Bergenström, Anne Maarit; (2002) HIV testing and prevention for women of reproductive age. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Voluntary counselling and HIV testing (VCT) policies for women in the UK have predominantly targeted antenatal clinic (ANC) attenders. VCT is not actively offered in termination of pregnancy assessment clinics (TOPCs) or family planning clinics (FPCs), despite threefold HIV seroprevalence in the former and reported preference for pre-pregnancy testing by antenatal women. In light of increasing seroprevalence among women, this cross- sectional study examined VCT for HIV among ANC, TOPC and FPC attenders with a structured questionnaire. The findings were compared for possible differences between the three groups. Independent predictors of HIV testing intention in each group were determined by multivariate analyses adopting the Health Belief Model as a theoretical framework. Knowledge of testing procedures, vertical transmission and therapeutic interventions was low. HIV risk disclosure was highest among TOPC women. While 67% of all women endorsed universal HIV test offer, actual test intention was lower in ANCs (36%), FPCs (10%) and TOPCs (18%; X2= 44.832, p= .0001). Predictors of testing intention were: reported partner test intention, worry about past risks (TOPC and FPC groups), reassurance from testing, prior HIV testing, endorsement of universal HIV test offer, comfort in discussing sensitive life-style information with health staff, not minding to think about HIV during clinic attendance and clinic attended (ANC). Of all predictors, only partner HIV testing intention emerged as a predictor in all three cohorts, although its frequency was low. These findings suggest that possible expansion of VCT service in TOPCs and FPCs may not increase test uptake unless the above predictors are appreciated in policy planning and service provision. Operations research to enhance the acceptability of VCT services by incorporating the present findings is required. Based on a critical examination of the limitations of the present study, further research is recommended to develop a specific theoretical model to explain HIV testing decisions.

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