Helleringer, S. AIDS and Behavior (October 2016), doi: 10.1007/s10461-016-1577-5.
This study used survey data (2009–2015) to examine why adolescents are tested for HIV at lower rates in 21 West and Central African countries. Low socioeconomic status (SES), stigma and discrimination, reduced social support, marriage power dynamics, and lack of education contribute to high adolescent fertility rates and lead to reduced uptake of HIV testing services (HTS) during antenatal care (ANC); this in turn leads to higher rates of mother-to-child transmission (MTCT). Findings across countries showed that >80 percent of women attended at least one ANC visit during their pregnancy. Adolescents were significantly less likely to receive HTS in 12 of the 21 countries. In several countries, marriage was associated with increased or decreased likelihood of receiving HTS; but for most countries there was no association. School attendance and household wealth were both associated with increased HTS. Women living in urban areas who attended ANC during the first trimester, and who attended ANC multiple times throughout the pregnancy, were also more likely to receive HTS. Reduced SES (in 8 of 12 countries) and low knowledge of MTCT (in 11 countries) were strongly associated with lower adolescent HTS uptake. The authors suggested that targeting low-income households, implementing education campaigns, providing incentives for ANC attendance, and developing interventions that prompt providers to provide adolescent HTS may help to address the HTS gap among adolescents.