With evidence on the benefits of the early diagnosis of HIV and the initiation of antiretroviral therapy (ART) mounting, HIV testing is a primary entry point for the prevention of HIV transmission. In sub-Saharan Africa, the scale-up of affordable and readily available HIV testing and treatment has allowed the region to make notable progress in the prevention of HIV/AIDS. UNAIDS has recently proposed a set of ambitious targets that, if achieved, are predicted to end the AIDS epidemic by 2030. The targets, known as 90-90-90, call for 90 percent of all people living with HIV (PLHIV) to know their status, 90 percent of those to receive antiretroviral therapy (ART), and 90 percent of ART recipients to achieve viral suppression.
This report focuses on the “first 90” in the 90-90-90 target, and seeks to answer four main questions. First, how does testing uptake vary by serological status, sex, and country? Second, what proportion of PLHIV are estimated to know their status, and how does this vary by sex, country, timing of the survey, and size of the epidemic? Third, what is the role of maternal care in HIV testing uptake among HIV-positive women? And fourth, what background and behavioral characteristics are associated with ever being tested for HIV among PLHIV?
This report analyzes data from Demographic and Health Surveys and AIDS Indicator Surveys fielded since 2006 in 15 sub-Saharan African countries where voluntary serological testing was conducted: Cameroon, Congo (Brazzaville), Ethiopia, Gabon, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. In the countries studied, we find that between 23 percent and 71 percent of PLHIV are estimated to know their status; on average across countries, after adjusting for ART coverage, 51 percent of PLHIV are estimated to know their status. The results reflect encouraging progress, but the achievement is far short of the 90 percent goal set by UNAIDS for 2020. Several gaps in HIV testing coverage still exist, particularly among adolescents, rural residents, and the poorest. While the need continues to target demographic groups at greatest risk of HIV, additional interventions focused on reaching the most socially vulnerable populations are essential.