Facilitators, Barriers, and Predictors of HIV Testing Among Hispanic Women

Background: 

Globally, HIV/AIDS has been a public health concern for over three decades. Thirty-five million people are currently estimated to be living with HIV in the world; 2.1 million of whom are new infections. In the United States (US), more than 1.2 million people are currently living with HIV; and in Florida, the Miami-Dade County currently has the highest number of HIV/AIDS cases. Further, the CDC finds that one in four people living with HIV are women, and these women made up an estimated 20% of all new HIV infections in the country at the end of 2010.   

HIV testing has been identified as the foundation for combating HIV infection through disease prevention and care efforts such as identification of infection, early treatment of infected persons, reducing the risk of transmitting HIV to others, effective treatment, linkage to care,  and treatment adherence. Lack of HIV testing has been associated with greater disease morbidity and mortality, particularly, as a result of late entry into care. By understanding the facilitators, barriers and predictors of HIV testing among Hispanic women, Healthcare providers may be able address factors that impact their health negatively.

Purpose:

To analyze facilitators, barriers, and predictors of HIV testing among Hispanic women in Florida. 

Methods:

This study is a secondary analysis of baseline data collected to test the effectiveness of the randomized clinical trial, SEPA III (Salud/Health, Educación/Education, Promoción/Promotion, y/and Autocuidado/self-care). Participants for this study were recruited in Miami, Florida specifically recruitment occurred at the Florida Department of Health and at the Miami Refugee Center, located in Miami-Dade County. Recruitment occurred also in public places frequented by Hispanic women (e.g., churches, clinics, supermarkets).  A total of 320 sexually active Hispanic women between 18 and 50 years old were enrolled in this study. Participants were assessed by female bilingual interviewers using structured questionnaires that contained questions about HIV related outcomes. Assessments were collected with the assistance of a web-based research management software system (e-Velos). Descriptive statistics and logistic regression were used for the analysis.

Results:

 The average age of participants was 34.79 (SD = 9.2). Most women (n = 306, 96%) were born outside the U.S., and 65.6% of them were living with their partners. The average level of education was 13.73 (SD = 3.3) years. The majority of the women (87.5%) had undergone HIV testing prior to their participation in the study. Twelve point two percent (12.2%) of them have not had HIV testing in the past. Facilitators for HIV testing were: Women reported that they were more likely to get tested for HIV if: an HIV rapid test is available (98.1%); if they get the results immediately (82.5%); if the HIV test is offered to them  instead of they asking for one (81.6%); if they get the results immediately (82.5%); and if they were tested with a blood sample rather than saliva (72.2%). Barriers for HIV testing were: no reason to believe they were infected (73.7%); concerns about lack of social support if the HIV test was positive ( 20.5%); testing would force them to stop some sexual practices (17.9%); and concerns about the confidentiality of the HIV test results (17.9%). The simultaneous logistic regression analysis described the relationship between the outcome variable, HIV Testing, and a set of independent variables found in the literature as possible predictors for HIV testing (e.g., age, living with a partner, years of education, and HIV knowledge) and the variables that the majority of the women in this study mentioned  as facilitators of  HIV testing  (HIV rapid test is available; if they get the results of the HIV test immediately; if an HIV test was offered instead of asking for one; and if they were tested with a blood sample instead of saliva). The variables “HIV knowledge” B = 0.30, SE = 0.12, p = .015, OR = 1.030 and “HIV test is offered instead of asking for one” B = 0.691, SE = 0.278, p = .013, OR = 1.995 were significantly related to HIV testing. This translates into the odds of HIV testing increasing approximately by two (OR 1.995) for every one-unit increase in “HIV test is offered instead of asking for one.”

Conclusion:

The majority of the women, participating in this study, were tested for HIV prior to their participation in SEPA III. They were tested during the pregnancy or when they arrived in the US as refugees in both cases, the HIV test is mandatory. Strategies to increase HIV testing among Hispanic women that has not been tested for HIV should consider facilitators, barriers, and predictors related to the test. Increasing HIV testing can contribute to improved linkage to care for women who are HIV positive. Thus, effective, culturally appropriate messages and prevention programs must to be developed and implemented to promote HIV testing. Increasing outreach into the Hispanic community to provide HIV education and to offer the test will increase the number of Hispanic women who will be willing to get tested.  Health care workers including HIV counselors providing test results may need training to address women’s stress and risk behaviors related to HIV risk. The promising findings of this study indicate that more research on HIV testing among Hispanic women should be conducted.