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O18.4 Sex differences in hiv knowledge, testing behaviours, and decision making influences in rural malawi
  1. A Norris1,2,
  2. A Esber1,
  3. E Chemey3,
  4. J Phuka4,
  5. JJ Kwiek5,
  6. AN Turner2
  1. 1Division of Epidemiology, College of Public Health, Ohio State University, Columbus OH, USA
  2. 2Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Ohio State University, Columbus OH, USA
  3. 3Child Legacy International, Malawi
  4. 4Department of Community Health, University of Malawi College of Medicine
  5. 5Department of Microbial Infection & Immunology, College of Medicine, Ohio State University, Columbus OH, USA


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.

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