Multilevel determinants of HIV counseling and testing, interpersonal communication about HIV/AIDS, and awareness of treatment options in Zambia

Objective: This study examines individual- and community-level factors affecting HIV testing, discussion of HIV, and awareness of treatment options among men and women in Zambia. Data and Methods: The 2005 Zambia Health Communication Partnership Baseline Survey collected information from a nationally representative sample of men and women. Concurrent data collection included a survey of community leaders regarding community characteristics, key infrastructure, and local attitudes related to HIV/AIDS. Using a multilevel framework, accounting for the social context in which individuals access information and gauge social norms, we estimate models predicting whether men and women get tested for HIV, discuss HIV with their partner(s) or children, and are aware of treatment options. Results: 9.3% of male and 15.0% of female respondents reported being tested for HIV in the past year. Factors associated with getting tested for HIV include: awareness of ARVs, perception that HIV is a serious problem in the community, believing that a family member would get tested, having multiple sexual partners in the last year, and having high personal risk perception. Living in a community that supports the idea that people with HIV can work is associated with knowing where ARVs are available. Further analyses will examine additional community-level factors hypothesized to be related to HIV testing, including availability of VCT services and attitudes regarding HIV/AIDS among respondents' peers and community and religious leaders. Conclusions: Findings suggest that community factors and perceptions about one's community may influence individuals' awareness of treatment options and decisions to seek VCT and discuss HIV/AIDS.