FACTORS INFLUENCING THE ACCEPTANCE OF HIV TESTING IN PREGNANT WOMEN LIVING IN BISSAU

Background: Stigma, socio-demographic, behavioral factors and the different strategies adopted for HIV testing and counselling (HTC) may influence the rate of test acceptance in Sub-Saharan Africa, rates have been frequently reported to be lower in West African Countries. Methods: All pregnant women attending the antenatal clinics in Bissau City, from January 2002 to May 2005, were asked to participate to an opt-out HTC program and, PMTCT was offered to HIV-1 positive women,. At the same time, a radio campaign focused on HIV/ AIDS awareness and prevention was, broadcasted all over the region. Results: 27,166 women were consecutively invited to join the HTC initiative. Of them, 369 (1.4%) refused to be counseled and 2,928 (10.8%) did not perform the HIV testing after being counseled. Test refusal accounted for 23% of women in 2002, but only for 6.4% in 2006 (p\0.001). Independent correlates of test denial resulted age (girls \18 years old at higher risk than women aged 18-34 years (p = 0.005)), illiteracy (\0.001) and reporting only one sexual partner in the last 12 months (p\0.001). Conclusions: The high acceptance rate of HIV testing in a West- African setting confirms the effectiveness of the opt-out strategy if provided together with HIV care and prevention. The progressive decrease of test refusal rate likely derives from the educational campaign and the increasing availability of well-functioning testing centers funded by the project. However, the higher test refusal among illiterates and younger women reveals the existence of particularly disadvantaged groups needing targeted intervention.