Background Based on data from the Demographic Health Survey (SLDHS) 2008, this study aims to identify factors associated with HIV prevalence and HIV testing in Sierra Leone.

Methods The SLDHS 2008 was conducted nationwide and included anonymous HIV testing via dried blood spot. All participants that were interviewed and tested for HIV are included in this analysis. Multiple logistic regression was used to identify factors associated with HIV infection and with ever having a voluntary HIV test.

Results 6,475 respondents were interviewed and tested for HIV; the response rate to testing was 86%. The HIV prevalence was 1.5%, and 10% had voluntarily tested for HIV. Of those found HIV infected 78% had never taken a voluntary HIV test, and 86% were sexually active in the last 12 months among whom 96% did not use a condom at last intercourse. Among women aged 15–49 years 40% had their HIV test during antenatal care (ANC). In regression analysis people separated, divorced or widowed, with urban residence and having first sexual intercourse at age 17–18 years, were more likely to be HIV positive. Undiagnosed infection was associated with not knowing that abstaining from sex can reduce HIV infection. Voluntary HIV testing was associated with urban residence, being married, female, education beyond primary level, using condoms at last sex, and knowledge of HIV.

Conclusions The HIV prevalence in Sierra Leone is relatively low compared to many African countries; however the high proportion of undiagnosed infection highlights the potential for rapid escalation of the epidemic in this country. Currently few people access voluntary testing beyond antenatal care and condom use is low. Interventions to address both these issues, and access to antiretroviral therapy, need to be sustained or expanded to ensure Sierra Leone’s HIV epidemic remains stable.