The UK National Guidelines on HIV Testing 2008 recommended that adults in areas where more than 2/1000 people were living with HIV be considered for an HIV test at the point of registration with general practice. The RHIVA2 trial of rapid HIV testing in primary care implemented and evaluated this recommendation across 20 general practices in a single UK borough using a pragmatic cluster randomised controlled trial (RCT) design. This trial, and the policy that underpinned it, reflected two more general developments: first, the move towards population screening to detect and treat disease in early and latent stages and second, the emergence of 'pragmatic' clinical trials that seek to account for complexity and measure interventions in their context of use. This interdisciplinary case study uses multiple methods and theoretical frames to explore what happened in the RHIVA2 trial at both an empirical and a theoretical level. Sub-studies reveal how the trial was justified, enacted and became meaningful as a policy, as a trial, and as an intervention in the lives of patients. My analyses show that two operating logics informed the justification and enactment of the trial and patterned patient and provider experiences. The first, the logic of normalisation for HIV aims to treat HIV infection as a medical condition 'like any other'. This logic emphasises general practice as a site of increased value and position in HIV management and as a space where population screening can be undertaken. Second, the logic of the pragmatic trial aims to measure interventions in the 'real world' but is revealed to produce unintended effects, raising questions about the claims of such trials to generalisability and reproducibility. This thesis demonstrates how contrasting versions of the research event ('multiplicity') can be produced through different modes of inquiry, raising questions about the tension between situated and generalisable findings.

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<strong>Background. </strong> Previous evidence suggests that persons who have emigrated from HIV-endemic countries experience higher rates of HIV infection and delayed diagnosis. Despite this evidence, limited research has examined HIV testing in these populations. <br /><br /> <strong>Objectives. </strong> To examine factors associated with HIV testing, as well as motivations underlying testing behaviour, within five East African communities in Toronto. <br /><br /> <strong>Methods. </strong> Secondary data analyses were conducted using cross-sectional data collected in face-to-face interviews with people from Toronto's Ethiopian, Kenyan, Somali, Tanzanian, and Ugandan communities. Logistic regression techniques were employed to assess factors associated with "ever vs. never testing," "repeat vs. non-repeat testing," and "independent vs. directive testing. " Reasons provided for testing and not testing were described. <br /><br /> <strong>Results. </strong> Individuals from all five communities were interviewed (n=270). Males were slightly over-represented (55. 9%). The average age was 35. 7 yrs (range 17-71). Three-quarters (75. 6%) of the sample had been tested for HIV. Two-thirds (65. 7%) of testers had tested more than once and 40. 7% had independently decided to get their most recent test. 71. 1% of testers reporting previous testing for immigration purposes. Testing behaviour varied greatly across communities. Ethnicity was predictive of "ever" and "repeat" testing. Risk behaviour (including multiple sex partners, concurrent sex partners, condom non-use, and/or improper condom use) was overwhelmingly not associated with testing. Fear of exposure through sexual activity was the most frequent reason for independent testing. Immigration authorities were the most common person to initiate directive testing, followed by physicians. Low perceived risk was the most common reason for not testing. <br /><br /> <strong>Conclusions. </strong> Testing rates within this population were quite high and the immigration process heavily impacted upon testing behaviour. Many determinants and motivations of testing have been identified and should be used to inform the design of interventions to promote testing behaviour in these communities. Nevertheless, many gaps have been identified by the current research and should be addressed by future research.

INTRODUCTION: In the United States, Blacks and Hispanics compared to Whites are disproportionately infected with HIV. Testing for HIV is critical to reduce HIV transmission, lower risk behaviors, and improve access to treatment among persons living with HIV. However, racial & ethnic minorities are tested at later stages of HIV. Previous studies that examined racial discrimination and HIV testing reported inconsistent findings and additional knowledge is needed to understand whether differential treatment based on race is an important barrier to HIV testing. AIM: We examined whether HIV testing is influenced by how an individual reacts to race-based treatment, rather than experiences of discrimination alone, among Whites, Blacks, and Hispanics; and we determined if this relationship was modified race and ethnicity. METHODS: We performed a cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System’s (n=12,579) self-reported HIV testing data and Reaction to Race (RR) module, which captures experiences of differential treatment based on race and an individual’s reaction to racialized treatment. Multivariable logistic regression was used to assess the association between RR-based treatment and HIV testing. Statistical interaction between RR-based treatment and race was assessed. RESULTS: Approximately 21% participants reported ever being tested for HIV, and 19% of the participants had one or more experiences of RR-based treatment. Prevalence of HIV testing was higher among Blacks (62%) and Hispanics (33%) compared to Whites (32%). In an adjusted model, the odds of HIV testing among those who reported one experience of Reactions to Race based treatment was 1.37 (95% CI: 1.08-1.75) times the odds among those with no experiences of RR-based treatment. We did not detect statistical interaction between RR-based treatment and HIV testing by race. DISCUSSION: Our findings suggest that experiences of racial discrimination may be counter intuitively associated with increased HIV testing overall and within each racial and ethnic group. Additional research is needed to clarify settings in which experiences of race-based treatment and the associated reactions to the treatment can positively or negatively influence HIV testing behaviors.

<strong>Background. </strong> Previous evidence suggests that persons who have emigrated from HIV-endemic countries experience higher rates of HIV infection and delayed diagnosis. Despite this evidence, limited research has examined HIV testing in these populations. <br /><br /> <strong>Objectives. </strong> To examine factors associated with HIV testing, as well as motivations underlying testing behaviour, within five East African communities in Toronto. <br /><br /> <strong>Methods. </strong> Secondary data analyses were conducted using cross-sectional data collected in face-to-face interviews with people from Toronto's Ethiopian, Kenyan, Somali, Tanzanian, and Ugandan communities. Logistic regression techniques were employed to assess factors associated with "ever vs. never testing," "repeat vs. non-repeat testing," and "independent vs. directive testing. " Reasons provided for testing and not testing were described. <br /><br /> <strong>Results. </strong> Individuals from all five communities were interviewed (n=270). Males were slightly over-represented (55. 9%). The average age was 35. 7 yrs (range 17-71). Three-quarters (75. 6%) of the sample had been tested for HIV. Two-thirds (65. 7%) of testers had tested more than once and 40. 7% had independently decided to get their most recent test. 71. 1% of testers reporting previous testing for immigration purposes. Testing behaviour varied greatly across communities. Ethnicity was predictive of "ever" and "repeat" testing. Risk behaviour (including multiple sex partners, concurrent sex partners, condom non-use, and/or improper condom use) was overwhelmingly not associated with testing. Fear of exposure through sexual activity was the most frequent reason for independent testing. Immigration authorities were the most common person to initiate directive testing, followed by physicians. Low perceived risk was the most common reason for not testing. <br /><br /> <strong>Conclusions. </strong> Testing rates within this population were quite high and the immigration process heavily impacted upon testing behaviour. Many determinants and motivations of testing have been identified and should be used to inform the design of interventions to promote testing behaviour in these communities. Nevertheless, many gaps have been identified by the current research and should be addressed by future research.

My main focus of interest in this dissertation is to evaluate the relationship between known risk factor for HIV and HIV testing behavior, with a particular interest in women. Utilizing data from the National Survey of Family Growth, I conduct both descriptive and logistic regression analysis to evaluate this relationship. In addition to examining this relationship for women overall, I also evaluate the differences between White and Minority women, and compare and contrast this relationship for men versus women. In this dissertation, I did find some evidence to indicate that women with factors that put them at risk for HIV are more likely to be tested than are women without risk, however the strength of this relationship differed across types of risk factors. Drug use was consistently stronger in predicting the likelihood of testing than were sexual risk factors, indicating a ?lag? in public health perception of risk due to heterosexual risk factors. I also found that African-American women had significantly higher prevalence of risk than did White women, although no difference was found in the relationship between risk and testing. Finally, sexual risk factors were a substantially stronger predictor of testing for men than it was for women. The findings reported in this dissertation have the potential for significant public health implications and indicate the need for further policies that target the populations identified in this research. While the evidence in this dissertation and elsewhere does suggest that these efforts have been successful for homosexual men and drug users, and marginally successful for women at risk due to heterosexual behavior, it is important that efforts that target women, especially African-American women, are increased.

Magister Public Health - MPH / Introduction: Despite overwhelming evidence about benefits of early initiation of antiretroviral treatment (ART) for HIV-exposed children in terms of reducing their morbidity and mortality, there are children in Uganda and globally who still do not access treatment. Early infant diagnosis (EID) of HIV infection offers an opportunity for identifying, follow up and testing for HIV-exposed infants. In Uganda, despite the availability of EID of HIV infection for infants, many are left undiagnosed or diagnosed when it is too late, resulting in high HIV-related child mortality. The aim of this research therefore was to explore the facilitators and barriers to EID of HIV for infants of mothers who delivered at Entebbe hospital in Uganda and from this propose lessons for increasing EID uptake. Methodology: The study utilised a qualitative exploratory approach using in-depth interviews with mothers who brought back their children for early HIV testing and those who never returned their children for testing. Key informant interviews were conducted with health care providers and peer mothers. Interviews were recorded and transcribed verbatim. Data were analysed using the thematic content analysis approach to identify themes and patterns in the data. Results: Individual, health facility, community and economic factors were found to affect EID uptake. Individual factors include limited knowledge about: the timing for EID, the efficacy of PMTCT interventions and HIV treatment and the fact that asymptomatic children can be HIV-positive. Other caregiver factors include fear of finding out their children are HIV-positive, denial of HIV status, fear of disclosure and the resulting stigma and discrimination, caregiver religious and cultural beliefs. The negative attitudes of the health care workers, fear of breach of confidentiality, inadequate EID information from the health care workers, caregiver place of delivery and long waiting times were the health facility factors affecting EID. Conclusion: Early infant diagnosis is a critical gateway to prevention and care services for paediatric HIV. The results of this study suggest that factors at caregiver level are critical drivers that influence uptake of EID at Entebbe hospital, Uganda. Providing information to caregivers and promoting awareness about the benefits of testing infants early are the recommended strategies for increasing uptake.

MSc (Med), Faculty of Health Sciences, University of the Witwatersrand, 2006

MA , Faculty of Humanities, University of the Witwatersrand, 2011 / South Africa has a high number of people living with HIV as UNAIDS (2009) projected the population of people living with HIV to be 5.7 million of which 20% of this population is said to be in employment. As a corrective measure, various strategies at national and company levels are being employed to get people to test for HIV. HIV testing helps people to know their status which is a gateway to informed prevention behavior and treatment. In workplaces, peer educators play an important role in getting workers to take up HIV test. As workplace peer educators mobilize workers to take up HIV test, they continue to face challenges. This precedes the broad objective of this study, which is to understand challenges faced by workplace peer educators in getting workers to take up HIV test. This report is a product of in-depth interviews, with fourteen peer educators, two wellness officers and the wellness coordinator. Participant observations and document analysis were also employed in gathering data. The data collection process extended from July to December 2010 in a mining company in the North West province in South Africa. Findings of the research revealled that despite the company’s HIV testing programme being a success as evidenced by a recorded cumulative annual uptake rate of 82% (2009), peer educators still face challenges emanating from environmental, programmatic and socio-interactional and perceptional factors. Environmental factors include skepticism based on precarious employment contracts while programmatic factors include certification of test results, speculation of test results based on time spent in the testing cubicle, consent procedures and incentivisation of testing. Lastly socio-interactional and perceptional factors that include stigma and discrimination, cultural beliefs, poor disclosure strategies, perceived racialisation of workplace testing centers and male workers relying on results from partner’s antenatal test were identified as another set of challenges faced by peer educators. The study suggests that in order to improve the HIV test uptake rate, in this context referring to the attainment of an absolute uptake rate, mitigation measure which include the use of trade unions in mobilizing workers for HIV testing, training on disclosure, re-negotiation and design of testing programmes and education must be considered. The adoption and administration of these measures into the case study company’s HIV test programme and other institutions facing the same challenges will help improve the HIV test uptake.

Despite the Centers for Disease Control and Prevention recommendations to test patients ages 13 to 64 years for HIV at health care settings, routine HIV testing is lacking. As a result, many people are unaware of their HIV seropositive status. The purpose of this quantitative cross-sectional study was to examine relationships between HIV testing and provider type, knowledge, attitudes, and behaviors regarding HIV testing in the acute care setting. The study was informed by social cognitive theory. Using a convenient sampling method, a questionnaire derived from previous surveys (Society of General Internal Medicine and University of Washington) was sent to 600 eligible acute care providers from a suburban Chicago hospital who treated HIV-negative patients ages 13 to 64 years. Completed surveys were received from 88 participants. Chi-square and multiple logistic regression testing showed no significant relationships between HIV testing and provider type (p = .09), age (p = .91), gender (p = .84), experience (p = 1), and race/ethnicity. However, knowledge of HIV testing regulations and positive attitudes about HIV testing were significantly associated with the likelihood of offering an HIV test (p = .026, p = .004 respectively). Results have some clinical importance, but also indicated a lack of routine opt-out HIV testing. Results may be used to promote HIV testing among acute care providers which could reduce HIV-status unawareness in the population.