Correlates of HIV testing among youth in three high prevalence Caribbean Countries Beverly E. Andrews, Doctoral Candidate University of Southampton, School of Social Sciences, Division of Social Statistics 1. Background 2. Data and Methods 3. Results. 3. Results cont’d Introduction An estimated 230,000 persons were living with HIV/AIDS in the Caribbean the majority of them are not aware of their status. Less than one-third of the persons living with HIV/AIDS n the Caribbean know their serostatus. Youth are at heightened risk of HIV infection because of socio-cultural norms and attitudes which promote risky behaviours. Young women are at increased risk of infection as their prevalence rates are about three times higher than the rates for young men. Studies on HIV testing in the Caribbean have not examined the levels of testing and determinants of HIV testing among youth years. Previous studies have focused on adults and have used non-representative convenience samples. This is the first study to examine HIV testing behaviours among youth using population based national samples. Objectives of study 1.To describe the prevalence of HIV testing among Caribbean youth 2.To identify the factors influencing HIV testing among Caribbean youth 3.To discuss the need to increase HIV testing among Caribbean youth and address the gender inequalities and social structural barriers in accessing HIV testing services. NEED FACTORS (e.g. Perceived risk, STI symptoms, health status, HIV status) TRADITIONAL PREDISPOSING FACTORS: (e.g. Socio- demographic characteristics) OUTCOME: EVER TESTED FOR HIV VIRUS VULNERABLE PREDISPOSING FACTORS: (e.g. Health beliefs, attitudes, HIV knowledge, and awareness, HIV risk behaviours,) ENABLING FACTORS: (e.g. income, health/medical insurance, use and access to medical care/health provider, health care institutions, clinic characteristics Theoretical framework: Andersen’s behavioural model of health service utilization Data Sources Data for this study were derived from nationally representative cross-sectional sample surveys of the AIDS Indicator Survey (AIS) of Guyana and the Demographic and Health Surveys (DHS) of Dominican Republic and Haiti. Face to face interviews conducted with all eligible men aged years and women aged years. The DHS and AIS collect information on socio-demographic characteristics, knowledge about HIV prevention, attitudes and behaviours, experiences with HIV testing, health and nutrition, fertility, reproduction, marriage and sexual activity. Sample and survey design Survey Sample design Two stage weighted, stratified sample. First stage comprise the selection of clusters of enumeration districts from the national census frame and Second stage entails the systematic selection of households within selected clusters. All men and women in selected households are eligible for interview. Study population Analysis limited to youth years who had ever heard of AIDS, heard of HIV testing and were sexually experienced. Final analysis sample sizes in each country: 875- Guyana 20,078 - Dominican Republic 6,821 - Haiti Measures Outcome measure: Ever tested for HIV? (yes/no) Independent variables: Traditional Predisposing factors: age, gender, marital status, educational attainment, residence Enabling factors: Socio-economic status Vulnerable predisposing factors: HIV knowledge, stigma attitudes, HIV risk behaviours, exposure to media Statistical Analysis Bivariate analyses: Used chi-squared test of association to differentiate the characteristics of HIV testers and non testers. Multivariate analyses: Multivariate regression modelling using backward elimination was carried out which accounted for the clustering, stratification and weighting in sample. Odds ratios and 95% confidence intervals are presented with robust standard errors. Analysis using STATA. 1.Socio-demographic characteristics of youth ever tested 60% of sample sexually experienced Mean age of sample was 20 years Proportion of females ranged from 48% in Dominican Republic to 64% in Haiti. 2.Prevalence of HIV Testing among Caribbean youth Percent of youth years ever tested for HIV 3.Model under which HIV testing was received 4. Discussion Low levels of HIV testing among Caribbean youth Majority of youth not being tested voluntarily Predisposing factors were primary correlates of HIV testing in youth. In Haiti enabling factor socioeconomic status was a significant correlate Gender inequalities faced by males and structural barriers by rural youth in accessing HIV testing Youth engaging in high risk behaviours show low levels of HIV testing 5. Policy Implications It is recommended that policy makers making HIV testing more accessible to youth notably males, youth under 18 and youth residing in rural areas. Structural barriers and inequalities faced by these youth in accessing HIV testing services should be investigated and incorporated in the design of interventions developed to increase uptake of testing. Low perceived risk of HIV infection and attitudes and beliefs surrounding HIV should also be addressed. Promoting routine testing among youth may be worth considering. Acknowledgements The author thanks supervisors Prof.N Madise and Dr. F Johnson. The Global Health Population Poverty and Policy GHP3 for funding to attend the APHA 2010 Conference. 4.Characteristics of Caribbean Youth ever tested for HIV Youth less likely to test for HIV were : Males Youth under 18 years Rural youth Youth more likely to test: Youth with more partners Married youth Youth who knows PLWA