Gender Disparities in the Utilization of Voluntary Counselling and Testing Services for HIV In Nairobi Province, Kenya
Otele, Judith Karimi
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HIV/AIDS has become a major public health concern worldwide. Its impact threatens the very existence of human race. HIV/AIDS has been shown to impact on men and women differently. In the absence of effective treatment and/or vaccine, behaviour change remains the most viable way of controlling and preventing the pandemic. Voluntary Counselling and Testing (VCT) has been shorn to play a major role in behaviour change for both seronegative and seropositive persons, which lead to safer sexual practices. Although the first case of HIV/ ,a was reported ;n 1984, VCT uptake has been low, especially AIDS in Kenya was reported among women. A combined retrospective and descriptive cross-sectional study was carried out in Nairobi, Kenya. The study set out to establish if there are gender disparities in the utilization of VCT services and factors underlying this trend. Data were obtained from clients' records for the period between September 2002 and September 2003 in 29 conveniently selected VCT sites. A total of 54267 records were reviewed. In addition, 401 respondents selected on a time-location serial sampling strategy were interviewed using a standard questionnaire. 58 counsellors (2 from each VCT site) and three technical advisors (each from NASCOP, Liverpool and CDC) were arse interviewed Data analysis was dome using Epi-info 2002 and MS-Excel. The association between variables was tested using Chisquare at 0.05 level of significance. In both the distribution of VCT users were males (53%) and females (47 %). Among the counsellors, 77.6% were females. Most (32%) VCT users were aged 21-25 years. With regard to age, there were similarly more males in all age groups except among those aged 16-25 years, where females constituted 53% of the users. The distribution of VCT clients by gender was representative of distribution of Nairobi residents by gender, which is 54% for males and 46% for females. VCT utilization was strongly associated with age (p<0.001), education (p<0.001), occupation (p<0.001) and marital status (p<0.001), with most clients being between 21-30 years, educated, employed and single, but with more males reporting better employment, education and single marital statuses than females. The main reason reported to have influenced VCT utilization was the need to know one's status and plan for future (79%). Signpost (55%) served as the most important source of VCT information for both males and females. More males (73%) than females (27%) formed a source of VCT information for their sexual partners. Condom use and acceptance was relatively low (22%) among all clients, although slightly more males than females reported higher condom use with both steady (54%) and non-steady partners (69%). Both males and females were less likely to use condom with steady partner (47%). Among those clients who received positive test results, 64% were women. Fear of positive test outcome (95.5%) and stigma associated with HIV/AIDS were identified as the greatest barrier to VCT utilization, especially among women. Disclosure about visiting VCT centre for services among clients and their sexual partners was very low (30.6%). VCT services can be made more effective through employing more counsellors and paying them well (65.5%), creating more awareness about HIV and VCT (65.5%), destigmatizing HIV (20.7%) and providing ARVs (17%). The study concluded that there were gender disparities in VCT utilization. Stigma associated with HIV needed priority attention, especially among females, if VCT was to prove an effective tool in HIV control and prevention. The results of this study may be useful in plamiing, implementation, monitoring and evaluation of VCT utilization. It may also serve as a guide in the provision of accurate information, education, and communication about VCT to Kenyans for effective policy formulation and improved community participation in the fight against the HIV/AIDS pandemic.
- MST-Zoological Sciences