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Canadian Journal of Public Health

, Volume 106, Issue 2, pp e4–e9 | Cite as

Individual and jurisdictional factors associated with voluntary HIV testing in Canada: Results of a national survey, 2011

  • Catherine A. WorthingtonEmail author
  • Liviana M. Calzavara
  • Samantha J. White
  • Dan Allman
  • Mark W. Tyndall
Quantitative Research

Abstract

r

HIV testing remains a central strategy for HIV prevention for its ability to link those who test positive to treatment and support. In Canada, national guidelines have recently changed as part of standard primary care to recommend voluntary HIV testing for those aged 16–64 years. Using results from a nationally representative survey, we examined individual and jurisdictional factors associated with voluntary testing.

Methods

A total of 2,139 participants were sampled using a regionally stratified, two-stage recruitment process. English or French interviews (by phone or online) were conducted during May 2011. Voluntary testing was defined as testing at least once for reasons other than blood donation, insurance purposes, immigration screening or research participation. Weighted logistic regression analysis (including socio-demographic, sexual activity, HIV/AIDS knowledge and jurisdictional factors of HIV prevalence and anonymous testing availability) were conducted for the overall sample, and stratified by sex.

Results

Twenty-nine percent (29%) of survey participants reported at least one lifetime voluntary HIV test. For the full-sample model, the following were associated with increased odds of testing: age <60 years, female sex, sexual minority status, perceived HIV knowledge, casual sex partner in previous year, and living in a higher-prevalence jurisdiction. For men, the strongest factor related to testing was sexual minority status (OR = 5.15, p < 0.001); for women, it was having a casual sex partner in the previous year (OR = 2.57, p = 0.001). For both men and women, residing in a jurisdiction with lower HIV prevalence decreased odds of testing.

Discussion

Sex differences should be considered when designing interventions to increase testing uptake. Jurisdictional factors, including HIV prevalence and testing modality, should be investigated further.

Key Words

HIV testing anonymous testing Canada 

Résumé

Objectif

Le dépistage du VIH demeure une stratégie centrale en matière de prévention du virus, car il permet d’aiguiller les personnes séropositives vers les traitements et le soutien disponibles. Au Canada, les lignes directrices nationales ont changé récemment dans le cadre des soins primaires normalisés, et l’on recommandemaintenant le dépistage volontaire du VIH pour les 16 à 64 ans. À l’aide des résultats d’une enquête représentative nationale, nous avons examiné les facteurs individuels et les facteurs liés à la région administrative associés au dépistage volontaire.

Méthodes

En tout, 2 139 participants ont été échantillonnés selon un processus de recrutement en deux étapes, stratifié selon la région. Des entretiens en anglais ou en français (par téléphone ou en ligne) ont été menés en mai 2011. Le dépistage volontaire était défini comme étant un dépistage au moins une fois pour une raison autre que pour donner du sang, à des fins d’assurance ou de contrôle des immigrants ou pour participer à une étude de recherche. Des analyses de régression logistique pondérées (incluant les facteurs sociodémographiques, d’activité sexuelle, de connaissance du VIH et du sida et les facteurs de prévalence du VIH et de disponibilité du dépistage anonyme selon la région administrative) ont été menées pour l’échantillon global, puis stratifiées selon le sexe.

Résultats

Vingt-neuf p. cent (29 %) des participants de l’enquête ont déclaré avoir subi au moins un dépistage volontaire du VIH au cours de leur vie. Pour le modèle utilisant l’échantillon entier, les facteurs suivants ont été associés à une probabilité de dépistage accrue: l’âge <60 ans, le sexe féminin, le statut de minorité sexuelle, les connaissances perçues du VIH, une ou un partenaire sexuel occasionnel au cours de l’année antérieure et le fait de vivre dans une région administrative à prévalence élevée de VIH. Chez les hommes, le facteur le plus fortement lié au dépistage était le statut de minorité sexuelle (RC = 5,15, p < 0,001); chez les femmes, c’était d’avoir eu une ou un partenaire sexuel occasionnel au cours de l’année antérieure (RC = 2,57, p = 0,001). Chez les deux sexes, le fait de vivre dans une région administrative où la prévalence du VIH était plus faible réduisait la probabilité du dépistage.

Discussion

RÉSULTATS: Il faudrait tenir compte des différences entre les sexes lorsqu’on conçoit des interventions pour accroître le recours au dépistage. Les facteurs comme la prévalence du VIH et les modalités de dépistage dans la région administrative devraient faire l’objet d’études plus poussées.

Mots Clés

VIH dépistage dépistage anonyme Canada 

References

  1. 1.
    Public Health Agency of Canada. Summary: Estimates of HIV prevalence and incidence in Canada, 2011, 2012. Available at: https://doi.org/www.catie.ca/sites/ default/files/Estimates-of-HIV-Prevalence-and-Incidence-in-Canada-2011.pdf (Accessed September 20, 2014).Google Scholar
  2. 2.
    Sabin CA, Lundgren, JD. The natural history of HIV infection. Curr Opin HIV AIDS 2013;8(4):311–17.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE, Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recommendations and Reports / Centers for Disease Control 2006;55(14):1.Google Scholar
  4. 4.
    DeMarco RF, Gallagher D, Bradley-Springer L, Jones SG, Visk J. Recommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions. Nurs Outlook 2012;60(2):72–80. doi: 10.1016/j.outlook.2011.06.002.CrossRefGoogle Scholar
  5. 5.
    British Columbia Office of the Provincial Health Officer. HIV testing guidelines for the province of British Columbia, 2014. Available at: https://doi.org/www.bccdc.ca/NR/rdonlyres/B35EDEBD-98CA-48BB-AB7C-B18A357AC19D/0/ HIV_GUIDE_051114.pdf (Accessed September 20, 2014).Google Scholar
  6. 6.
    Thornton AC, Delpech V, Kall MM, Nardone A. HIV testing in community settings in resource-rich countries: A systematic review of the evidence. HIV Med 2012;13(7):416–26. doi: 10.1111/j.1468-1293.2012.00992.x.CrossRefGoogle Scholar
  7. 7.
    Public Health Agency of Canada. HIV screening and testing guide, 2013. Available at: https://doi.org/www.phac-aspc.gc.ca/aids-sida/guide/hivstg-vihgdd-eng. php (Accessed June 9, 2014).Google Scholar
  8. 8.
    Houston S, Archibald CP, Strike C, Sutherland D. Factors associated with HIV testing among Canadians: Results of a population-based survey. Int J STD AIDS 1998;9(6):341. doi: 10.1258/0956462981922377.CrossRefGoogle Scholar
  9. 9.
    EKOS Research Associates Inc. 2012 HIV/AIDS attitudinal tracking survey: Final report (prepared for Public Health Agency of Canada), 2012. Available at: https://doi.org/www.ekos.com/admin/articles/038-12.pdf (Accessed September 20, 2014).Google Scholar
  10. 10.
    Kaai S, Bullock S, Burchell AN, Major C. Factors that affect HIV testing and counseling services among heterosexuals in Canada and the United Kingdom: An integrated review. Patient Educ Couns 2012;88(1):4. doi: 10.1016/j. pec.2011.11.011.CrossRefGoogle Scholar
  11. 11.
    Choudri Y, Cule S. Factors associated with testing for HIV among females and males in Canada. Can J Infect Dis Med Microbiol 2006;17(Supplement A):42A.Google Scholar
  12. 12.
    Choudri Y. Patterns in factors associated with testing for HIV among the general population in Canada in the last decade. AIDS 2008- XVII International AIDS Conference: Abstract, no. TUPE0472.Google Scholar
  13. 13.
    Du P, Camacho F, Zurlo J, Lengerich, EJ. Human immunodeficiency virus testing behaviors among US adults: The roles of individual factors, legislative status, and public health resources. Sex Transm Dis 2011;38(9): 858–64.CrossRefGoogle Scholar
  14. 14.
    Centre for Inner City Research, St. Michael’s Hospital. An evaluation of HIV testing and counselling practices in Ontario, 2010. Available at: https://doi.org/www.stmichaelshospital.com/crich/wp-content/uploads/Ontario-HIV-testing- counseling-evaluation-2010-final-report.pdf (Accessed September 20, 2014).Google Scholar
  15. 15.
    Kassler WJ, Meriwether RA, Klimko TB, Peterman TA, Zaidi A. Eliminating access to anonymous HIV antibody testing in North Carolina: Effects on HIV testing and partner notification. J Acq Imm Def Synd Human Retrovirol: Official Publication of the International Retrovirology Association 1997; 14(3):281. doi: 10.1097/00042560-199703010-00013.CrossRefGoogle Scholar
  16. 16.
    Hertz-Picciotto I, Lee LW, Hoyo C. HIV test-seeking before and after the restriction of anonymous testing in North Carolina. Am J Public Health 1996;86(10):1446–50. doi: 10.2105/AJPH.86.10.1446.CrossRefGoogle Scholar
  17. 17.
    Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance report to December 31, 2012. Surveillance and Epidemiology Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2013. Available at: https://doi.org/www.catie.ca/sites/default/ files/HIV-AIDS-Surveillence-in-Canada-2012-EN-FINAL.pdf (Accessed September 20, 2014).Google Scholar
  18. 18.
    Public Health Agency of Canada. HIV/AIDS epi updates, Chapter 7 Perinatal HIV transmission in Canada. Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2010. Available at: https://doi.org/www.phac-aspc.gc.ca/aids-sida/ publication/epi/2010/index-eng.php (Accessed September 20, 2014).Google Scholar
  19. 19.
    International Labour Organization, World Health Organization. Joint ILO/ WHO guidelines on health services and HIV/AIDS. 2005. Available at: https://doi.org/www.whqlibdoc.who.int/publications/2005/9221175537_eng.pdf (Accessed September 20, 2014).Google Scholar
  20. 20.
    World Health Organization, Joint United Nations Programme on HIV/AIDS. Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva, Switzerland: World Health Organization, 2007. Available at: https://doi.org/www.unicef.org/aids/files/PITCGuidance2007_Eng.pdf (Accessed September 20, 2014).Google Scholar
  21. 21.
    Public Health Agency of Canada. HIV/AIDS epi updates, Chapter 3 HIV Testing and Surveillance Systems in Canada. Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2010. Available at: https://doi.org/www.phac-aspc.gc.ca/aids-sida/publication/epi/2010/index-eng.php (Accessed September 20, 2014).Google Scholar
  22. 22.
    Yeager DS, Krosnick JA, Chang L, Javitz HS, Levendusky MS, Simpser A, Wang R. Comparing the accuracy of RDD telephone surveys and internet surveys conducted with probability and non-probability samples. Public Opin Q 2011;75(4):709–47. doi: 10.1093/poq/nfr020.CrossRefGoogle Scholar
  23. 23.
    DiSogra C, Callegaro M, Hendarwan E. Recruiting probability-based web panel members using an address-based sample frame: Results from a pilot study conducted by knowledge networks, 2009. Available at: https://doi.org/www.knowledgenetworks.com/ganp/docs/jsm2009/abs_jsm_2009_submitted.pdfGoogle Scholar
  24. 24.
    Waxman MJ, Merchant RC, Celada MT, Clark, MA. Perspectives on the ethical concerns and justifications of the 2006 Centers for Disease Control and Prevention HIV testing recommendations. BMC Med Ethics 2011; 12(1):24. doi: 10.1080/15265161.2011.560339.CrossRefGoogle Scholar
  25. 25.
    Canadian HIV/AIDS Legal Network. Shifting HIV testing policies. Fact Sheet, 2007. Available at: https://doi.org/www.aidslaw.ca/publications/publicationsdocEN. php?ref=713 (Accessed September 20, 2014).Google Scholar

Copyright information

© The Canadian Public Health Association 2015

Authors and Affiliations

  • Catherine A. Worthington
    • 1
    • 2
    Email author
  • Liviana M. Calzavara
    • 2
    • 3
  • Samantha J. White
    • 2
    • 3
  • Dan Allman
    • 2
    • 3
  • Mark W. Tyndall
    • 2
    • 4
    • 5
  1. 1.Public Health and Social PolicyUniversity of VictoriaVictoriaCanada
  2. 2.The CIHR Social Research Centre in HIV PreventionTorontoCanada
  3. 3.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  4. 4.Division of Infectious DiseasesThe Ottawa HospitalOttawaCanada
  5. 5.Department of MedicineUniversity of OttawaOttawaCanada

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