At Risk but Untested: Discordance Between Behavioural HIV Risk and Recent HIV Testing Among Sexually Active Women and Men in Ghana, a Cross-Sectional Analysis of the 2022 Demographic and Health Survey
Godwin Adjei Vechey, Joel Torvike, Mary Lucky Kutsi, Augustine Suglo Dakurah, Millicent Edem AkpakaBackground
HIV testing finds the most undiagnosed infections when it reaches people whose behaviour puts them at risk. We examined whether recent HIV testing in Ghana follows behavioural risk among sexually active women and men.
Methods
We analysed 11,162 women and 4,437 men aged 15 to 49 who were sexually active in the past 12 months in the 2022 Ghana Demographic and Health Survey. Behavioural risk was defined as two or more partners, condomless sex with a non-marital, non-cohabiting partner, or a reported sexually transmitted infection or genital sore in the past 12 months. The outcome was an HIV test with receipt of the result in the past 12 months. We compared testing by risk status and used survey Poisson regression to estimate adjusted prevalence ratios (aPR). Reporting followed the STROBE statement.
Results
Overall, 41.0% (95% CI 39.8 to 42.3) reported at least one risk marker, and 86.1% (84.9 to 87.2) of them had not been tested in the past year (women 82.9%, men 92.3%). People at risk were tested less often than people at lower risk (13.9% vs 17.6%; ratio 0.79, 0.71 to 0.88) and received 35.5% of recent tests. After adjustment for age, marital status, pregnancy and socioeconomic characteristics, testing did not differ by risk status (aPR 1.01, 0.89 to 1.15). Women who were pregnant or had given birth in the past year received 64.9% of women’s recent tests, and outside that group 89.8% of at-risk women were untested. Among people at risk, never having heard of HIV self-test kits (women aPR 1.14, 1.08 to 1.21; men 1.07, 1.03 to 1.13) and lacking health insurance (women 1.05, 1.01 to 1.10; men 1.04, 1.01 to 1.08) were associated with being untested.
Conclusions
Recent HIV testing in Ghana does not follow behavioural risk: people at risk are tested no more often than others with similar characteristics. Women’s testing depends largely on antenatal care, and most at-risk men are untested. Testing approaches outside antenatal care, including self-testing and testing linked to care for sexually transmitted infections, are needed to reach people at risk.