Background: In Canada, failure to disclose HIV+ status before sex can result in incarceration and status as a registered sex offender for life. In 2012, the Supreme Court of Canada ruled that there is no legal mandate for HIV disclosure before sex if (i) a condom is used and (ii) HIV viral loads are extremely low. There is very little known about how the legal mandate for HIV disclosure might inequitably affect the health and safety of sex workers. Purpose: This study critically interrogates the interplay between the legal mandate for HIV disclosure and the routine health-conscious practices (e.g., HIV testing, condom use) of HIV-negative survival sex workers, with particular attention to inequitable health and safety outcomes. This study also qualitatively investigates the structural and social forces that mediate vulnerability to HIV infection and transmission among sex workers, their clients, and their non-commercial, intimate partners. Method: This study employed an adapted grounded theory approach to conducting and analyzing (n=9) open-ended, in-depth interviews with a convenience sample of currently working and recently exited sex workers who were clients at PEERS, an NGO offering services and support to sex workers in Victoria, Canada. Findings: The criminalization of HIV nondisclosure had no discernable influence on behavioural HIV risk factors or HIV testing. Participants lacked accurate knowledge of the legal mandate for HIV disclosure. HIV-related health literacy was low. Participants strongly supported HIV disclosure as a legal obligation – but only for exacting justice, and not for reliably offering protective health benefits. The uptake of high-risk sexual practices was driven almost exclusively by (i) extreme needs when servicing clients (e.g., drugs, childcare, money) and (ii) the rich symbolism of condomless sex in non-commercial, intimate partnerships. Participants reported differential degrees of entrenchment in the sex trade at various times in their working lives due to extreme needs. Participants emphasized the importance of ongoing HIV testing as a personal responsibility in order to monitor and maintain their sexual health. Participants identified increased uptake of HIV-related knowledge as affording the most significant protective health benefits against HIV infection. Implications: Lower levels of HIV-related health and legal literacies in the sample call for greater scrutiny of the impacts of initiatives such as ‘Seek and Treat for Optimal Prevention of HIV/AIDS’ (or STOP HIV/AIDS®) which target vulnerable populations across British Columba [BC]. Deeply entrenched sex workers have little recourse to exit the sex trade immediately upon receiving an HIV+ test result, especially in under-resourced social assistance milieux. Targeting this population for HIV testing facilitates the creation of a new caste of HIV+ potential criminals, despite the well-established, beneficial health outcomes at the individual and population levels from early commencement of antiretroviral treatment. Conclusion: Survival sex workers require special considerations in HIV pre-test counselling. The empowerment of sex workers can come firstly through the enhancement of HIV-related health – and legal – literacies. Full knowledge of the advantages and disadvantages of HIV testing will allow the consent for HIV testing to be truly informed. New HIV testing guidelines make BC the first province to recommend regular HIV screening for all adults. These guidelines also recommend exclusion of discussions of the criminalization of HIV nondisclosure in pre-test counselling for all patients. Re-thinking the consent for HIV testing among sex workers is crucially important for their immediate health and safety. / Graduate

Research on rates of HIV testing among individuals diagnosed with Bipolar Disorder (BPD) is limited, while HIV infection continues to rise among BPD individuals. The problem is that BPD individuals are at high risk for HIV infection due to non-adherence to treatment for bipolar disorder and manic episodes that can lead to high-risk behaviors. The goal of the study was to examine the association between selected demographic variables, having a bipolar diagnosis, engaging in high-risk behaviors, inability to afford treatment for bipolar disorder, non-adherence to treatment for bipolar disorder, and substance abuse, and their relationship to obtaining an HIV test (the dependent variable) for individuals with BPD. The epidemiologic triangle model served as the theoretical model to assist with interpreting findings. Data collected from 383 BPD diagnosed individuals from the 2007 National Health Interview Study were analyzed using binary logistic regression, chi-square, and multiple logistic regression methods. The results indicated that all 5 behavioral independent variables were significantly associated (p=.000) with obtaining an HIV test. Significant associations were also found for demographic variables (race, gender, and homelessness) as confounding factors that influenced HIV testing among BPD individuals. Implications for positive social change are increased education on the risks of HIV infection and the need for appropriate HIV testing among BPD diagnosed individuals in an effort to protect the health and welfare of this vulnerable population.

HIV incidence among Black men who have sex with men (BMSM) is extremely high in contrast to their estimated population size and compared to other racial groups. Researchers have established that a significant proportion of these new cases annually originate from HIV transmission by BMSM who are unaware of their HIV status. The purpose of the study was to assess the relationship between age, sexual behavior, social support, substance use, internalized homophobia, depression, and HIV test history in BMSM. Guided by the social ecological model (SEM) as the conceptual framework, a quantitative cross-sectional study was designed to analyze secondary data from the HIV Prevention Trials Network Study 061. Bivariate and multivariate logistic regression was used to estimate the association. The research goal was to identify strategies to engage BMSM with infrequent/nonexistent HIV testing history into testing services. While there was very little difference between the bivariate and multivariate models, the results indicated that BMSM who were younger in age, had lower levels of internalized homophobia, and were recruited at a particular study site were more likely to have tested for HIV in the past 12 months. The other variables did not show a significant relationship to HIV testing history. Implications for positive social change included informing HIV prevention and testing messages and strategies that will result in an increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories. This increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories will reduce the number of BMSM who are unaware of their HIV status and who may subsequently transmit HIV to their sexual partners unknowingly.

This study examined associations between the prevalence of HIV testing and factors or behaviors that influence HIV testing in U.S.A. 9th to 12th graders using the 2017 Youth Risk Behavior Surveillance Survey (YRBSS) data. Selection criteria was based on a positive report of sexual debut (Ever had sex? Yes/No). Outcome of interest was having ever tested for HIV. Independent risk factors included age, sex, grade, race, condom use, age at first sexual intercourse, number of lifetime sexual partners, use of contraceptives, use of drug or alcohol before last sexual activity and several other factors. Chi-square and logistic regression analyses were conducted to evaluate factors associated with HIV screening participation. HIV testing prevalence was 20.34%. Females (53.97%) were more likely to participate in HIV screening test than males (67.37% females versus 32.63% males) and had higher odds of testing (OR: 2.229; p <.0001). Those in 11th and 12th grade, aged greater than 16 and with multiple sexual partners had higher rates of HIV testing. Strongest associations with HIV testing were older age at 1st sexual intercourse, odds ratio (OR): 0.413; (p ≤.0001), having three or more sexual partners (OR: 2.023; p ≤.0001), being female (OR: 2.021; p ≤.0001), use of contraceptives (OR: 1.828; p ≤.0001) and describing grades in school as mostly A’s or B’s (OR: 0.696; p ≤.001).

South Africa has the highest global burden of HIV/AIDS with over 7.9 million people living with HIV/AIDS. Women and girls bear a disproportionate burden of the disease, which is potentially driven by low levels of correct HIV knowledge and high levels of gender-based violence. Our study aimed to determine the factors that influence uptake of HIV testing among reproductive aged women between 15-49 years in South Africa. Data from the 2016 (N=8514) iteration of the Demographic and Health Survey was utilized. Our outcome variable was HIV testing (yes/no) and our predictor variables were age at first sex, highest educational level, marital status, and recent condom use. We conducted descriptive statistics, chi-square analysis and T-test for our categorical and continuous variables (age at first sex), respectively. We further conducted multiple logistic regression to determine predictors of HIV testing. Frequencies, mean age at first sex, p-values, odds ratios, and 95% confidence intervals with alpha set to 0.05 were reported. Of 6489 women included in the final analysis, 5915 (91.15%) of women had ever been tested for HIV, 4964 (76.50%) and 746 (11.50%) had secondary and higher education as their highest educational level The mean age at first sex for women who had ever tested for HIV was 17.55 + 2732.7 years compared to 17.17 + 3119.7 years for women who had never tested for HIV (P<0.0001). The majority of respondents were never married (N=3415,52.63%) and 1746 women (26.91%) were married. Women who used condom during the last sex were 2883 (44.43%) compared to 3606 (55.57%) women who did not. The relationship between marital status and HIV testing (P=0.0009) and condom use and HIV testing (P=0.0471) were all statistically significant. After adjusting for confounders, we found that women with primary education had a 44.4% decrease in the odds of HIV testing and women with no education had a 61% decrease, compared to women to women who had secondary education (OR = 0.556, CI= 0.429-0.719, P<0.0001), (OR = 0.394, CI= 0.251-0.620, p<0.0001)., Women who had higher education had a 46% increase in the odds of HIV testing compared to women who had secondary education (OR = 1.460, CI= 1.049-2.033, P=0.0249). Being married and living with partner were associated with a 59.6% and 90% increase in the odds of having been tested HIV (OR = 1.596, CI= 1.276-1.996, P<0.0001) and (OR = 1.907, CI= 1.441-2.524, P<0.0001) compared to women who had never been married. No longer living together/separated was associated with a 4.5 times higher odds of HIV testing (OR = 4.491, CI= 1.826-11.045, P=0.0011) among women compared to never been married. Age at first sex was not significantly associated with HIV testing in the final model (OR = 1.028, CI= 0.995-1.062, P= 0.1020). Our study suggests the need to increase basic education up to secondary level and beyond among women in South Africa to increase uptake of HIV testing and reduce the burden of HIV/AIDS.

Introduction: HIV remains a leading cause of death globally, with over two-thirds of the cases in sub-Saharan Africa. Zimbabwe, a country located in East Africa, part of Sub-Saharan Africa, ranks in the top five countries with the highest prevalence of HIV in Africa (HIV prevalence in Zimbabwe estimated as 21.4% in 2019). Previous studies demonstrated HIV testing prevalence of 66.9% in East Africa. This study aimed to assess the prevalence of HIV testing amongst women of reproductive age in Zimbabwe, alongside some predictors of HIV testing amongst this population. Methods: Cross-sectional study design using the 2015 Demographic and Health Surveys (DHS) data for women aged 15-49. The prevalence of HIV testing as the outcome variable and the highest educational level, age at first sex, current marital status, and condom use as the predictor variables of interest were assessed. Descriptive statistics (frequencies, percents) and test of significance (using Chi-squared test)were conducted. Bivariate and multivariate logistic regression were completed to assess for the independent relationship between each predictor variable and HIV testing prevalence and, all predictor variables and HIV testing prevalence, respectively. Odds ratio estimates, 95% confidence intervals and p-values werereported. All analyses were performed using the Statistical Analysis System (SAS) version 9.4. The initial sample size included 9955 women. However, the effective sample size used in the statistical analysis was 7130 after accounting for missing variables. Results: About 9 in 10 women in the sample had ever been tested for HIV. Secondary education was the most prevalent highest level of education (64%). About 67% women had their first sex at age 15-19; peak incidence seen at ages 17 and 18 (15.3%). Multivariate analysis showed statistically significant associations between all independent variables and HIV testing (P-value Conclusion: Increasing highest educational level, age at first sex and condom use in Zimbabwe would likely increase the prevalence of HIV testing further. Focused education on the importance of HIV testing before the age of 15 will be beneficial in ensuring HIV testing as soon as sexual intercourse is established. Policy efforts are needed to address these HIV testing predictors. Causality is not implied.

<p>As of 2021, 38.4 million people worldwide are living with Human Immunodeficiency virus (HIV), with eastern and southern Africa having the highest prevalence. The efficacy of treatment is determined by identifying acute HIV infections (AHI) and prompting early antiretroviral therapy (ART) initiation to achieve viral suppression and reduce the risk of transmission. Existing rapid tests that detect host antibodies are affected by long seroconversions which allow the viruses to remain undetected until long after infection. On the contrary, highly sensitive nucleic acid amplification test (NAAT) based assays, serving as the gold standard for detection are restricted by their long turnaround time and high cost of implementation thus, restricting their use in low resource settings. Further, drug resistance cases and patient non-compliance to treatment may lead to HIV progression to aids; therefore, effective viral load monitoring is a critical component in the HIV care continuum. To address the gaps in viral load monitoring and early HIV detection, I propose to develop assays for handheld self-test platforms to detect low concentrations of HIV via two different approaches: 1) I will optimize an existing NAAT - based assay to semi-quantitatively detect HIV particles that were spiked in clinical samples and 2) I will Investigate the binding kinetics between HIV p24 antigen and Anti-HIV-1 p24 Antibody using the principle of Bio-layer Interferometry. Thus, I will lay the foundation for the development of a novel and highly sensitive p24 detection assay. Overall, this work will enable detection of ahi detection as well as support people living with HIV (PLHIV) management, all while remaining connected to healthcare and provider support. </p> <p><br></p>

No description available.

Appendix B (leaves 217-218), Appendix M (leaves 239-247) and Appendix O (leaves 253-259) in English and Amharic / The purpose of this research was to develop HIV testing Health Belief Scale (HTBS) that contains the constructs of Health Belief Model (HBM), and also to analyse HIV testing intention and behaviour among university students. The mixed method approach was used in phases. First, Literature review and in-depth interviews were conducted to develop item pool for HTBS, which was followed by content validity assessment by experts. In the second phase, a pilot survey was conducted on randomly selected 318 university students to refine the HTBS using item analysis and Exploratory Factor Analysis (EFA). Lastly, cross-sectional survey was conducted on representative sample of 612 students in order to further refine the HTBS using Confirmatory Factor Analysis (CFA) and also analyse predictors of HIV testing intention and behaviour. A total of 61 items was written for the HTBS and 23 of these were generated from the in-depth interviews. Content validity assessment by three experts indicated that the average content validity index (CVI) for the 61 items was 91.2% which was more than the recommended cut off point of 90%. The HTBS, after experts review, contained 64 items. EFA indicated that a five factor model which was roughly consistent with HBM was identified and 44 items were retained based on factor loading and reliability analysis. The Cronbach’s alpha for all the six constructs of HBM and HIV testing intention in the HTBS were >0,70. (susceptibility, benefit, self-efficacy and HIV testing intention) fitted the sample data based on chi-square test. However, all the seven constructs demonstrated RMSEA value of less than 0.08 and GFI value of >0.90 indicating acceptable fit. The final HTBS was reduced to 39 items based on factor loading and reliability assessment. All the constructs demonstrated a Cronbach’s alpha value >0.70 except for perceived susceptibility and cues to action. Analysis of multiple linear regression indicated that class year, perceived benefit, perceived self-efficacy and cues to action were significant predictors of HIV testing intention. However, only marital status and cues to action were significant predictors of recent history of HIV testing through analysis of binary logistic regression. / Health Studies / D.Litt. et Phil. (Health Studies)

HIV/AIDS is a growing concern in the African American community. From 2005 to 2008, there was a 12% increase in HIV/AIDS diagnoses among African Americans (CDC, 2010a). African American males have higher rates of HIV/AIDS diagnoses than any other ethnic or racial groups. In 2006, 65% of the HIV/AIDS cases among African Americans were from adult males (CDC, 2010a). These higher rates are in part attributed to higher levels of sexual risk-taking including unprotected sex, sex with multiple partners, and sex with high-risk partners. African American adult men get tested at almost the same rate (52%) as African American women 53% (CDC, 2007). HIV testing is important to the prevention of HIV/AIDS and can result in substantial reductions in risk behaviors (Marks, Crepaz, & Janssen, 2006; Weinhardt, Carey, Johnson, & Bickham, 1999). Masculinity, a man’s concept of what it means to be man, influences engagement in sexual risk-taking behaviors (Bowleg, 2004, Duck, 2009; Lichtenstein, 2004), as well as health-seeking behaviors (Hammond, Matthews, Mohottige, Agyemang, & Corbie-Smith, 2010; Royster, Richmond, Eng, & Margolis, 2006). One form of masculinity, hypermasculinity is related to sexual risk-taking behaviors, especially among young African American males. The purpose of this dissertation was to investigate the relationship between hypermasculinity and sexual risk-taking, and HIV testing among African American males. One hundred twenty-six African American male college students were recruited to participate in an HIV prevention intervention for African American women on a Historically Black College and University (HBCU) campus. Prior to participating in the intervention, participants completed a questionnaire with measures of hypermasculinity, sexual behavior, and HIV testing. The results showed that hypermasculinity predicted frequency of sex. Hypermasculinity and frequency of sex predicted lifetime HIV testing. Frequency of sex and the number of sex partners predicted current HIV testing (in the past month). The interaction between hypermasculinity and frequency of sex was marginally significant. The findings from this research may increase our understanding of sexual risk-taking, improve HIV testing initiatives, and be useful in the development of HIV prevention programs for African American heterosexual males.