005/2006 and 2010/2011, especially
for women (females OR=5.60; males OR=2.57). Most PREP factors associated with HIV
testing are largely consistent with patterns in Southern Africa (e.g., higher uptake by women
and those who are wealthier), but unique patterns have also emerged. In particular, results
reveal important gender differences: rural residence is associated with lower uptake of HIV
testing for women (OR=0.74) but higher for men (OR=1.16); community wealth is a more
important factor in enabling HIV testing than household wealth for women, but the converse is
true for men; and individual-level, rather than community-level stigma is important for women,
while for men, it is community-level stigma that is important.
Conclusion: Observed gender disparities in determinants of HIV testing calls for gender specific
response. Couple-oriented HIV counselling and testing services where men accompany
their spouse to HIV screening during pregnancy may help increase HIV testing uptake for
males and reduce gender disparities.
KEY WORDS: HIV testing; Community-level determinants; Gender disparity; Multilevel analysis;
Zimbabwe demographic and health surveys (ZDHS).