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Factors Influencing Couples Seeking HIV Volunteer Counseling & Testing in Addis Ababa Ethiopia

Introduction
Ethiopia is the third most-populous nation in Africa with about 90 million people, world’s eighth least-developed country and is among the Sub-Saharan African countries most affected by HIV/AIDS with an adult prevalence rate of 2.4%, an estimated 1.3 million people living with HIV and 804,184 AIDS orphans (CIA World Fact Book, 2010; Ethiopia AIDS Resource Center National Fact Sheet, 2010). The Ministry of Health and the National HIV/AIDS Prevention and Control Office reported 137,494 new HIV infections, 28,073 AIDS deaths, 90,311 positive pregnancies and 14,276 HIV positive births in 2010.
Most new infected people in sub-Sarharan Africa occur during heterosexual relations and within long term relationships of discordant couples where one partner is infected and the other partner is not. (UNAIDS, 2010, Malamba, Meriman et, al. 2005). As the number of heterosexual infections increase in couples, there will be an increase in the number of discordant couples and an increase in HIV transmission. Research shows that the prevalence of discordant couples varies between 36% and 85% in 12 eastern and southern Africa countries (UNAIDS, 2010;16).  Annual HIV transmission rates within HIV-sero-discordant couples are estimated between 7% and 20% depending on whether the couple is provided counseling and testing (Allen, Meinzen-Derr, Kautzman, et.al, Malamba et.al. 2005). Research studies have shown Couple Voluntary Testing and Counseling(CVCT) is an effective prevention strategy for couples to learn their HIV status, reduce HIV transmission through risk reduction behavior change, have continuous risk reduction counseling and monitoring of HIV status, and referral of infected partners with for care and treatment within sero-discordant couples (Shitaye,A., et.al, 2004; Lurie, Williams, Zuma, Mkaya-Mwamburi, Garnett, Sweat, Gittelsohn, and Karmim, 2003, Allen et.al, 2003; Bunnell, Ekwanu, Solberg, Bikaako-Kajura, 2006).
In Zambia, Rwanda, and Uganda studies have shown that couples that participate in CVCT have sub and have lower rates of transmission by 50% ( xxxx). However, uptake of CVCT services has been low. Few studies have assessed factors that affect utilization of CVCT services in hospitals, antenatal clinics, and home-based settings but none have been conducted in model sites. The primary purpose of this study is to better understand and determine what the relationship is between demographic and socio-cultural factors of couples to seek CVCT services in Ethiopia. The secondary purpose of this study is to describe possible strategies deemed most appropriate within the Ethiopian cultural context.
Problem Statement
 
Sub-Suharan Africa accounts for two-thirds of the world’s HIV. As the number of people living with HIV has increases due to advances in treatment, HIV will continue to be a major public health concern. It is estimated that HIV infection rates also cause concerAs a result of continued infection rates, d in every region of Voluntary counseling and testing Research studies have shown that two –thirds of people between the ages of 20-49 are living in a martial or co-habiting unit (xxxx). Yet only 2 out of 10 people know their HIV status. Findings in research
A review of the literature found 2 previous CVTC studies conducted in Addis Ababa; one in 2001-2003 at antenatal clinics in a Prevention of Mother to Child Transmission (PMTCT) study. The findings were 16,480 pregnant women agreed to be tested and bring their partners. 449 partners returned for counseling and testing with a ___participation rate. The recommendations were that for CVCT to succeed in the antenatal setting it will be important to identify specific reasons partners decline testing and provide additional means of support for the women to be able to share their test results with partners.
The second study conducted from 2006- 2007 at 6 government hospitals had a 14% CVCT participation rate out of 771 clients. Further research is recommended on developing specific approaches to promote CVCT services. Due to the emerging HIV-negative partner at risk group with cohabiting and discordant couples and low uptake of CVCT in Addis Ababa, there is an urgent need for research in finding the best ways to increase awareness, promote usage, availability and assessibilty of couple counseling and testing services.
A 2008 Epidemiological Synthesis study by Ethiopia HIV/AIDS Prevention and Control Office found that most of the discordant couples reside in urban areas, and the HIV-negative partners may be the group at greatest risk of contracting HIV. Couple counseling and testing services were noted to be non-existent or rudimentary in the country. Therefore, services for couple counseling and education on appropriate preventive behaviors needed to be developed as a high priority.
 
This study aims to assess if there is a relationship between various socio-demographic factors, socio-cultural factors, and model sites settings in influencing couples on using CVTC services at 6 model sites in Addis Ababa woreda (health district). No CVTC study has been conducted on these sites. The research findings will be used to make recommendations to the woreda and the Federal Ministry of Health (FMOH) in development of future HIV prevention interventions and promote uptake of CVCT. .
Research Questions
How does socio-demographic factors influence uptake of CVCT?
 
How does socio-cultural factors influence uptake of CVCT?
 
What is the relationship of socio-demographic factors on the uptake of CVCT?
 
How does the VCT setting influence uptake of CVTC?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
References
Addis Ababa City Administration Health Bureau. 2007. Statistics from MAC-E Campaign. Addis Ababa, Ethiopia.
Centers for Disease Control and Prevention (CDC). 2007. The Emergency Plan in Ethiopia. Atlanta, USA: CDC. Retrieved April 13 from http://www.cdc.gov/nchstp/od/gap/countries/ethiopia.htm
CIA – The World Fact book – Ethiopia (2010) Website –Retrieved April 12, 2011 from
Ethiopia Demographic Profile, 2011, http://www.indexmundi.com/ethiopia/demographics_profile.html
Ethiopia AIDS Resource Center (2010). National Fact Sheet 2010. Retrieved April 13, 2011 from http://www.etharc.org/resources/healthstat/nationalfactsheet/13-nationalfactsheet2010.html
Federal Democratic Republic of Ethiopia. (2006). Report on Progress towards Implementation of the Declaration of Commitment on HIV/AIDS. Retrieved April 20, 2011, from http://data.unaids.org/pub/Report/2006/2006_country_progress_report_ethiopia_en.pdf
HIV and AIDS in Africa. Rebirth Africa Life on the Continent, 2000. Retrieved April 12, 2011 from http://www.rebirth.co.za/AIDS_in_Africa_1.htm
 
Lurie, M.N., Williams, B.G., Zuma, K., Mkaya-Mwamburi, D., Garnett, G.P., Sweat,
M.D., Gittelsohn, J., and Karim, S.S. (2003) Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa. Aids. 17(15), 2245-2252.
Malamba, S.S., Mermin, J.H., Bunnell, R., Mubangizi, J., Kalule, J., Marum, E., Hu, D.J.,
Wangalwa, S., Smith, D., and Downing, R. (2005) Couples at risk: HIV-1 concordance and discordance among sexual partners receiving voluntary counseling and testing in Uganda. J Acquir Immune Defic Syndr. 39(5), 576-580.
 
Shitaye, A., Nuru, A., Getu, D., et.al Knowledge and attidude towards voluntary counseling and testing for HIV: a community based study in northwest Ethiopia. Ethiopia Journal of Health Dev 2004, 18 (2): pp. 82-89.
UNAIDS (2010) ‘UNAIDS report on the global AIDS epidemic’ Retrieved April 20, 2011, from http://www.avert.org/hiv-aids-africa.htm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
REVIEW OF LITERATURE………………………………
Epidemic Update World and Sub-Saharan…………….
Voluntary Counseling and Testing
Demographics and HIVTesting……………
HIV/AIDS Knowledge and HIV Testing………………
Perceived Susceptibility and Testing…………..
Facilitators that Motivate People to Test and Stated
Reasons for Getting Tested……
Theoretical and Conceptual Framework………………………
The Health Belief Model
 


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