Voluntary testing and counselling for HIV. "Are adults in rural communities ready to test?" A descriptive survey.

OBJECTIVE: To describe rural adult preparedness to test for HIV, perceived susceptibility, response to peer group opinion, perceived positive and negative outcome expectations of testing.

DESIGN: Cross sectional descriptive study.

SETTING: Mashonaland West Province, Zimbabwe.

SUBJECTS: Purposive convenience sample; 204 adults, 102 females, aged 18 to 50.

MAIN OUTCOME MEASURES: Stage of preparedness to test for HIV, perceptions of susceptibility, response to peer group opinion, negative and positive expectations about testing.

RESULTS: None of the 204 participants had knowingly been tested for HIV prior to the study; 55.8% had heard about Voluntary Counselling and Testing (VCT) and 21.0% had thought about testing. Of these, 15 (34.8%) had already talked to somebody about testing. When compared with married respondents, significantly more singles expressed preparedness to test for HIV in the next six months (p = 0.040). Only 14.2% of respondents expressed willingness to pay for a test. Females worried more than males about "getting HIV in the future" (p = 0.019). Singles were more likely to worry about their partners' current HIV status than married and once married respondents (p < 0.001). When compared with women, men showed more likelihood of responding to pressure from friends to test for HIV (p = 0.039). Strongly articulated fears about testing included being seen by friends at a VCT centre, stigmatisation, violence and stress. Significantly more women than men were fearful that an HIV test would be painful (p = 0.006). Similarly, women were more fearful than men about taking an HIV test (p = 0.007), the possibility of waiting for the result (p = 0.022) and returning for results (p = 0.020). Anticipated positive outcomes of testing included getting assistance in the early stage of the disease.

CONCLUSION: Knowledge of HIV status acquired voluntarily in a psychologically and socially supportive environment will be a significant motivator for individuals and their partners to initiate and maintain safer sexual behaviour. Our study showed some preparedness among adults from two rural communities to test for HIV. While current strategies to promote VCT in urban areas reflect sensitivity to many of the fears of adults expressed in this study, the initiative must be expanded to embrace rural communities. There is a need to build on positive perceptions about testing and embrace a strategy that disables fear, particularly among women. The initiative must go beyond the individual as the primary target and be promoted within the broader context of the community with the assistance of credible opinion leaders. It should also link closely with other services that offer primary prevention, pilot treatment and support activities.