Introduction HIV remains the leading cause of death among Malawian adults. Nationally, 72% of women and 51% of men report having had an HIV test. In the Central Region, 9% of women and 6% of men are estimated to be HIV-infected. Making the decision to be tested and treated for HIV would be critical to implementation of the treatment-as-prevention approach to HIV control.
Methods Using a standardised instrument and electronic data capture, our research program, Umoyo wa Thanzi (UTHA, Health for Life), interviewed reproductive-age women (n = 1030) and their male partners (n = 442) living in rural Lilongwe District. We assessed relationships between decision-making factors and timing of the most recent HIV test.
Results Both HIV knowledge and HIV testing access were high, although women differed from men. The majority (73%) knew that people with HIV may appear well (women 70%, men 80%, p = 0.001) and (88%) knew that condom use prevents HIV transmission (women 86%, men 91%, p = 0.004). Ninety percent reported ever having tested for HIV, and recent testing was more common in women: 65% of women and 59% of men had been tested in the past year (p = 0.019). Fewer women (74%) than men (89%) knew that their partner had tested (p < 0.001), and fewer women (22%) than men (27%) reported concerns about testing confidentiality (p = 0.044). Concerns about knowing HIV-status (overall 15%) or fearing partner’s response (overall 14%) were uncommon. Decision-making factors—knowing about partner’s testing, concerns about confidentiality or about knowing HIV-status, or fears of partner’s response—were not associated with HIV test timing for women or men.
Conclusion Women had and men had differential HIV knowledge and decision-making influences in rural Malawi, though these did not predict differential testing behaviours. Planned work by our team includes comprehensive, community-based HIV testing; such testing will be accompanied by referrals for ART.
Disclosure of interest statement The authors have no conflicts of interest or financial disclosures to report.