Effect of home-based HIV counselling and testing on stigma and risky sexual behaviours: serial cross-sectional studies in Uganda.

BACKGROUND: A large, district-wide, home-based HIV counselling and testing (HBHCT) programme was implemented in Bushenyi district of Uganda from 2004 to 2007. This programme provided free HBHCT services to all consenting adults of Bushenyi district and had a very high uptake and acceptability. We measured population-level changes in knowledge of HIV status, stigma and HIV-risk behaviours before and after HBHCT to assess whether widespread HBHCT had an effect on trends of risky sexual behaviours and on stigma and discrimination towards HIV. METHODS: Serial cross-sectional surveys were carried out before and after the implementation of HBHCT programme in Bushenyi district of Uganda. A total of 1402 randomly selected adults (18 to 49 years) were interviewed in the baseline survey. After the implementation, a different set of randomly selected 1562 adults was interviewed using the same questionnaire. Data was collected on socio-demographic characteristics, sexual behaviour, whether respondents had ever tested for HIV and stigma and discrimination towards HIV/AIDS. RESULTS: The proportion of people who had ever tested for HIV increased from 18.6% to 62% (p<0.001). Among people who had ever tested, the proportion of people who shared HIV test result with a sexual partner increased from 41% to 57% (p<0.001). The proportion of persons who wanted infection status of a family member not to be revealed decreased from 68% to 57% (p<0.001). Indicators of risk behaviour also improved; the proportion of people who exchanged money for sex reduced from 12% to 4% (p<0.001), who used a condom when money was exchanged during a sexual act increased from 39% to 80% (p<0.001) and who reported genital ulcer/discharge decreased from 22% to 10% (p<0.001). CONCLUSION: These data suggest that HBHCT rapidly increased the uptake of HCT and may have led to reduction in high-risk behaviours at population level as well as reduction in stigma and discrimination. Because HBCT programmes are cost-effective, they should be considered for implementation in delivery of HIV services especially in areas where access to HCT is low.

High uptake of home-based, district-wide, HIV counseling and testing in Uganda.

More than 80% of the people infected with HIV in low-income countries of sub-Saharan Africa do not know their HIV serostatus. Innovative measures of increasing access to HIV counseling and testing (HCT) are urgently needed so as to improve care and prevention. We implemented a home-based HCT program in Bushenyi District from September 2004 to March 2007, in Uganda where approximately 90% of people aged older than 14 years had never tested for HIV to gauge whether it was acceptable and increased uptake of HCT. Twenty-nine teams comprising a counselor and a laboratory assistant systematically visited homes offering HCT for all people older than 14 years of age and at-risk children (mother deceased or HIV infected) using a rapid HIV testing three-test algorithm. HIV-infected people received cotrimoxazole prophylaxis, were supplied with long-lasting insecticide-treated bed nets and equipment for treatment of drinking water at home, and were referred for assessment for antiretroviral therapy. The program reached 92,984 (63%) of all the homes in the district. Of these, 32,3621 people were eligible for HCT, and 28,2857 (87%) were present at home and were offered pretest counseling. A total of 264,966 (94%) accepted testing and received their results, of whom 11,359 (4.3%) were HIV-infected. Ninety percent of those testing had never tested before. The cost of testing was $7.83 per previously untested client. Ninety-seven percent of HIV-infected people initiated cotrimoxazole prophylaxis, 74% received bed nets, 70% received water treatment equipment, and 11% began antiretroviral therapy. Forty-four percent of people who were in an HIV-discordant relationship were infected. These results demonstrate that home-based HCT was well-accepted, feasible, and effective in identifying HIV-infected individuals who did not know their HIV status in rural Uganda.

Predictors of use of traditional medicine by patients with sexually transmitted infections in southwest Uganda.

OBJECTIVES: We studied the predictors for use of traditional medicine among patients with sexually transmitted infections (STIs). DESIGN: We interviewed a consecutive sample of patients with STIs. SETTINGS: Mbarara and Bushenyi districts in southwestern Uganda. SUBJECTS: Two hundred and twenty-four (224) patients presenting with STIs who used allopathic (101) or traditional medicine (123). OUTCOME MEASURES: Using an interviewer-administered questionnaire, patients answered questions regarding their socioeconomic conditions, STI symptoms, and attitudinal beliefs, normative and self-efficacy beliefs toward use of traditional medicine. RESULTS: The independent predictors of using traditional medicine were (1) presenting with genital ulcers as a symptom [Adjusted Odds Ratio (AOR 3.45) 95% confidence interval (CI) 1.14-10.41], (2) presenting with a positive syphilis test (AOR 9.67, 95% CI 2.70-34.11), (3) having had STI symptoms for more than 30 days (AOR 3.61, 95% CI 1.28-11.58), (4) not presenting with urethral discharge as a symptom (AOR 12.56, 95% CI 5.37-19.87), (5) believing that traditional medicine prevents (AOR 4.53, 95% CI 1.89-11.92), or completely cures STIs (AOR 14.72, 95% CI 2.15-50.27), (6) being likely to use medicine recommended by traditional healers (AOR 17.60, 95% CI 2.89-40.01), (7) and being unlikely to be influenced by allopathic health workers in choice of type of medicine (AOR 15.98, 95% CI 3.52-72.48). CONCLUSIONS: Use of traditional medicine is influenced by symptoms of STI and by having positive beliefs about traditional medicine and traditional healers.