Attitudes towards HIV Testing and Treatment
It is not always true that higher educational attainment automatically translates into better
knowledge on all subjects. However, it is true that as one advances in education, they are
likely to have more and better knowledge about a specific subject such as the HIV epidemic.
Therefore, the study cannot purport to have measured the participants’ knowledge on the HIV
and AIDS merely by inquiring into their educational attainment. This study assumed that the
participants had adequate and accurate knowledge on the HIV pandemic and that they were
acutely aware of the transmission pathways, and the risks involved in engaging in unsafe
sexual behaviours. This was based primarily on prior research which had established that the
general population in Kenya had a high knowledge of HIV/AIDS (NACC, 2014). The study
demanded either the making of the assumption or a determination of the participants’ HIV
knowledge level since attitudes are more often influenced by the amount of accurate
knowledge one has on a subject. The knowledge as well as the attitudes held by an individual
about or towards certain behaviours influences them to behave in particular ways. Therefore,
being aware of the level of knowledge and attitudes held by the general population provides
an understanding of what may motivate individuals to agree to abandon behaviours that are
risky and adopt safe ones.
To investigate the participants’ attitude towards HIV testing and treatment, the study asked
participants to indicate their willingness to test for HIV and start treatment. The number of
responses for each variable investigated varied per the participants’ demographic
characteristics. Table summarizes the number of participants that responded to the two
issues based on the demographic characteristics. Table Willingness to Test and Treatment
HIV
Willingness to
Variable
Test % Treat %
Age 353
96.4
349 95.4
Gender 354
96.7
350 95.6
Marital Status 353
96.4
349 95.4
Education Level 352
96.2
348 95.1
Income Level 307
83.9
307 83.9
Table 4.19 shows that responses varied between 307 and 354 for Willingness to test for
HIV while they varied between 307 and 350 for willingness to start treatment. Results of
this study show that the best predictor of Willingness to test and start treatment for HIV
was gender while the worst predictor of Willingness to test and start treatment for HIV
was the level of income. Further, Table 4.20 provides tabulated responses of participants
measured on the basis of age, gender, marital status, level of education, and income.
Table Demographic Characteristics versus Test & Treatment Willingness
Demographic Responses Testing Attitudes Treatment
Variables
Variables No. N (%) N (%)
Below 24 172 166 (96.5) 163 (94.8)
Age Between 24 & 49 176 171 (97.2) 171 (97.2)
Over 49 16
16
(100) 15 (93.8)
Male 154 150 (97.4) 146 (94.8)
Gender
Female 211 204 (96.7) 204 (96.7)
Single 184 178(96.7) 172(93.5)
Marital Status Married 166 161(97.0) 163(98.2)
Widow/ Divorced 14
14
(100) 14(100)
Primary 21
20
(95.2) 21(100)
Education Level Secondary 130 129 (99.2) 125(96.2)
Post-Secondary 212 198 (93.4) 199(93.9)
Below Kshs. 24,000 206 198(96.1) 199(96.6)
Income Kshs. 24,000 – 99,000 97
95
(97.9) 95 (97.9)
Over Kshs. 99,000 14
14
(100) 13 (92.9)
Table 4.20 shows that the more advanced in age individuals became, the more
favourable attitudes they developed towards both testing and treatment for HIV. For
example, 96.5% of those aged below 24 years held favourable attitudes towards testing
for HIV compared to 97.2% of those aged between 24 and 49 years. However, all
(100%) of those aged over 49 years indicated having a Willingness to test for HIV.
Therefore, age is a good predictor of the likelihood of testing for HIV. Despite being
consistent with some former studies (Mooi, Van Der Maas & De Melker, 2014), this
finding, however, is inconsistent with other past studies which held the view that
persons advanced in age are less likely to test for HIV (Maina et al., 2014; NASCOP,
2009). The likely explanation for this difference could be due to the mean age of the
participants in the sample that was biased towards a younger population.
Despite testing for HIV being clearly the first step towards prevention and provision of
appropriate care and treatment (Gardner et al., 2011), there are many factors that influence
willingness associated with testing for HIV including perceived risk of contracting HIV such
as engaging in sex with CSWs (Wang et al., 2009). However, AIDS related fear and stigma
are reportedly major barriers to testing for HIV (Kalichman, et al., 2010).
The trend regarding attitudes towards treatment according to the study data is unclear.
Majority of the participants in all age categories held favourable attitudes towards HIV
treatment. In particular, about 95 % of the under 24s held favourable attitude towards
HIV treatment, compared to 97 % of those aged between 24 and 49, and only 94% of the
over 49s. Perhaps, lack of clear cut determination of this trend may be due to the bias in
the number of over 49s participants included in the study. The sample consists of too few
over 49s to make meaningful statistical determination of the trend.
Among some of the most important factors affecting decision making uptake regarding
counselling, testing, care, and treatment are HIV related stigma and discrimination (Florom-
Smith & De Santis, 2012; Low et al., 2013; Mukolo et al., 2013). Thus, the consequences of
HIV related stigma and discrimination on an individual are obvious. They include lack of
interest: to test for HIV; to seek for care and treatment; and, to enhance control and
prevention, which would otherwise improve their quality of life (Young & Bendavid, 2010).
A number of studies have recognized the necessity of educating communities on the
advantages of testing for HIV. The advantages far outweigh the disadvantages as the
consequences of not testing for HIV may imply suffering and eventually facing an early
death (Chaudoir et al., 2012; Gilbert & Walker, 2010; Pitpitan et al., 2012).
AIDS will remain a substantial problem if gender inequity is not addressed because
vulnerability to contracting HIV has been shown to increase where relationships are
dominated by gender-power inequity and Gender based violence [GBV] (UNAIDS,
2009; Decker et al., 2009). Prevalence of gender-power inequity and GBV result from
several factors. A study involving Zambian women, for example, demonstrated the
limited agency women have in sexual matters. The study found women virtually lacking
the power to either decline unsafe sexual advances or demand the use of a condom to
protect themselves. Another factor contributing to the increase in women’s vulnerability
to HIV is the age-mixing sexual pattern that encourages older men to engage in sex with
young girls (CSO, MOH, University of Zambia, & Measure Evaluation, 2010).
While majority of the studies investigating how GBV is related to HIV susceptibility
focus on gender inequity and AIDS (Jewkes, Dunkle, Nduna, & Shai, 2010; Jewkes,
Sikweyiya, Morrell, & Dunkle, 2011), few seem to have explored the impact of GBV on
access to care and treatment. More recently, studies based on clinical practice in Zambia,
have examined women who had suffered GBV. In these studies, it was shown that often
women who suffered GBV have greater odds of not seeking for care and treatment
services for fear of being abandoned by family or suffer further violence (UNIFEM,
2011; Persson et al., 2011).
Considering that some of these factors influence vulnerability and resistance to seeking
treatment and care, this study sought to investigate participants’ attitudes towards testing
for HIV. The study found no gender attitudinal differences related to HIV and AIDS
since, they were approximately balanced, (97.4 for males compared with 96.7 for
females), with a less than a percentage point in favour of men.
The process that enables majority of the infected to know their HIV status is through
testing. Available evidence shows that testing for HIV results in behavioural change
which reduces the risk of HIV infection and anxiety over the likelihood of being infected;
as well as enhance the facilitation of safe disclosure of infection status (Cremin et al.,
2010). The dangers of being ignorant about one's HIV status include continued
transmission of HIV in the community and this poses a higher risk of opportunistic
infections such as TB (Corless, & Pittman-Linderman, 2014) and cryptococcal meningitis
(Park et al., 2009), which can lead to early death.
Furthermore, the study found that more females (96.7%) than males (94.8%) held
favourable attitudes towards HIV treatment. This implies that more women than men
tend to accept treatment perhaps for the reason that men tend to have a questioning
attitude. It is from this point of view that gender inequality has been widely argued to be
one of the key drivers of HIV infection (UNAIDS, 2012). Research evidence shows that
more often gender inequalities create vulnerabilities to HIV infection that are specific for
women. As a result, studies on the role of gender in mediating HIV vulnerability have,
for important reasons, centred on how inequalities act as a barrier for women to seek care
and treatment services (Ehrhardt, Sawires, Peacock, & Weston, 2009).
Therefore, policies, programmes and donor funding that aim at examining the gender
inequality question in the context of HIV have arguably focussed more on women than
men (Higgins, Hoffman, & Dworkin, 2010). Indeed, whenever men have been
considered, it is because of their being the problem rather than being affected. Worse
still, solutions focus singly on bettering the wellbeing of women (Keeton 2007). Few
studies have focussed on the impact of HIV on men themselves, how to inculcate into
men test, care and treatment seeking behaviours or comprehending men’s health-seeking
behaviours. Perhaps, this has been described as ‘a major challenge that is poorly
recognized’ (Mills, Ford and Mugyenyi, 2009, p.276).
The other issue that the study inquired into was whether being in a marital relationship
mediates against risky behaviours. The study found that majority (96.7%) of those not in
a marital relationship (singles) held favourable attitudes towards HIV testing, but fewer
(93.5%) indicated a willingness to start treatment if they ever tested positive for HIV.
Likewise, the majority (97%) of the married held favourable attitudes towards testing,
however, an even higher number (98.2%) indicated a willingness to start treatment if they
ever tested positive for HIV. Lastly, all (100%) widows and divorcees held favourable
attitude towards both testing and willingness to start treatment. Although a majority of
the un-married would prefer knowing about their HIV status, less were willing to face the
prospect of starting treatment probably due to stigma, the fear of discrimination and
desertion by peers, especially if results of the test and treatment would be made public.
Whereas HIV testing serves as the gateway to seeking treatment, care, and prevention, its
uptake in the SSA region is very low and painfully slow. For example, by 2015;
approximately 60% of the people infected with HIV had known their status. But, of that
125
number, men accounted for only 30%. Consequently, men are less likely to test for HIV
putting them at higher risk of early death due to lack of treatment (WHO, 2016). The
findings of this study agree with available studies that there is a wide disparity between
willingness to test per se and actually testing for HIV. For example, a study of 554
respondents selected from a community in Ghana, found that while 83.8% of the
respondents were willing to test for HIV, only 45.8% actually tested for HIV (Yawson et
al., 2014).
Factors associated with favourable response to HIV screening include confidentiality,
presentation of VCT as routine rather than an option, and perceived high risk. However,
often willingness fails to translate to testing for HIV largely due to stigmatization. In
addition, lacking awareness of the VCT services; the fear of being stigmatized and
discriminated; the notion that HIV/AIDS is incurable and therefore pointless to test for
HIV; the fear of coping with the results if the test turns positive; high HIV risk
perception, divorce, and isolation have been identified as the main barriers to the uptake
of VCT (Apanga, Akparibo, & Awoonor-Williams., 2015; Meshesha, 2014). Other
factors influencing the uptake of HIV testing include the HIV/AIDS-related knowledge,
risk perception and practice of confidentiality in handling test results or counselling
among patients (Sekoni, Aderibgibe, & Akande, 2014).
Another issue that the study explored was whether the level of formal education improves the
attitudes held towards HIV testing and treatment. Arising out of the analysis, the study
observed that 95.2% of those educated to primary level of education held favourable attitudes
towards HIV testing while all (100%) participants held a favourable attitude towards HIV
treatment. For those educated to secondary school level, virtually all of them (99.2%) held
favourable attitudes towards HIV testing compared with 96.2% with favourable attitudes
towards HIV treatment. Finally, 93.4% of the post-secondary graduates held favourable
attitude towards HIV testing and roughly a similar number (93.9%), held favourable
attitudes towards HIV treatment.
These results concur with findings by prior studies. For example, a study conducted in Kenya
revealed that accepting to test for HIV is associated with individual-level factors, such as age,
and educational attainment (Byamugisha, Tumwine, Semiyaga, & Tylleskär, 2010). Also,
participants with higher formal educational attainment were more likely than those with low
formal educational attainment to have adequate HIV/AIDS knowledge (Lliyasu, Abubakar,
Kabir, & Aliyu, 2006). Evidence accumulated from research shows that higher educational
attainment correlates with less vulnerability to HIV/AIDS risk-taking (Baker, Leon, &
Collins, 2010). As a result, this makes education a critical tool in the war against the
epidemic. Although currently, AIDS is incurable, but, it is manageable. It is against this
background that the World Bank takes the view that education could possibly be the only
substitute vaccine accessible to humans. Accordingly, UNICEF remains adamant in holding
the view that for now, education remains the only valuable tool for controlling HIV/AIDS
until a more effective remedy is found (WFP, 2013).
To underscore the importance of education and its correlates, Mondal, Rahmanm, Rahman,
& Akter, (2012) assessed the knowledge and awareness of 10,996 women aged between
15 and 49 years against factors enhancing both control and prevention of HIV. The results
showed that there were statistically significant correlations between the educational
attainments of the participants and their partners against the level of their HIV/AIDS
knowledge and awareness. This is perhaps why the World Bank is committed to ensuring
that the education of children is accorded the highest priority in a world troubled,
devastated, and overwhelmed by the pandemic (World Bank, 2013).
Such a conviction is grounded in good quality education being ranked among the most
successive and cost-effective approaches for combating the scourge. In sum, educational
attainment correlates positively with knowledge and awareness of HIV/AIDS. In other
words, the more-educated one is (level), the greater the odds for advancing knowledge
and awareness of the HIV pandemic. Furthermore, this may not be all as there are
chances that such knowledge can be the basis for changing behaviour.
One other factor that is likely to mediate participants' attitude towards testing and starting
treatment for HIV is perhaps level of income. The study found that for those earning less than
Kshs. 24,000 per month, majority of them (96.1%) held favourable attitudes towards HIV
testing while a slightly higher proportion (96.6%) held favourable attitude towards treatment.
For those earning incomes of between Kshs. 24,001 and 99,000, virtually all of them (97.9%)
held favourable attitude towards both HIV testing and treatment. Finally, for those earning
over Kshs. 99,000; all of them held favourable attitudes toward HIV testing. However, it was
only 92.9% of them that held favourable attitudes toward HIV treatment. Poor physical
health among PLWHA is related to both quality of life and unemployment. In these
circumstances, income is an excellent predictor for health-related quality of life. Furthermore,
food uncertainty is related to treatment interruptions, poor access to treatment and HIV-
related mortality. It is an important marker of low income because the cost of HIV
medications can be a significant burden, despite the government covering fully antiretroviral
medications for now. In addition, income for many PLWHA is reduced as the associated
health problems mean either leaving paid employment or being forced to reduce working
hours.
Whereas the study found that gender and education were the best predictors of both
willingness to test and to start treatment for HIV, it found level of income being a poor
predictor. Although attitudes towards HIV testing become increasingly favourable with
increasing age, and income; attitudes towards treatment are not as favourable.
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