Determinants of Voluntary HIV Counseling and Testing: A Tiered Model of the Ethiopian Demographic and Health Survey | BMC Women’s Health
In developing the current National Strategic HIV Plan, the Ethiopian government set itself the global goal of achieving the 90-90-90 goals by stepping up targeted HIV testing and counseling services, practically eliminating MTCT, optimizing the quality of care, and maintain and treatment . This study uses a nationally representative cross-sectional sample of women to examine the individual and community determinants that influence the acceptance of VCT among women of childbearing age in Ethiopia. Therefore, the results of this study indicate that several determinants at the individual and community levels are associated with women of childbearing age receiving VCT.
In this study, VCT uptake was high among unmarried women compared to unmarried women. This finding is in line with other studies carried out in Ethiopia [18, 25]. The high rate of testing in married women could be due to the majority of women believing that VCT is useful in preparation for marriage , and after marriage, women are more likely to visit the health facilities for perinatal services that are available in most health facilities, including VCT.
Women aged 35 years or older and 25–34 years of age were most likely to be tested. The results of this survey are in line with other studies, suggesting that VCT uptake varies with age [18, 19, 22, 23, 25, 26, 28]. Previous documented studies of HIV / AIDS awareness and knowledge in women of childbearing potential showed that the likelihood of increased awareness and knowledge of HIV / AIDS increases with age, which could increase VCT uptake . This is likely due to the fact that the fear of stigma and discrimination by society towards ingesting VCT was less common among older people than among younger age groups .
We found that VCT use increased with educational levels and family wealth. This finding relates to other studies elsewhere, in which women with a higher level of education [1, 20,21,22,23,24] and higher family wealth [18, 19, 22,23,24] have a higher chance of getting HIV tests. This finding underscores the importance of education and higher wealth in the growth of HIV testing and counseling. Possible reasons could be the increased awareness and knowledge of HIV among educated women and women from the wealthiest households . This association was likely also due to the fact that women with higher incomes and higher levels of education were more likely to use maternal health services that have women’s autonomy and are close to information [32, 33]. Another possible rationale could be that in this study, most women from the wealthiest families (91%) and more educated (94%) had ≥ 4 ANC follow-ups, which may increase VCT. However, the current study contradicts a study carried out in China that shows a negative association between income and VCT utilization . This disagreement could be due to the different instruments used to measure the wealth index, where the DHS program used principal component analysis to calculate the wealth index (a composite measure of a household’s cumulative standard of living) while in the previous study the monthly one Income was used.
As previously documented, we observed that women with a thorough knowledge of HIV were more likely to have VCT. receive [18, 21, 23,24,25,26, 28, 34]. One possible explanation is that knowledgeable women are aware of the benefits of having an HIV test. This finding suggests that the discussion about HIV increases the acceptance of HIV testing; Therefore, a dialogue on this issue and the prevention of stigma are essential [35, 36].
VCT uptake was higher in those with risky sexual behavior. This was in line with studies done in different countries [18, 19, 22, 24, 26]. This is because women with risky sexual behavior have fear and uncertainty about their serostatus, which leads to them being tested for HIV than those without risky sexual behavior.
Consistent with previous studies in Ethiopia [18, 19, 22], Nigeria , Malawi  and china , this study found that women who had a stigma against PLWHA had decreased VCT uptake. This association could possibly be due to the cultural and moral values associated with sexual orientation that greatly determine people’s attitudes towards PLWHA. Individuals infected with HIV are perceived as socially disapproved premarital or extramarital sexual affairs that could lead to the misconception of HIV testing due to fear of the negative consequences of social disapproval .
This study also assesses the association between community level determinants and VCT uptake. Our result showed that VCT use was higher among women who lived in communities where the proportion of respondents were more educated than the median and where women were from more affluent communities, which is consistent with results from an in Burkina Faso study concurs . This study also suggests that women living in communities with high HIV knowledge are more likely to be tested for HIV, that is, living in communities where HIV is actively treated appears to have a strong impact on willingness to test . This compares with previous literature suggesting that involvement of individuals in community group discussions about HIV had increased the likelihood of VCT ingestion compared to those who did not . One study has shown that community features / interventions are very effective in increasing the use of preventive measures .
Strength and Limitations of the Study
The main strength of this study is the use of nationally representative data collected with standardized and validated data collection tools. In addition, a high-level model (multilevel analysis) was used, which takes into account the relevance of EDHS data in the determination of estimates. However, our study is without restrictions. Due to the secondary nature of the data, factors such as treatment availability, occupational factors and support programs were not included in the analysis.