Abstract:
With evidence on the benefits of the early
diagnosis of HIV and the initiation of
antiretroviral therapy (ART) mounting, HIV
testing is a primary entry point for the
prevention of HIV transmission. In sub-
Saharan Africa, the scale-up of affordable
and readily available HIV testing and
treatment has allowed the region to make
notable progress in the prevention of
HIV/AIDS. UNAIDS has recently proposed a set
of ambitious targets that, if achieved, are
predicted to end the AIDS epidemic by 2030.
The targets, known as 90-90-90, call for 90
percent of all people living with HIV (PLHIV)
to know their status, 90 percent of those to
receive antiretroviral therapy (ART), and 90
percent of ART recipients to achieve viral
suppression.
This report focuses on the “first 90” in the
90-90-90 target, and seeks to answer four
main questions. First, how does testing
uptake vary by serological status, sex, and
country? Second, what proportion of PLHIV are
estimated to know their status, and how does
this vary by sex, country, timing of the
survey, and size of the epidemic? Third, what
is the role of maternal care in HIV testing
uptake among HIV-positive women? And fourth,
what background and behavioral
characteristics are associated with ever
being tested for HIV among PLHIV?
This report analyzes data from Demographic
and Health Surveys and AIDS Indicator Surveys
fielded since 2006 in 15 sub-Saharan African
countries where voluntary serological testing
was conducted: Cameroon, Congo (Brazzaville),
Ethiopia, Gabon, Kenya, Lesotho, Malawi,
Mozambique, Namibia, Rwanda, Swaziland,
Tanzania, Uganda, Zambia, and Zimbabwe. In
the countries studied, we find that between
23 percent and 71 percent of PLHIV are
estimated to know their status; on average
across countries, after adjusting for ART
coverage, 51 percent of PLHIV are estimated
to know their status. The results reflect
encouraging progress, but the achievement is
far short of the 90 percent goal set by
UNAIDS for 2020. Several gaps in HIV testing
coverage still exist, particularly among
adolescents, rural residents, and the
poorest. While the need continues to target
demographic groups at greatest risk of HIV,
additional interventions focused on reaching
the most socially vulnerable populations are
essential.