Predictors of willingness to accept pre-marital HIV testing and intention to sero-sort marital partners; risks and consequences: Findings from a population-based study in Cameroon

IntroductionThe objectives of this study was to investigate and compare levels of acceptability of pre-marital HIV testing; and intention to sero-sort future marital and its associated factors among unmarried adults in two cities in Cameroon.MethodsA population-based survey was conducted simultaneously in the cities of Kumba and Buea, located in the Southwest region of Cameroon. Data were collected from September to October 2016 by trained interviewers who administered questionnaires to eligible and consenting unmarried adults aged 21–35 years. Data were weighted and logistic regression analyses performed to identify significant predictors. The level of statistical significance was set at pResultsA total of 1,406 respondents (767 in Kumba and 639 in Buea) participated in the study. In the pooled sample, the median age of respondents was 26 years (IQR = 23–29) and over half (54.8%) were males. Over 90% of respondents in both cities indicated their willingness to accept pre-marital HIV testing. Respondents who had previously tested for HIV in Kumba (AOR = 7.87; 95%CI, 4.02–15.44) were significantly more likely to accept premarital HIV testing than those who had never tested for HIV. In Kumba, older age (AOR = 0.42; 95%CI, 0.18–0.96) and those unemployed (AOR = 0.22; 95% CI, 0.06–0.76) were significantly less likely to accept pre-marital HIV testing. In Buea males (AOR = 0.64 95% CI, 0.45–0.89) who would test HIV negative would be significantly less likely to accept to marry an HIV positive partner. In Buea, respondents who indicated a moderate risk of contracting HIV (AOR = 1.71; 95%CI, 1.09–2.66, p = 0.018) were significantly more likely to accept to marry an HIV positive partner. The major limitation of the study was that a hypothetical situation was used to ask respondents about their willingness to accept pre-marital HIV testing rather than actual HIV test acceptance.ConclusionsMost respondents expressed their willingness to undergo pre-marital HIV testing. However, majority of respondents who would test HIV negative would refuse to marry their partner who tests HIV positive. These findings suggest that interventions to reduce HIV infection and fight against stigma and discrimination should be reinforced at community level.引言 本研究旨在调查并比较喀麦隆两座城市中未婚成年人对婚前HIV检测的接受程度，以及其血清学择偶（serosorting）意愿及其相关影响因素。 研究方法 本研究在喀麦隆西南地区的昆巴市与布埃亚市同步开展基于人群的调查。2016年9月至10月，由经过培训的调查员对符合纳入标准且已签署知情同意的21~35岁未婚成年人进行问卷调查以收集数据。研究对数据进行加权处理，并开展逻辑回归分析以识别具有统计学意义的预测因素，将统计学显著性水平设定为p。 研究结果 本研究共纳入1406名受访者，其中昆巴市767名，布埃亚市639名。合并样本中，受访者的中位年龄为26岁（四分位间距IQR=23~29岁），超过半数（54.8%）为男性。两座城市中均有超过90%的受访者表示愿意接受婚前HIV检测。在昆巴市，既往曾接受HIV检测的受访者（调整后比值比（Adjusted Odds Ratio, AOR）=7.87；95%置信区间（95% Confidence Interval, CI）=4.02~15.44）较从未接受过HIV检测的受访者更愿意接受婚前HIV检测，差异具有统计学意义。昆巴市中，年龄较大者（AOR=0.42；95%CI=0.18~0.96）以及失业人群（AOR=0.22；95%CI=0.06~0.76）接受婚前HIV检测的意愿显著更低。在布埃亚市，检测结果为HIV阴性的男性（AOR=0.64；95%CI=0.45~0.89）更不愿意与HIV阳性伴侣成婚，差异具有统计学意义。布埃亚市中，认为自身感染HIV的风险为中等程度的受访者（AOR=1.71；95%CI=1.09~2.66，p=0.018）更愿意与HIV阳性伴侣成婚。本研究的主要局限性在于，研究通过假设情境询问受访者的婚前HIV检测接受意愿，而非实际的检测接受行为。 研究结论 绝大多数受访者表示愿意接受婚前HIV检测。然而，大部分检测结果为HIV阴性的受访者会拒绝与HIV阳性的伴侣成婚。本研究结果提示，应在社区层面加强降低HIV感染率、对抗HIV污名化与歧视的干预措施。