Social inequality and HIV-testing: Comparing home- and clinic-based testing in rural Malawi

摘要: Abstract The plan to increase HIV testing is a cornerstone of the international health strategy against HIV/AIDS epidemic, particularly in sub-Saharan Africa. This paper highlights problematic aspect that plan: reliance on clinic- rather than home-based testing. First, drawing DHS data from across Africa, we demonstrate substantial differences socio-demographic and economic profiles between those who report having ever had an test, never one. Then, using random household survey rural Malawi, show substituting for clinic-based may eliminate this source inequality tested not tested. result, which stable modeling frameworks, has important implications accurately equitably addressing counseling treatment programs comprise AIDS, promise shape future trajectory epidemic Africa beyond. "Even as vastly increased funding become available, most vulnerable its impact continue receive least access prevention, care services." (UNAIDS Reference Group Human Rights 2007:1) 1. Introduction Over last several years, dramatic increases AIDS reductions price ART have promised transform life-prospects HIV+ individuals poor countries. In all but handful countries, yet be realized, especially (SSA). main reason HIV-testing regimes, "critical gateway" (Rennie Behets 2006) counseling, remain mired two distinct problems. first, generally low prevalence continent, widely recognized. As shown Table 1, uses Demographic Health Surveys administered field 26 SSA only 16 percent respondents test (column 3). spite much larger percentage both declare their willingness 4), know where they can get one 5). It also recent 10 these example, people been asked whether discrete waves (administered average 2000 2005). During five years separate 15 49 year olds claimed 10.9 26.3 percent. second problem with contemporary regime related inequalities within given country. express itself ways. first spatial boundaries, settings signal ethnic political boundaries. social represented simplest terms by individuals' characteristics. type within-country focus article. three sections use order highlight scale testing, is, extent testees' characteristics differ untested counterparts. section briefly review key institutional responses problems: expansion Voluntary Counseling Testing (VCT); substitution "opt-out" traditional VCT approaches; emergence Finally, third section, time collected evaluate stronger or weaker association households' other words, available evidence identify moving out clinics would make process more equitable different groups. …