July 26, 2019 | Erin Bluvas, firstname.lastname@example.org
In his latest effort to reduce rates of HIV/AIDS in Tanzania, health promotion, education, and behavior assistant professor Donaldson Conserve has published a paper on developing national strategies for reaching men with HIV testing services in Tanzania. Published in BMC Health Services Research, the article reports on enablers and barriers to HIV testing uptake in men and describes strategies proposed in Tanzania’s Male Catch-Up Plan to address some of these barriers.
Despite stabilization and decline in HIV/AIDS infection rates over the past three decades, sub-Saharan Africa accounts for 64 percent of new HIV infections. Tanzanians experience disparities in HIV prevalence in age, gender and rural-urban differences.
The HIV prevalence rate among women ages 25-29 is three times higher compared to men in the same age group. Further, 55 percent of men living with HIV self-reported that they were unaware of their HIV status – despite the scale up of HIV testing services and treatment in health care facilities and communities across the country and the availability of free antiretroviral treatment.
To continue the decline of HIV incidence overall and lower the prevalence of transmission to women by men who are unaware of their positive HIV status, the Tanzania Commission for AIDS (TACAIDS), UNAIDS Tanzania, the National Institute of Medical Research at Muhimbili University and other partners created the Male Catch-Up Plan. This plan focuses on increasing the number of men who test for HIV so that they know their status, can receive treatment, and stop the spread of infections – particularly to the female population, which is disproportionately affected by higher incidence rates [learn more with this press release from the National Institutes of Health and information from the MenStar Coalition].
“Through previous research, including our own, we know that general barriers to utilizing HIV testing services include HIV-related stigma and discrimination, lack of confidentiality, fear of an HIV-positive test result and increased waiting time to obtain a test result,” Conserve says. “Among men in particular, their reluctance to test for HIV is influenced by a masculinity ethos and a heightened sense of risk related to extramarital relationships and resultant fear of receiving a positive diagnosis.”
Conserve has been conducting HIV/AIDS research in Tanzania since 2009 when he was a graduate student at the Pennsylvania State University under the tutelage of Gary King, who is a co-author on the article. In 2016, Conserve received a National Institutes of Health (NIH) Pathway to Independence Award (K99/R00) to create the Self-Testing Education and Promotion (STEP) Project. The purpose of the STEP Project, which is based in Dar es Salaam, Tanzania, is to investigate whether HIV self-testing versus testing at a health care facility would be an acceptable and feasible approach of increasing HIV testing among social networks of men.
Akeen Hamilton, an HPEB doctoral student who is studying with Conserve, is spending the summer in Tanzania working on the STEP Project. With support from Pauline Jolly’s NIH-funded Minority Health International Research Training Program, he plans to use some of the data he is collecting for his dissertation project, which will focus on preexposure prophylaxis (PrEP) knowledge and willingness to use among some of the men. Conserve himself kick started his sub-Saharan African AIDS/HIV research with a similar grant that took him to South Africa when he was an undergraduate student – an experience inspired him to pursue work in this area.
Through nearly 150 qualitative interviews with men in Dar es Salaam through the STEP Project, Conserve and his team found that enablers of HIV testing included the desire to check one’s health, high HIV risk perception, wanted to protect oneself if tested negative and encouragement by sexual partners. Barriers included fear of a positive test result and low HIV risk perception.
The researchers proposed the following strategies from the Male Catch-Up Plan to address these barriers: social and cultural approaches to promote an enabling environment to encourage health seeking behavior, safe behavior, social marketing to promote condoms, and providing peer education programs, one of which Conserve recently launched through his STEP Project. Additional recommendations include expanding targeted HIV testing, HIV self-testing and integrating HIV services with other health services. Conserve and his collaborator, Judith Luande from TACAIDS, reported on these findings at a conference on accelerating men’s HIV service delivery and uptake in Eastern and Southern Africa that was held in Johannesburg, South Africa in May.