Date of Graduation

2014

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Ilana RA Chertok

Committee Co-Chair

Michael Andrew

Committee Member

Usha Sambamoorthi

Committee Member

Arif Sarwari

Committee Member

R Constance Wiener

Abstract

Introduction: In sub-Saharan Africa, HIV/AIDS is one of the leading causes of mortality that disproportionately affects women and children. In this sub-region, 57% of those living with HIV are women and is home for 90% of children under the age of 15 that are living with HIV. This study examined socio-demographic and behavioral factors associated with HIV testing and HIV seropositivity among women and children using nationally representative data.;Methods: The study employed a cross-sectional study design using data from Demographic and Health Survey and AIDS Indicator Survey, conducted between the years 2006 and 2012 from 25 countries in sub-Saharan Africa. The main outcomes of interest for the three studies included testing and receiving test results of HIV among women 15-45 years (n=255,048), HIV seropositivity among women 15-45 years (n = 155,356), and HIV seropositivity in children 0-14 years (n=15,034). Multilevel modeling techniques were employed to explore the association of these outcomes and individual, community and country level factors.;Results: With respect to HIV testing and reporting test results, women who were married or who had been married were more likely to report HIV testing and receiving test results,. Higher parity was associated with higher likelihood of HIV testing. The odds of HIV testing and receiving test results reduced with decreasing education and decreasing household wealth status. Employed women and women with moderate and high media exposure were more likely to report HIV testing and receipt of test results. Rural residents had reduced odds HIV testing and receiving test results (Adjusted odds ratio, aOR=0.79; 95% CI 0.69, 0.90). The odds of HIV testing and receipt of test results was lower for women with high enacted HIV/AIDS stigma (aOR=0.77; 95% CI 0.72, 0.81). A one-unit increase in a country's expenditure on public health (% of GDP), the odds of testing and receipt of test results increased by 48% (aOR=1.48; 95% CI 1.19 to 1.83). In terms of HIV seropositivity, factors that include age, marital status, parity, and pregnancy status, type of residence, stigma, and age at first sex, involvement in premarital sex and having multiple partners were significantly associated with higher odds of testing HIV positive. Factors associated with HIV seropositivity in children 0-14 years include maternal HIV seropositivity (Adjusted odds ratio, aOR = 16.61; 95% CI 16.40, 16.82), maternal age at birth, maternal marital status, maternal employment status and maternal level of HIV/AIDS awareness.;Conclusion: Testing for HIV and receiving test results and HIV seropositivity among women and children in sub-Saharan Africa are influenced by a complex set of socio-demographic and behavioral characteristics at different levels. The development of effective intervention to prevent HIV infection in these groups requires a much deeper exploration of the influence of these factors.

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