HIV counseling and voluntary testing among pregnant women in Swaziland

More than 90 percent of HIV infections in infants and children occur during pregnancy, labor, delivery and breastfeeding. HIV counseling and voluntary testing during antenatal care have been proven to reduce the risk of HIV transmission from mother to child, by increasing knowledge about safe behaviors related to HIV, ascertaining HIV status, identifying women in need of follow up care and increasing coverage of effective antiretroviral regimens. However, in developing countries where 95% of mother-to-child transmissions take place, such interventions are not widely accessible or available. Using a nationally representative survey, this study set out to examine correlates associated with the occurrence of counseling and uptake of HIV testing in Swaziland, a country highly burdened by HIV/AIDS. The findings demonstrate that national coverage of counseling programs remains low in Swaziland; only 62 percent of women have received counseling during antenatal. The likelihood of receiving HIV counseling is influenced by parity, education, place of residence, and region. The results also show that the uptake of voluntary testing is not universal; among women who have been offered an HIV test during antenatal care routine, only two-thirds accepted to be tested. The uptake of HIV testing is associated with parity, education, SES, STD diagnosis in the previous year and with HIV counseling. Taken together, the results highlight the need for closing gaps in geographic coverage of HIV counseling, for increasing the provision of HIV testing and for addressing socio-economic and cultural impediments that prevent women from making use of such services.