HIV testing among adults in a high prevalence district in India.

Background: HIV testing is a key component of HIV control efforts. We examined the distribution of HIV testing in a population-based sample from Guntur district in Andhra Pradesh, which is estimated to have one of the highest prevalence rates of HIV in India.
Methods: A total of 12,994 persons (15-49 years of age) were interviewed in Guntur district. We assessed associations with the uptake of HIV test, place and reasons for undergoing HIV testing and awareness of voluntary counselling and testing centres (VCTC) among sexually active adults.
Results: The age-, sex-, urban- and rural-adjusted prevalence of HIV testing was 21.1% (95% CI: 19.1-23.2). The uptake of HIV testwas higher in women (27.2%) than in men (18.8%). Increasing education level, urban area residence and being in an occupation requiring mobility were significantly associated with uptake of the HIV test. A previous test for HIV was reported by 37.8% of men and 30.3% of women. The adjusted prevalence of VCTC awareness was 5.4% (95% CI: 4.3-6.4), being higher in men (9.2%) than in women (3.5%). Among those who had undergone HIV testing, 83.9% of men and 76.2% of women did so at a private sector health facility. Women were significantly more likely to under-go testing at VCTC/public sector facility (23.5%) than men (15%). More men (47.6%) than women (3.3%) reported undergoing testing voluntarily (p < 0.001). Women reported pregnancy (57.4%) as the most common reason for undergoing the test.
Conclusion: These population-based data highlight the patterns of HIV testing and their associations. The high proportion of HIV testing in the private sector suggests the need to strengthen counselling in this sector to enhance HIV prevention activities.