Introduction
Method
Study Eligibility Criteria
Sources of Information
Search Strategy
Data Collection
Data Abstraction and Quality Assessment
External validity
| |
Representativeness of sample | • Was the sample representative of the target population (consecutive or random sample) or were all of the population eligible? |
Percentage of selected individuals whom agreed to participate | • Were at least 80 % of those eligible to participate in all groups (where relevant) recruited? |
Internal validity
| |
Performance bias | • Was there an objective method for measuring whether HIV testing took place? Was there at least one non self- report measure, e.g. clinic records? |
Detection bias | • Were measures of psychological variables objective or of established reliability and validity? |
Attrition bias | • Were at least 80 % of those invited to participate in the study included in final analysis (for intervention/cohort studies)? |
Selection bias/control of possible confounding variables | • Were possible confounding variables (a) measured (b) considered in the analysis? |
Statistical Analysis
Results
Study Characteristics
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Adam et al. [31] | Australia Urban and rural areas MSM aged ≥16 years | Cross-sectional Convenience sampling Response rate 73.7 %
n = 309 Mean age 29.3 years |
HIV-related knowledge: 8 items. Dichotomous response options
Perceived susceptibility to HIV: 2 items. Likert scale, α = 0.91
Perceived severity of HIV
1 item. Likert scale
Perceived pros of testing: 10 items. Likert scale, α = 0.83
Perceived cons of testing
11 items. Likert scale, α = 0.81
Positive vs. negative attitudes to testing: 5 item. Likert scale, α = 0.91.
Subjective norms: 5 items. Likert scale, α = 0.92
Perceived behavioural control
5 items. Likert scale, α = 0.91
Fear of testing: 11 items. Likert scale, α = 0.89
Perceived stigma
15 items. Likert scale, α = 0.85 Scales developed for current study | Self-reported previous HIV testing: Not tested/non routine testing/ Moderate routine testing/ Highly routine testing |
HIV-related knowledge: significantly associated with testing routine (univariate p < 0.001; multivariate p < 0.05)
Perceived susceptibility to HIV, Ns
Perceived severity of HIV, Ns
Perceived pros of testing: Significantly associated with testing routine (univariate p < 0.001; multivariate, p < 0.001). Moderate-routine, no-routine and non-testers perceived less pros than highly routine testers (AOR 0.20, p < 0.001; AOR 0.15, p < 0.001; AOR 0.09, p < 0.001, respectively)
Perceived cons of testing: significantly associated with testing routine in univariate (p < 0.001) but not multivariate analysis (ns)
Positive vs. negative attitudes to testing: significantly associated with testing routine (univariate, p < 0.001; multivariate, p < 0.01). Moderate-routine, no-routine and non-testers perceived less positives of testing than highly-routine testers (AOR 0.54, p < 0.05; AOR 0.36, p < 0.001; AOR 0.36, p < 0.01, respectively)
Subjective norms: significantly associated with testing routine in univariate (p < 0.001) but not multivariate analysis (ns)
Perceived behavioural control: significantly associated with testing routine (univariate, p < 0.001; multivariate, p < 0.001). Moderate-routine, no-routine and non-testers perceived less behavioural control than highly-routine testers (AOR 0.32, p < 0.05; AOR 0.27, p < 0.01; AOR 0.16, p < 0.001, respectively)
Fear of testing: significantly associated with testing routine in univariate (p < 0.001) but not multivariate analysis (ns)
Perceived stigma: significantly associated with testing routine in univariate (p < 0.001) but not multivariate analysis (ns). No-routine testers perceived more stigma than highly-routine testers (AOR 1.91, p < 0.05) |
Andrinopoulos et al. [33] | Jamaica HIV-negative Male inmates of correctional facility aged ≥18 years Voluntary testing while incarcerated | Cross-sectional Stratified random sampling by facility section Response rate 89 %
n = 298 Age range 18–68 years |
Perceived current risk of HIV infection: 1 item. Likert scale | Accepting HIV test |
HIV coping self-efficacy: high coping self-efficacy associated with higher likelihood of testing (OR 2.05, 1.43–2.93, p < 0.001; AOR 1.86, 1.24–2.78, p = 0.003)
External stigma: Ns (OR 1.03, 0.67–1.59, p = 0.90)
Internal stigma: Ns (OR 1.09, 0.84–1.41, p = 0.51)
HIV testing stigma: low testing stigma associated with higher likelihood of testing (OR 1.69, 1.17–2.44, p = 0.01; AOR 1.71, 1.05–2.79, p = 0.03)
Perceived current risk of HIV infection: Perceiving risk associated with higher likelihood of testing (OR 1.94, 1.27–2.97, p = 0.002; AOR 2.51, 1.57–4.01, p < 0.001)
Perceived social support: Ns (OR 1.11, 0.83–1.49, p = 0.47)
HIV-related knowledge: Ns (OR 1.21, 0.92–1.60, p = 0.18) |
Berendes and Rimal [34] | Malawi Urban areas Adolescents and adults resident in selected townships | Cross-sectional Systematic random sampling
n = 890. 407 (45.7 %) males, 483 females (54.3 %). Age range 12–88 years |
HIV-related knowledge: 12 items. Dichotomous response options, α = 0.59
Self-efficacy: 8 items. Likert scale, α = 0.90
Stigma towards people living with HIV (PLWH): 9 items. Dichotomous response options, α = 0.65 All developed for current study | Self-reported previous HIV testing |
HIV-related knowledge
Positive association with previous testing (B = 0.03, 0.01–0.05, p < 0.05)
Self-efficacy
Positive association with previous testing (B = 0.47, 0.16–0.78, p < 0.01)
Stigma towards PLWHA
Negative association with HIV testing (B = −0.85, −1.64 to −0.06, p < 0.05) |
Berkley-Patton et al. [35] | U.S.A. Urban areas African American, church-affiliated | Cross-sectional Convenience sampling. n = 210: 77 (36.6 %) males, 133 (63.3 %) females. 18–87 years. 188 (89.4 %) African Americans, 22 (10.6 %) other ethnicity | Self-reported previous HIV testing: Lifetime and Last 12 months |
HIV-related knowledge
Significant association with lifetime HIV testing in univariate (r = 0.19, p < 0.01) but not multivariate analysis (AOR 1.05, 0.83–1.33, ns)
Intention to test annually for HIV
Significant association with lifetime testing in univariate (r = 0.17, p < 0.05) but not multivariate analysis (AOR 1.03, 0.94–1.13, ns) Significant association with testing in last 12 months (r = 0.33, p < 0.01; AOR 1.21, 1.08–1.35, p < 0.01) | |
Bogart et al. [67] | South Africa HIV-negative individuals using STI clinics | Cross–sectional Convenience sampling, n = 783 471 (60.2 %) males, 312 (39.8 %) females. Mean age = 28.9 years. 736 (94 %) Black African, 47 (6 %) other ethnicity |
HIV-related knowledge
11 items with dichotomous response options. Adapted from [140], α = 0.71
HIV-related stigma
11 items on Likert scale From [141], α = 0.71
Belief in AIDS-related genocidal conspiracy
1 item developed for current study
Knowing someone
with HIV/AIDS
| Self-reported previous HIV testing |
HIV-related knowledge
Ns (AOR 1.06, 0.98–1.14). 1.HIV-related stigma
Ns (AOR 0.82, 0.60–1.10)
Belief in AIDS-related genocidal conspiracy
Belief in genocidal conspiracy significantly associated with less testing (AOR 0.85, 0.74–0.98, p < 0.05)
Knowing someone with HIV/AIDS
Ns (AOR 1.23, 0.89–1.69) |
Bohnert and Latkin [68] | U.S.A. Urban. Aged ≥18 years. African Americans. High drug use rate. No recent enrolment in HIV behavioural intervention | Cross-sectional Respondent-driven sampling
n = 1430 880 (61.5 %) males, 551 (38.5 %) females |
Belief in AIDS-related conspiracy theories
2 items on Likert scale Developed for current study
Depression
20 items on Likert scale From [142]
α = 0.90 | Self-reported previous HIV testing |
Belief in AIDS-related conspiracy theories
Individuals with conspiracy beliefs less likely to have never tested (OR 0.51, 0.28–0.92, p < 0.05; AOR 0.43, 1.30–4.30, p < 0.01)
Depression
Individuals with depression more likely to have never tested (OR 1.38, 0.90–2.12, ns; AOR 1.61, 1.02–2.52, p < 0.05) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Burchell et al. [69] | Canada Testing while incarcerated Adult inmates of correctional centres (serving <2 years) | Cross-sectional Stratified sampling by correctional centre. Response rate 89 %, n = 597 439 (73.5 %) males, 158 (26.5 %) females Age 18–40+ years |
Perceived future risk for HIV infection (while incarcerated)
1 item on Likert scale
Attitude towards
mandatory HIV testing policy
1 item on Likert scale Developed for current study
Knowing someone with HIV/AIDS inside prison
| Self-reported HIV testing in last year while incarcerated |
Perceived future risk for HIV infection (while incarcerated)
Ns (AOR 2.20, 0.98–4.90, p = 0.06)
Attitudes towards mandatory HIV testing policy
Individuals who agreed with mandatory testing for correctional staff and inmates more likely to have tested (AOR 2.00, 1.20–3.30, p = 0.01)
Knowing someone with HIV/AIDS inside prison
Among 18–29 year olds, significantly associated with testing (AOR 2.70, 1.30–5.70, p = 0.01). Among 30–39 year olds, significantly associated with testing (AOR 2.90, 1.30–6.60, p = 0.01). Among >40 year olds, ns (AOR 0.23, CI 0.05–1.10, p = 0.06) |
Corno and de Walque [36] | Lesotho. Urban and rural areas. Women aged 15–49, men aged 15–59. | Cross-sectional Stratified sampling by district. n = 20,833, 6114 (29.3 %) males, 14,719 (70.7 %) females |
Stigmatising attitudes to PLWHA
5 items on Likert scale Developed for current study
α = 0.79 Data from 2004/2009 Demographic and Health Survey (LDHS) | Self-reported previous HIV testing |
Stigmatising attitudes to PLWHA
Negative association between stigmatising attitudes and testing for women (β = −0.03, SE = 0.004, p < 0.01; βadj = −0.03, SE = 0.01, p < 0.01) and men (β = −0.04, SE = 0.01, p < 0.01; βadj = −0.02, SE = 0.01, p < 0.01) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
***Creel and Rimal [37] | Namibia Rural and urban areas Sexually active individuals ≥15 years old | Cross-sectional Systematic random sampling
n = 2671 1211 (45.3 %) males, 1459 (54.7 %) females |
Perceived susceptibility
1 item on Likert scale
Self-efficacy
4 items on Likert scale
α = 0.73 | Self-reported previous HIV testing |
Perceived susceptibility
Higher perceived susceptibility associated with less likelihood of testing (AOR 0.89, 0.82–0.97, p < 0.01)
Self-efficacy
Higher self-efficacy associated with greater likelihood of testing (AOR 1.24, 1.04–1.48, p < 0.05) |
Cremin et al. [38] | 13 countries in Sub-Saharan Africa. Women aged 15–49, men 15–59 Permanent residents of selected households | Cross-sectional Cluster sampling Response rate, 81.9–98.1 %. n = 134,965. 65,867 (48.8 %) males, 69,098 (51.2 %) females |
Stigmatising attitudes to HIV
1 item on Likert scale | Self-reported previous HIV testing and collection of results |
Stigmatising attitudes to HIV
HIV testing lower among those expressing stigmatising attitudes: in women in Rwanda (AOR 0.75, 0.60–0.93) Ns relationship between stigmatising attitudes and testing in HIV: in women in Zimbabwe (AOR 1.13, 0.91–1.41) and Senegal (AOR 0.60, 0.34–1.06) and in men in Rwanda (AOR 0.90, 0.70–1.16), Zimbabwe (AOR 0.96 (0.72–1.29) and Senegal (AOR 0.55, 0.21–1.41) |
Das et al. [39] | India. Urban and rural areas Married men aged 15–54. | Cross-sectional Cluster sampling. n = 39257. 87 % response. 21386 (54.5 %) aged 36–54 years |
Knowledge about HIV routes of transmission and prevention
Knowledge about HIV risk behaviours and prevention
| Self-reported previous HIV testing |
Knowledge about HIV routes of transmission and prevention
Significant association with testing (AOR 1.18, 1.12–1.23, p < 0.01)
Knowledge about HIV risk behaviours and prevention
Ns association with testing (AOR 1.03, 1.00–1.07) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Delva et al. [70] | Bosnia and Herzegovina, Macedonia, Serbia and Montenegro. Urban. High school students | Cross-sectional Cluster sampling
n = 2150. 1022 (47.5 %) males, 1128 (52.5 %) females. Age range 12–24 years (M = 16.7 years) |
Self-assessed health
1 item on Likert scale
Suspicion of having had an STI
1 item with dichotomous response options
Knows friend or relative with HIV
1 item with dichotomous response options | Self-reported previous HIV testing |
Self-assessed health
Individuals who self-assessed health as ‘poor/very poor’ more likely to have tested (AOR 6.59, 1.45–29.84, p = 0.01)
Suspicion of having had an STI
Individuals who did not suspect they had a previous STI less likely to have tested (AOR 0.29, 0.11–0.79, p = 0.01)
Knows friend or relative with HIV
Knowing a friend/relative with HIV associated with testing (AOR 8.67, 3.77–19.95, p < 0.0001) |
Desai and Rosenheck [71] | 18 sites across 9 states, U.S.A. Homeless adults with serious mental illness. Not involved in another treatment program | Prospective cohort. Recruited through outreach services. n = 5890. 3599 61.1 %) males, 2289 (38.9 %) females. Mean age = 38.7 years. 2482 (42.2 %) White, 3401 (57.8 %) other ethnicity. 14.8 % attrition. |
Worry about getting AIDS
1 item on Likert scale | Getting tested for HIV in 3-month follow-up period after contact with programme |
Worry about getting AIDS
Extent of worry positively associated with HIV testing (β = 0.06, SE = 0.03, AOR 1.06, p < 0.04) |
Dorr et al. [92] | U.S.A. Voluntary HIV testing at student clinic Heterosexual university students | Cross-sectional Convenience sampling. n = 111 42 (38 %) males, 69 (62 %) females Mean age 20.3 years. 103 (93 %) White/European, 5 (4.5 %) Asian American, 1 (1 %) African American, 2 (1.5 %) other ethnicity |
Health Belief Model
Perceived susceptibility
1 item ‘likelihood of testing positive for HIV in lifetime’ on Likert scale
Perceived severity
1 item on Likert scale
Perceived benefits
1 item on Likert scale
Perceived barriers
1 item on Likert scale
Perceived norms
1 item on Likert scale Developed for current study
Consideration of Future Consequences (CFC). Individuals with higher CFC more influenced by long-term consequences of behaviour, from [143]. 12 items on Likert scale. α = 0.84 | Undertaking HIV test the same day at the student clinic (comparison group: never having an HIV test) |
Health Belief Model
Perceived susceptibility
Ns (AOR = 0.01, p = 0.99)
Perceived severity
Ns (AOR = 0.96, p = 0.93)
Perceived benefits
Greater perceived benefits positively associated with testing (AOR = 0.38, p < 0.01)
Perceived barriers
Ns (AOR 1.61, p = 0.08) Perceived norms
Ns (AOR 0.72, p = 0.26)
CFC
Greater CFC positively associated with testing (AOR 0.23, p < 0.01) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Earnshaw et al. [40] | U.S.A. Injecting drug users (IDU) receiving methadone maintenance therapy at clinic | Cross-sectional Convenience sampling Response rate 30.6 %. n = 93 47 (50.5 %) males, 46 (49.5 %) females. Mean age 37.1 years. 63 (67.7 %) White, 13 Black (14 %), 13 Latino (14 %), 4 (4.3 %) other ethnicity |
HIV stigma mechanisms
Stereotypes
α = 0.76
Prejudice
α = 0.81
Discrimination
α = 0.73 From [101]
Perceived future risk of HIV
1 item on Likert scale | Frequency of HIV testing |
HIV stigma mechanisms
Stereotypes
Ns (B = 0.08, SE = 0.21, β = 0.05)
Perceived future risk of HIV
Individuals perceiving lower risk engaged in less frequent testing (B = 0.45, SE = 0.20, β = 0.26, p < 0.05) |
Fenton et al. [72] | UK. Urban. Migrant Africans. | Cross-sectional Convenience sampling. 74.8 % response rate. n = 748. 396 (52.9 %) males, 352 (47.1 %) females Age range 16–70 years. From: Congo/Zaire: 176 (23.5 %), Kenya: 121 (16.2 %), Uganda: 132 (17.6 %), UK: 10 (1.3 %), Zambia: 106 (14.2 %), Zimbabwe: 158 (21.1 %), Other: 45 (6 %) |
Perceived future risk of HIV
Perceived group norms of using condoms with new partners
| Self-reported previous HIV testing |
Perceived future risk of HIV
Perceived risk positively associated with testing among men (OR 2.35, 1.47–3.76; AOR 2.28, 1.34–3.90) but not women (OR 1.02, 0.63–1.66)
Perceived group norms of using condoms with new partners
Lower perceived group norms ns associated with testing among men (OR 0.78, 0.47–1.30) and women (OR 0.58, 0.31–1.07) |
Flowers et al. [41] | United Kingdom Urban area. MSM. Not known to be HIV positive Attending commercial gay venues | Cross-sectional Stratified sampling by time and location Response rates 78 % (year 2000), 62 % (year 2010)
n = 1382 |
Perceived benefits of HV testing
3 items on Likert scale
Fear of a positive HIV test result
5 items on Likert scale
Clinic-related barriers
4 items on Likert scale
Attitudes towards sex with HIV-positive partners
3 items on Likert scale
Norm for HIV testing
1 item on Likert scale | Self-reported previous HIV testing: Recent testing (in 12 months prior to survey) Non-recent testing (>12 months prior to survey) Never testing |
Perceived benefits of HV testing Non-testers perceived less benefits of testing than recent testers (AOR 0.75, 0.60–0.93, p = 0.01). Ns difference between non-testers and non-recent testers (AOR 0.92, 0.73–1.16, p = 0.46). Ns difference between non-recent testers and recent testers (AOR 0.82, 0.65–1.02, p = 0.07)
Fear of a positive HIV test result Non-testers had greater fear of a positive result than recent testers (AOR 2.19, 1.76–2.71, p < 0.001). Non-testers had greater fear than non-recent testers (AOR 1.53, 1.22–1.93, p < 0.001). Non-recent testers had greater fear than recent testers (AOR 1.42, 1.14–1.78, p = 0.002)
Clinic-related barriers
Ns difference between non-testers and recent testers (AOR 1.19, 0.93–1.51, p = 0.17). Ns difference between non-testers and non-recent testers (AOR 1.20, 0.92–1.56, p = 0.17). Ns difference between non-recent testers and recent testers (AOR 0.99, 0.77–1.26, p = 0.92)
Attitudes towards sex with HIV-positive partners Non-testers had more negative attitudes than recent testers (AOR 1.24, 1.04–1.48, p = 0.02). Non-testers had more negative attitudes than non-recent testers (AOR 1.35, 1.11–1.63, p = 0.002). Ns difference between non-recent testers and recent testers (AOR 0.92, 0.78–1.08, p = 0.33)
Norm for HIV testing Non-testers perceived testing to be less of norm than recent testers (AOR 0.57, 0.48–0.67, p < 0.001). Non-testers perceived testing to be less of norm than non-recent testers (AOR 0.64, 0.53–0.77, p < 0.001). Ns difference: non-recent vs. recent testers (AOR 0.89, 0.76–1.05, p = 0.16) |
Ford et al. [73] | U.S.A. Urban area. Adults ≥18 years attending STI clinic. Black ethnicity Seeking STI diagnosis or screening for possible STI | Cross-sectional Convenience sampling Response rate 87 %. n = 408 Age range 18–59 years. 408 (100 %) Black/African American |
Perceived risk of HIV
1 item From [144]
HIV-related knowledge
4 items with dichotomous response options. From CDC’s Behavioral Risk Factor Surveillance System [145] | Self-reported previous HIV testing |
Perceived risk of HIV infection
Ns. p = 0.12
HIV-related knowledge
Ns, p = 0.86 |
Ford et al. [74] | U.S.A. Routine testing at STD clinic. Adults ≥18 years. Self-reported Black ethnicity Seeking STI diagnosis or screening for possible STI | Cross-sectional Convenience sampling Response rate 87 %
n = 373 163 (43.7 %) males, 210 (56.3 %) females |
Perceived racism
10 items on Likert scale
α ≥ 0.70
Stress coping mechanisms
1 item, responses categorised as healthful (e.g., ‘exercise’), passive (e.g. ‘sleeping’), or negative (e.g. ‘drinking’) | HIV testing via blood draw, as recorded by the clinic |
Perceived racism
Higher perceived racism associated with higher likelihood of HIV testing (OR 1.68, 1.17–2.40; AOR 1.64, 1.07–2.52)
Stress coping mechanisms
Healthful coping not associated with testing (AOR 1.08, 0.91–1.27) Passive coping not associated with testing (AOR 0.89, 0.78–1.01) Negative coping not associated with testing (AOR 0.96. 0.89–1.05) |
Ford et al. [42] | U.S.A. Urban area Older adults aged ≥50 years No previous diagnosis of HIV infection | Cross-sectional Stratified sampling by public health venue and time. n = 226. 146 (64.6 %) males, 80 (35.4 %) females. Age 50–85 years |
Belief in AIDS-related conspiracy theories 4 items on Likert scale From [148], α = 0.84
Perceived future risk of HIV
8 items. Likert. Adapted [150], α = 0.59
HIV-related knowledge 8 true/false items for current study | HIV testing in last 12 months |
Belief in AIDS-related conspiracy theories
Belief associated with higher likelihood of testing in last 12 months (OR 1.86, 1.03–3.34; AOR 1.94, 1.05–3.60)
Mistrust in government
Mistrust associated ns with less likelihood of testing in last 12 months (OR 0.71, 0.45–1.11) but associated with testing in last 12 months in adjusted analysis (AOR 0.43, 0.26–0.73)
Perceived future risk of HIV
Ns, p = 0.33
HIV-related knowledge
Ns, p = 0.07 |
Gu et al. [43] | China. Urban area Voluntary counselling and testing (VCT) MSM based in Hong Kong Aged ≥18 years | Cross-sectional Convenience sampling Response rate approximately 80 % for participants recruited from gay venues.
n = 577 |
HIV/STD-related knowledge 3 items with dichotomous response options. Developed for current study
Theory of Planned Behaviour (TPB)
Attitudes 3 items on Likert scale:
Subjective norms
3 items on Likert scale.
Perceived behavioural control
3 items on Likert scale:
Behavioural intentions
1 item on Likert scale All TPB measures developed for current study
Level of fear of contracting HIV
1 item on 10-point numeric rating scale
Perceived discrimination towards local MSM
1 item on Likert scale | Self-reported uptake of VCT: Last 12 months Lifetime |
HIV/STD-related knowledge Positive association between >2 correct responses and VCT in last 12 months (OR 2.38, p < 0.001; AOR 2.35, 1.64-3.37, p < 0.05) and lifetime (OR 2.36, p < 0.001; AOR 2.45, 1.72–3.49, p < 0.001). Attitudes. ‘It is necessary to take up antibody testing regularly’ –associated with VCT in last 12 m (OR 1.87, p < 0.01; AOR 1.69, 1.14–2.52, p < 0.01) and lifetime (OR 1.70, p < 0.01; AOR 1.51, 1.03–2.21, p < 0.05). ‘HIV antibody testing can protect you’—associated with VCT in last 12 m (OR 2.35, p < 0.05; AOR 2.12, 1.23–3.68, p < 0.01) and lifetime (OR 2.24, p < 0.001; AOR 2.06, 1.26–3.37, p < 0.01). ‘There are good testing services in Hong Kong’—associated with VCT in last 12 m(OR 1.69, p < 0.01; AOR 1.69, 1.19–2.41, p < 0.01) and lifetime (OR 1.70, p < 0.01; AOR 1.56, 1.09–2.23, p < 0.05) Subjective norms ‘Perceived prevalence of MSM who have been tested for HIV’: perceiving a higher prevalence of testing (≥21 %) associated with VCT in last 12 m (OR 3.60, p < 0.001; AOR 3.69, 2.04–6.68, p < 0.001) and lifetime (OR 3.43, p < 0.001; AOR 3.68, 2.02–6.70, p < 0.001).‘Perceived that >50 % MSM peers would NOT test in the future’—negatively associated with VCT in last 12 m (OR 0.59, p < 0.01, AOR 0.56, 0.39–0.80, p < 0.01) and lifetime (OR 0.71, p < 0.05; AOR 0.68, 0.48–0.97, p < 0.05). ‘Most MSM gave positive comments on HIV testing’—associated with VCT in last 12 m (OR 1.63, p < 0.01; AOR 1.66, 1.16–2.36, p < 0.01) and lifetime (OR 1.92, p < 0.001; AOR 1.88, 1.31–2.71, p < 0.001). Perceived behavioural control ‘You can take up HIV testing if you wish’ –associated with VCT in last 12 m (OR 1.96, p < 0.05; AOR 1.66, 1.01–2.91, p < 0.05) and lifetime (OR 2.07, p < 0.01; AOR 1.74, 1.04–2.90, p < 0.05). ‘You have confidence you will take up HIV testing regularly’: associated with VCT in last 12 m(OR 4.60, p < 0.001; AOR 4.71, 3.22–6.89, p < 0.001) and lifetime (OR 3.51, p < 0.001; AOR 3.31, 2.25–4.87, p < 0.001).‘You will take up HIV testing even if afraid to know results’: associated with VCT in last 12 m (OR 4.19, p < 0.001; AOR 3.85, 2.44–6.08, p < 0.001) and lifetime (OR 4.37, p < 0.001; AOR 4.00, 2.66–6.00, p < 0.001). Behavioural intentions Any chance of testing in 6 m associated with VCT in last 12 m (OR 3.08, p < 0.001; AOR 2.88, 1.96–4.23, p < 0.001) and lifetime (OR 2.24, p < 0.001; AOR 2.12, 1.47–3.04, p < 0.001). Level of fear of contracting HIV Associated with decreased VCT in last 12 m (OR 0.63, p < 0.05; AOR 0.63, 0.40–0.99, p < 0.05) and lifetime (OR 0.64, p < 0.05) Perceived discrimination
Ns with 12 m VCT (OR 0.90; AOR 0.78, CI 0.54–1.13), with lifetime VCT (OR 0.73, p < 0.1; AOR 0.65, 0.45–0.95, p < 0.05) |
References | Location, inclusion/ exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Hendriksen et al. [75] | 48 communities in Tanzania, Zimbabwe, South Africa (Vulindlela, Soweto) and Thailand. Aged 18–32 living in selected households | Cross-sectional Stratified sampling by community
n = 14,818 6638 (44.8 %) males, 8180 (55.2 %) females |
Perceived social norms
6 items on Likert scale Developed for current study
Stigma
19 items on Likert scale From [151]. 3 dimensions: negative attitudes towards PLWH (α = 0.82), perceived discrimination (α = 0.81), equity (α = 0.68) | Self-reported previous HIV testing |
Perceived social norms Ns (for all sites): Tanzania (OR 0.77, 0.40–1.48); Zimbabwe (OR 1.82, 0.81–4.10); Vulindlela (OR 0.57, 0.26–1.22); Soweto (OR 0.82, 0.53–1.25); Thailand (OR 1.01, 0.54–1.91)
Stigma In Thailand, high stigma significantly associated with lower levels of testing (OR 0.43, 0.29–0.64, p < 0.001). Tanzania (OR 0.71, 0.42–1.17, ns) Zimbabwe (OR 0.56, 0.25–1.25, ns); Vulindlela (OR 0.86, 0.46–1.59, ns) Soweto (OR 0.85, 0.57–1.27, ns) |
Hong et al. [44] | Guangxi, China Urban area Female sex workers (FSW) | Cross-sectional Cluster sampling Response rate approximately 70 %. n = 1022 1022 (100 %) females. Age range 15–50 years 862 (84.4 %) Han Chinese, 160 (15.6 %) non-Han |
Self-rated HIV knowledge
1 item on Likert scale
Perceived future risk of HIV
1 item on Likert scale | Self-reported previous HIV testing |
Self-rated HIV knowledge
Higher self-rated knowledge associated with higher likelihood of testing (AOR 3.25, 1.95–5.55, p < 0.001)
Perceived future risk of HIV
Ns (AOR 0.70, 0.47–1.05) |
Hoyt et al. [45] | U.S.A. Rural and urban areas. MSM, primary residence in selected areas in Arizona. Aged ≥18 years | Prospective cohort. Convenience and snowball sampling
n = 394. Mean age 37 years (SD = 11.35). 299 (76 %) White, 51 (13 %) Latino, 20 (5 %) African American, 16(4 %) Native American, 8 (2 %) Asian American Attrition rate 38 % |
Institutional mistrust
Systematic discrimination
4 items on Likert scale, α = 0.86
Organisational suspicion
4 items on Likert scale, α = 0.77
Conspiracy beliefs
3 items on Likert scale, α = 0.76 Developed for current study
Perceived susceptibility
3 items on Likert scale | Self-reported previous HIV testing |
Institutional mistrust
Systematic discrimination
Higher perceived systematic discrimination associated with lower likelihood of testing (AOR 1.61, 1.14–2.28, p < 0.01)
Organisational suspicion
Ns (AOR 1.01, 0.67–1.52)
Conspiracy beliefs
Ns (AOR 0.78, 0.50–1.22)
Perceived susceptibility
Ns for ethnic minority MSM (r = −0.1) and White MSM (r = 0.04) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Huang et al. [46] | China Urban area MSM aged ≥18 years | Cross-sectional Respondent-driven sampling
n = 404 Mean age 29.6 years (SD = 10.4) 386 (96 %) Han, 16 (4 %) non-Han. 200 (49.5 %) money boys, 204 (50.5 %) general MSM |
Perceived risk of current HIV infection. 1 item with dichotomous response options
Sexual Attitudes [155]. Measures sexual permissiveness/responsibility, α = 0.75 (sex workers), α = 0.81 (general MSM)
Loss of Face [156]. Measures perceptions of social propriety, self-discipline and social status. 21 items on Likert scale. α = 0.71 (sex workers), α = 0.78 (general MSM)
Knowledge of testing site 1 item with dichotomous response options
HIV-related knowledge 8 items with dichotomous response options Developed for current study | Self-reported previous HIV testing |
Perceived risk of current HIV infection
Ns (AOR 0.90, 0.60–1.60)
Sexual Attitudes
Ns. p = 0.26
Loss of Face
Ns, p = 0.26
Knowledge of testing site
Not knowing a testing site significantly associated with never testing (AOR 5.50, 2.70–11.30, p < 0.05)
HIV-related knowledge
Lower knowledge significantly associated with never testing (AOR 0.80, 0.70–0.90, p < 0.05) |
Johnston et al. [47] | South Africa. Urban area. VCT. Black males ≥18 years old. >1 sexual partner in last 3 months. Partner either <24 years old or ≥ 3 years younger than participant | Cross-sectional Respondent-driven sampling
n = 421 Age range 18–62 years |
Perceived risk of current HIV infection
1 item on Likert scale | Acceptance of VCT at study site |
Perceived risk of current HIV infection
Ns: ‘Somewhat likely infected’ (ref. ‘very unlikely’)—OR 1.40; AOR 1.40, p = 0.18); ‘Very likely infected’ (ref. ‘very unlikely’): OR 1.50; AOR 1.80, p = 0.09 |
Kakoko et al. [76] | Tanzania Urban and rural areas Primary school teachers in selected districts (districts selected on availability of testing services) | Cross-sectional Convenience sampling Response rate 94 %
n = 918 315 (34.29 %) males, 603 (65.7 %) females Age range 21–59 years |
Self-rated health status
1 item on Likert scale
Intention to test for HIV
3 items on Likert scale Developed for current study
α = 0.75
Perceived susceptibility to HIV
4 items. Likert.Developed for current study.α = 0.75
Affordability of HIV testing
1 item on Likert scale
Perceived accessibility of HIV testing, 1 item on Likert scale
HIV-related stigma
1 item on Likert scale
Absence of cure for HIV/AIDS
1 item on Likert scale
Belief only people who suspect HIV infection should test
1 item on Likert scale
Uncertainty about confidentiality
1 item on Likert scale
Fear of dying earlier if diagnosed with HIV: 1 item on Likert scale. Developed for current study | Self-reported previous HIV testing |
Self-rated health status. Compared with ‘poor/very poor’ status, positively rated status associated with greater likelihood of testing: ‘Fair’—OR 2.36, 1.10–5.06, p < 0.05; AOR 2.22, 1.02–4.84, p < 0.05. ‘Good/very good’—OR 2.85, 1.32–6.17, p < 0.01; AOR 2.54, 1.15–5.62, p < 0.05
Intention of testing for HIV Ns (OR 1.25, 0.80–1.97; AOR 1.18, 0.75–1.88)
Perceived susceptibility to HIV Ns (OR 0.99, 0.72–1.38; AOR 0.98, 0.78–0.88).
Affordability of HIV testing Ns (OR 0.81, 0.58–1.12; AOR 0.80, 0.57–1.12)
Accessibility of HIV testing Poor accessibility of testing sites associated with less likelihood of testing (OR 0.45, 0.28–0.78, p < 0.01; AOR 0.62, 0.40–0.98, p < 0.05)
HIV-related stigma Low perceived stigma associated with greater likelihood of testing in univariate (OR 1.72, 1.23–2.40, p < 0.05) but not multivariate analysis (AOR 0.92, 0.60–1.42, ns)
Absence of cure for HIV/AIDS Disagreement with belief in no cure for HIV/AIDS associated with higher likelihood of testing (OR 2.19, 1.56–3.06, p < 0.01; AOR 1.00, 1.01–2.33, p < 0.05)
Belief only people who suspect HIV infection should test Belief associated with less likelihood of testing (OR 0.63, 0.46–0.88, p < 0.01; AOR 0.52, 0.33–0.81, p < 0.01)
Uncertainty about confidentiality Belief that test results are confidential associated with greater likelihood of testing in univariate (OR 1.51, 1.08–2.11, p < 0.05) but not multivariate analysis (AOR 0.85, 0.57–1.26, ns)
Fear of dying earlier if diagnosed with HIV Less fear associated with >likelihood of testing (OR 2.87, 2.04–4.03, p < 0.01; AOR 1.93, 1.26–2.95, p < 0.05) |
Kalichman and Simbayi [77] | South Africa Urban area Individuals living in selected township | Cross-sectional Convenience sampling
n = 500 224 (44.8 %) males, 276 (55.2 %) females Median age range 21–25 years 490 (98 %) Black ethnicity |
HIV testing attitudes
5 items with dichotomous response options. Adapted from [157]
HIV-related stigma 13 items with dichotomous response options. Adapted from [158] | Self-reported previous HIV testing |
HIV-related knowledge
Ns (AOR 0.49, 0.15–1.58)
HIV testing attitudes
‘Getting tested for HIV helps people feel better’—agreement associated with testing (AOR 2.9, p < 0.01) ‘Getting tested for HIV helps people from getting HIV’—agreement associated with testing (AOR 2.2, p < 0.01) ‘People in my life would leave me if I had HIV’—agreement negatively associated with testing (AOR 0.5, p < 0.01) ‘People who test positive should hide it from others’—agreement negatively associated with testing (AOR 0.4, p < 0.01) ‘I would rather not know I had HIV’—agreement negatively associated with testing (AOR 0.5, p < 0.01)
HIV-related stigma
Individuals with stigmatising beliefs less likely to have tested: ‘People who have AIDS are dirty’—AOR 0.30, p < 0.01 ‘People who have AIDS should be ashamed’—AOR 0.40, p < 0.01 |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Kaufman et al. [115] | 11 districts, Malawi. Adults aged ≥18 years Sexually experienced | Intervention (individual and community behaviour change). Stratified sampling by district and exposure group
n = 594. 271 (45.6 %) males, 323 (54.4 %) females. Mean age 29.1 years (males), 27.7 years (females) |
HIV-related knowledge
11 items with dichotomous response options
α = 0.63
Self-efficacy
9 items on Likert scale
α = 0.73
Perceived risk of HIV (to self and family)
3 items on Likert scale
α = 0.81 | Self-reported HIV testing in last year |
HIV-related knowledge
AOR 1.05, 0.96–1.16, ns
Self-efficacy
AOR 0.99, 0.94–1.05, ns
Perceived risk of HIV
AOR 0.98, 0.93–1.02, ns
IVs adjusted for baseline scores pre-intervention exposure Intervention exposure associated with increases in HIV-related knowledge (β = 0.20, 0.06–0.34, p < 0.01) and self-efficacy (β = 0.35, 0.08–0.62, p < 0.01) Intervention exposure associated with testing (AOR 1.40, 1.16–1.70, p < 0.001) |
Kellerman et al. [78] | U.S.A. Urban. Individuals at high risk for HIV (MSM, IDU, heterosexual individuals recruited from gay bars, outreach, STD clinics). Aged ≥18 years Resident in selected state Self-reported HIV-negative | Cross-sectional Convenience sampling
n = 1711 1270 (74.2 %) males, 441 (25.8 %) females 18–44 years 757 (44.2 %) White, 385 (22.5 %) African American, 389 (22.7 %) Hispanic |
HIV testing knowledge
4 items on Likert scale: Developed for current study
HIV testing fear
4 items on Likert scale: Developed for current study | Self-reported previous HIV testing |
HIV testing knowledge ‘If I had HIV I would tell my sex partners’—agreement positively associated with testing, p < 0.0001. ‘People I have sex with want to know my HIV status’—agreement positively associated with testing, p < 0.0001)
‘Medical care can help sick people with HIV to be healthier’—among MSM, agreement positively associated with testing, p < 0.0001.‘Medical care can help well people with HIV to be healthier’—among MSM, agreement positively associated with testing, p < 0.0001
HIV testing fear ‘I could handle finding out I had HIV’—among MSM, agreement positively associated with testing, p < 0.0001.‘I
would rather not know I had HIV until I had to’– agreement negatively associated with testing, p < 0.0001. ‘If I had HIV, I wouldn’t tell people’: agreement negatively associated with testing, < 0.001). ‘If I had HIV, my sex life would be ruined’—agreement negatively associated with testing, p < 0.001 |
Knox et al. [49] | South Africa Urban area MSM living in greater Pretoria 18–40 years | Cross-sectional Convenience sampling
n = 300 Age range 18–40 years 199 (66.3 %) Black, 101 (33.7 %) White ethnicity |
Sexual minority stress
Internalised homophobia
Sexual orientation-based discrimination (lifetime and in past year)
| Self-reported previous HIV testing. Ever tested. Tested in past year |
HIV-related knowledge Low HIV-related knowledge negatively associated with ever testing, AOR 0.90, 0.80–1.00, p = 0.05. No association with testing in past year vs. testing >1 year ago, p = 0.99
Sexual minority stress Internalised homophobia. Negatively associated with ever testing, p = 0.02. Negatively associated with testing in past year vs. testing >1 year ago, AOR 0.63, 0.43–0.94, p = 0.02. Sexual orientation-based discrimination (lifetime and in past year). No association between lifetime discrimination and ever testing, p = 0.34, or testing in past year vs >1 year ago, p = 0.11. No association between discrimination in past year and ever testing, p = 0.95) Discrimination in past year associated with testing in past year vs. testing >1 year ago, p = 0.02 |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Koku [50] | Ghana. Urban and rural areas Women 15–49 years. Sexually active in last 12 months | Cross-sectional Stratified sampling by enumeration area
n = 3766 |
HIV-related knowledge 5 items with dichotomous response options.
Personal stigma 4 items with dichotomous response options, | Self-reported previous HIV testing |
HIV-related knowledge High level of knowledge associated with higher likelihood of testing (AOR 1.64, 0.28–0.77, p < 0.01)
Personal stigma‘I would keep a relative’s HIV infection a secret’—ns (AOR 1.02, 0.69–1.51).‘A female teacher with AIDS should not teach’—agreement associated with less likelihood of testing (AOR 0.74, 0.40–0.88, p < 0.01) |
Lau and Wong [79] | China, Urban area. Male. Reported sexual intercourse with female sex worker (FSW) in past 6 months | Cross-sectional
n = 250 Age range 18–45 + years |
Perceived future risk of HIV 1 item. Dichotomous response.
Perceived efficacy of condom use
1 item on Likert scale
Knowledge about modes of HIV transmission 1 open-ended question, number of correct answers coded. | Self-reported HIV testing in past 6 months |
Perceived risk of contracting HIV
Ns (OR 1.47, 0.74–2.94, p = 0.27)
Perceived efficacy of condom use
Ns (OR 1.42, 0.31–6.47, p = 0.99)
Knowledge about modes of HIV transmission
Ns (OR 1.63, 0.68–3.91, p = 0.38) |
Lofquist [51] | Kenya. Urban areas One of at-risk populations: FSW, low-income women (LIW), men on worksites (MOW), and policemen Aged 15–49 years | Cross-sectional Cluster sampling Response rate 99 % for all populations FSW: n = 1749 LIW: n = 2076 MOW: n = 2097 Policemen: n = 568 |
Health Belief Model
Perceived susceptibility
Perceived risk for contracting HIV
1 item on Likert scale
Knowledge of HIV prevention
3 items. Dichotomous response. Developed for current study
Perceived severity. 1 item with dichotomous response options
Perceived barriers. HIV/AIDS-related myths. 6 items with dichotomous response options
Perceived stigma. 6 items with dichotomous response options
Confidentiality availability. 1 item with dichotomous response options Developed for current study
Perceived benefits. Utility of VCT if HIV-negative. 7 items with dichotomous response options
Utility of VCT if HIV-positive. 9 items with dichotomous response options. Developed for current study
Knows someone with HIV. 1 item with dichotomous response options. | Self-reported previous HIV testing |
Health Belief Model
Perceived susceptibility.
Perceived risk for contracting HIV. FSW: Moderate/high perceived risk negatively associated with testing (AOR 0.68, p < 0.05); LIW: Ns (AOR 0.53); MOW: Ns(AOR 0.96). Policemen: Ns (AOR 0.86)
Knowledge of HIV prevention: FSW: Ns (AOR 0.85); LIW: Ns (AOR 1.27) MOW: Ns (AOR 0.89); Policemen: Ns (AOR 0.80)
Perceived severity. FSW: Ns (AOR 0.71); LIW: Ns (AOR 0.83); MOW: Ns (AOR 0.73). Policemen: Ns (AOR 0.58)
Perceived barriers. HIV/AIDS-related myths. FSW: higher level of myths negatively associated with testing (AOR 0.72, p < 0.05); LIW: Ns (AOR 1.38); MOW: Ns (AOR 1.32); Policemen: Ns (AOR 0.99)
Perceived stigma. FSW: Ns (AOR 1.10); LIW: Ns (AOR 0.87); MOW: Ns (AOR 0.82); Policemen: Ns (AOR 1.01)
Confidentiality availability. FSW: Ns (AOR 0.72); LIW: belief confidential testing is unavailable associated with less likelihood of testing (AOR 0.39, p < 0.001); MOW: belief confidential testing is unavailable associated with less likelihood of testing (AOR 0.41, p < 0.01); Policemen: Ns (AOR 0.72)
Perceived benefits. Utility of VCT if HIV-negative. FSW: Ns (AOR 0.95); LIW: significant negative association with testing (AOR 0.74, p < 0.05); MOW: perceiving a higher level of utility of VCT if HIV-negative was negatively associated with testing (AOR 0.75, p < 0.05); Policemen: Ns (AOR 0.99).
Utility of VCT if HIV-positive. FSW: Ns (AOR 0.96); LIW: Ns (AOR 0.95); MOW: Ns (AOR 1.20); Policemen: Ns (AOR 1.04)
Knows someone with HIV FSW: Ns (AOR 1.01); LIW: Ns (AOR 1.10); MOW: Ns (AOR 1.43); Policemen: Ns (AOR 1.70) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Ma et al. [52] | China Urban area Heterosexual attendees of four STD clinics Sexually active Aged >14 years | Cross-sectional Convenience sampling Response rate 78.8 %
n = 823 517 (62.8 %) males, 306 (37.2 %) females 342 (41.6 %) aged < 30 years |
Perceived risk of HIV
Perceived risk of STD
HIV-related knowledge
4 items with dichotomous response options. α = 0.83
Awareness that county has established VCT site
| Self-reported HIV testing in last 6 months |
Perceived risk of HIV For men, significant association with HIV testing (OR 4.04, 1.60–10.16, p = 0.003). For women, ns (OR 0.77, 0.09–6.53, p = 0.81) Perceived risk of STD For men, ns (OR 0.59, 0.32–1.08, p = 0.09). For women, ns (OR 0.94, 0.50–1.76, p = 0.84). HIV-related knowledge For men, getting 1–3/4 correct, and 4/4 correct (reference: 0/4 correct) significantly associated with testing (OR 5.93, 1.35–26.04, p = 0.02; OR 9.90, 2.31–42.33, p = 0.002, respectively). For women, ns association between getting 1–3/4 correct and testing (OR 1.13, 0.51–2.50, p = 0.77; but significant association between 4/4 correct items and testing (OR 3.16, 1.42–7.03, p = 0.005). Awareness that county has established VCT site
For men, awareness associated with testing (OR 2.99, 1.61–5.56, p = 0.001) For women, awareness associated with testing (OR 2.75, 1.50–5.06, p = 0.001) |
Mack and Bland [91] | U.S.A. Rural and urban areas Voluntary testing. Aged ≥ 50 years | Cross-sectional Simple random sampling
n = 21132. Age range 50–64 years |
Perceived future risk of HIV
1 item on Likert scale. 1996 Behavioral Risk Factor Surveillance System (BRFSS) | Self-reported voluntary HIV testing |
Perceived future risk of HIV
Perceived medium/high risk associated with higher likelihood of voluntarily testing (AOR 0.60, p = 0.002). Perceived low risk ns (AOR 0.86, p = 0.08) |
MacPhail et al. [90] | South Africa Rural and urban areas Adolescents aged 15–24 years Sexually experienced | Cross-sectional Stratified sampling by enumeration area
n = 7655. 3609 (47 %) males, 4058 (53 %) females 6583 (86 %) Black ethnicity |
Knowing someone with HIV/AIDS
Knowing someone who died of HIV/AIDS
Rejecting a friend with HIV
| Self-reported previous HIV testing |
Knowing someone with HIV/AIDS
Among men, ns (AOR = 1.06, 0.73–1.56, p = 0.75) Among women, ns (AOR 1.20, 0.95–1.50, p = 0.12)
Knowing someone who died of HIV/AIDS
Among men, significant association with testing (AOR 1.68, 1.14–2.47, p = 0.01).
Rejecting a friend with HIV
Among men, ns (AOR 0.63, 0.34–1.18, p = 0.15) Among women, ns (AOR 0.63, 0.39–1.03, p = 0.067) |
Maguen et al. [80] | U.S.A. Urban area Lesbian, gay or bisexually oriented students | Cross-sectional Convenience sampling. n = 117. 63 (52 %) males, 53 (44 %) females, 1 (4 %) trans. Mean age: males 20.1 years, females 19.9 years. 86 (73.5 %) White, 13 (11.1 %) Black, 6 (5.1 %) Latino, 5 (4.3 %) Asian, 5 (4.3 %) Biracial, 1 (0.9 %) other. |
HBM variables
Perceived susceptibility
1 item on Likert scale: ‘I am so sure I don’t have the AIDS virus that I don’t have to be tested.’
Perceived barriers to HIV testing
11 items on Likert scale Adapted from [163]
α = 0.85 | Self-reported previous HIV testing |
Perceived susceptibility
Lower perceived susceptibility associated with less likelihood of testing (AOR 3.45, p < 0.01)
Perceived barriers to HIV testing
Higher perceived barriers associated with less likelihood of testing (AOR 1.15, p < 0.05)
HBM variables together accounted for an additional 18 % variance of model (over and above demographic/behavioural factors), R
2 = 0.18, χ
2 = 24.29, p < 0.01 |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Massari et al. [53] | France Urban area Aged ≥18 years Living in selected households in each census block | Cross-sectional Systematic random sampling Response rate 71 %. n = 3023 1423 (47.1 %) males, 1600 (52.9 %) females Age range 18–60 years. 2068 (68.4 %) French, 536 (17.7 %) French/other ethnicity parents, 419 (13.9 %) other ethnicity |
Perceived risk of HIV
1 item with dichotomous response options
Perceived social support
1 item with dichotomous response options | Self-reported previous HIV testing |
Perceived risk of HIV
In men, low perceived risk for HIV associated with never testing (AOR 1.71, 1.23–2.38, p = 0.05).
Ns in women (tested vs. never tested, p = 0.29)
Perceived social support
Ns in tested and untested men (tested vs. never tested, p = 0.96), and women (tested vs. never tested, p = 0.12) |
Matovu et al. [54] | Uganda. Urban and rural areas. Individuals in long-term relationships (duration at least 1 year) Women aged 18–49, men aged 18–54 | Case–control Stratified sampling by catchment area
n = 787. 359 (45.6 %) males, 428 (54.4 %) females. 296 (37.6 %) aged 18–24 years |
Belief HIV discordance is possible
1 item with dichotomous response options
Perceived risk of HIV
1 item on Likert scale | Self-reported previous HIV testing (individual) Self-reported uptake of couples’ HCT |
Belief HIV discordance is possible Belief significantly associated with previous (individual) testing (OR 1.94, 1.37–2.75; AOR 1.77, 1.20–2.63, p < 0.05)
Perceived risk of HIV
Ref: Very likely to be at risk.
Ns association between unknown risk and previous couples’ HCT (OR 1.63, 0.92–2.87; AOR 0.64, 0.32–1.29)
Ns association between very unlikely risk and previous couples’ HCT in adjusted analysis (OR 2.25, 1.32–3.83; AOR 1.64, 0.86–13.13)
Ns association between a limited risk and previous couples’ HCT (OR 1.27, 0.85–1.91; AOR 1.38, 0.83–2.28) |
McGarrity and Huebner [55] | U.S.A. Urban area HIV-negative MSM | Prospective cohort (over 6 months). Convenience and snowball sampling
n = 487. 18–72 years (mean age 35.7 years). 362 (74.4 %) White, 67 (13.8 %) Latino, 56 (11.5 %) other ethnicity. Attrition rate 31 % |
Intention to test for HIV in next 6 months
1 item on Likert scale | Self-reported HIV testing during 6 month follow-up period |
Intention to test for HIV in next 6 months
Significant association between intention and testing (AOR 1.32, 1.13–1.54, p < 0.001) Socioeconomic status (SES) moderated association between intention and behaviour, with intention being a significant predictor of testing behaviour in high SES individuals (AOR 1.53, p < 0.001), but not low SES individuals (AOR 1.14, ns) |
McNaghten et al. [81] | Zimbabwe Rural and urban areas Provider-initiated testing Individuals aged 15–29 years Living in selected households in census areas | Cross-sectional Stratified random sampling by location. 76 % response rate among females, 72 % among males
n = 9010. 4200 (46.6 %) males, 4810 (53.4 %) females |
Perceived risk of HIV
| Provision of blood specimen for HIV test at time of study |
Perceived risk of HIV
Ns in women (‘no risk’: p = 0.06).
Ns in men (‘no risk’: p = 0.18). |
Melo et al. [93] | Brazil Individuals receiving care at mental health institutions or outpatient clinics Aged ≥18 years | Cross-sectional Simple random sampling Response rate 89.6 %, n = 2475 1147 (48.2 %) males, 1233(51.8 %) females |
HIV-related knowledge
10 items with dichotomous response options From [93]
Perceived risk of HIV
1 item on Likert scale | Self-reported previous HIV testing |
HIV-related knowledge
Higher HIV-related knowledge associated with increased likelihood of testing (OR 2.93, 2.11–4.06, p < 0.001; AOR 1.65, 1.24–2.18, p < 0.001).
Perceived risk of HIV
‘Not known’ (ref. ‘high risk’)—associated with less likelihood of testing (OR 0.48, 0.34–0.67, p < 0.001; AOR 0.57, 0.43–0.77, p < 0.001). ‘No risk’—associated with less likelihood of testing in crude but not adjusted analysis (OR 0.62, 0.43–0.88, p = 0.009; AOR 0.75, 0.54–1.04, ns). ‘Medium risk’—ns (OR 0.83, 0.59–1.17; AOR 0.83, 0.59–1.16) |
Menser [97] | U.S.A. Urban area Students | Cross-sectional Convenience sampling. n = 440 174 (40 %) males, 261 (60 %) females Age range 18–55 years (M = 19.5 years). 355 (83.1 %) Caucasian, 31 (7.3 %) African American, 27 (6.3 %), Asian/Pacific Islander, 6 (1.4 %) Hispanic, 8 (1.9 %) other |
Pro-HIV testing items
Security and responsibility
3 items on Likert scale: e.g. ‘Taking an HIV test would give you a sense of security’.
Adapted from [164]
Con-HIV testing items
Fear of needles
1 item on Likert scale Adapted from [164]
Perceived risk of HIV
4 items on Likert scale From [164] | Self-reported previous HIV testing |
Pro-HIV testing items
Security and responsibility
Significantly associated with testing, p = 0.006
Con-HIV testing items
Fear of needles
Significantly associated with no testing, p = 0.02
Perceived risk of HIV
Significantly associated with testing, p < 0.05 |
Mirkuzie et al. [58] | Ethiopia. Urban area. Antenatal HIV testing Women not known to be HIV-positive Attending antenatal care for first time in pregnancy | Prospective cohort Convenience sampling. 96.5 % response rate.
n = 3033. Age range 15–25+ years. Attrition rate 3.5 % |
Prevention of mother-to-child transmission (PMTCT) knowledge
5 items with dichotomous response options. Developed for current study
TPB constructs
Intention to test for HIV
3 items on Likert scale
Perceived barriers
4 items on Likert scale Developed for current study | Testing for HIV in follow-up period (clinical records) |
Prevention of mother-to-child transmission (PMTCT) knowledge
PMTCT knowledge ns associated with testing (AOR 0.66, 0.38–1.16)
TPB constructs
Intention to test for HIV
Stronger intention associated with increased likelihood of testing (AOR 2.38, 1.45–3.85)
Perceived barriers
Lower perceived barriers ns associated with testing (AOR 1.41, 0.83–2.38) |
Norman and Gebre [89] | Jamaica Urban area University students Sexually experienced | Cross-sectional Convenience sampling. n = 961 309 (32.2 %) males, 652 (67.8 %) females Mean age 28.2 years (SD = 9.1) |
Perceived future risk of HIV
1 item on Likert scale
Personal awareness of HIV
Participants asked if knew someone infected with HIV or had died from AIDS. 1 item with dichotomous response options | Self-reported previous HIV testing |
Perceived future risk of HIV Ns association with testing (p = 0.88; AOR 1.25, 0.92–1.70, p = 0.16).
Personal awareness of HIV. Significant association with testing (p < 0.001; AOR 1.39, 1.02–1.90, p = 0.04) |
Norman [82] | Jamaica Rural and urban areas Individuals living in selected households Aged 15–49 years | Cross-sectional Stratified random sampling by parish. n = 1800 914 (50.8 %) males, 886 (49.2 %) females Mean age 30.1 years (SD = 10.8) |
Perceived future risk of HIV
1 item on Likert scale
Personal awareness of HIV
Participants asked if knew someone infected with HIV or had died from AIDS 1 item with dichotomous response options | Self-reported previous HIV testing |
Perceived future risk of HIV
Significant positive association with testing (OR 1.43, 1.15–1.77, p < 0.01; AOR 1.36, 1.09–1.70, p < 0.01)
Personal awareness of HIV
Significant positive association with testing (OR 1.54, 1.26–1.90, p < 0.001; AOR 1.39, 1.11–1.74, p < 0.01) |
Norman et al. [83] | Puerto Rico Urban area Female Resident of Public Housing Department | Cross-sectional Convenience sampling
n = 1138 Mean age 36.8 years (SD = 12.3) |
Perceived future risk of HIV 1 item on Likert scale
Personal awareness of HIV
Participants asked if knew someone infected with HIV or had died from AIDS. 1 item with dichotomous response options
HIV-related knowledge 21 items with dichotomous response options Developed for current study | Self-reported previous HIV testing |
Perceived future risk of HIV Significantly associated with testing (AOR 1.60, 1.11–2.32, p < 0.05)
Personal awareness of HIV Knowing family/friends with HIV/AIDS associated with testing (AOR 1.86, 1.19–2.92, p < 0.01).
HIV-related knowledge Ns (AOR 1.02, 0.95–1.10, ns) |
Pettifor et al. [59] | South Africa Urban area Attendees of STI, family planning and VCT clinic Aged ≥15 years | Cross-sectional Convenience sampling
n = 198 Mean age 24.5 years 198 (100 %) Black African |
HIV-related stigma
Blame/shame. 10 items on Likert scale
Discrimination. 8 items on Likert scale
Equity. 5 items on Likert scale From [165]
α = 0.71–0.86 [165]
Perceived norms 7 items on Likert scale
Perceived availability of ARVs
5 items on Likert scale | Self-reported previous HIV testing |
HIV-related stigma
Blame/shame: more shame associated with less likelihood of testing (OR
0.35, 0.16–0.78; AOR
0.35, 0.16–0.77).
Discrimination: lower discrimination ns associated with testing (OR 1.18, 0.60–2.32)
Equity: high equity associated with testing (OR 2.85, 1.17–6.90; AOR 2.87, 1.20–6.86)
Perceived norms. ‘Most people want to get tested for HIV’: Disagreement associated with testing (OR 2.56, 1.23–5.37; AOR 2.59, 1.29–5.24). ‘Most people get tested only if they are sick’: Agreement associated with testing (OR 4.91, 1.68–14.30, AOR 4.66, 1.70–12.76)
Perceived availability of ARVs
‘ARVs are easily available in the community’: Ns associated with testing (OR 0.48, 0.20–1.13). ‘ARVs are affordable’: Ns associated with testing (OR 1.72, 0.73–4.04) |
Prati et al. [60] | Italy Rural and urban areas MSM aged >18 years who have had sex with a man in the previous 12 months | Cross-sectional Convenience sampling
n = 14,409 Age range 18–79 years |
Internalised homophobia
From [166]
Awareness of HIV testing services
1 item on Likert scale
HIV test self-efficacy
1 item on Likert scale | Self-reported previous HIV testing: Never tested/tested in past year/tested >12 months ago |
Internalised homophobia Higher homophobia ns associated with increased likelihood of never testing compared with testing in past year (AOR 1.00, 0.96–1.04); or increased likelihood of testing more than a year ago compared with testing in past year (AOR 1.04, 1.00–1.08)
Awareness of HIV testing services Not knowing whether free HIV testing was available associated with increased likelihood of never testing compared with testing in past year (AOR 0.18, 0.15–0.21); and increased likelihood of testing more than a year ago compared with testing in past year (AOR 0.52, 0.44–0.61)
HIV test self-efficacy Those who were ‘not at all confident’ were more likely to have never tested than tested in past year (AOR 5.01, 3.56–7.46); and had increased likelihood of testing more than a year ago than testing in past year (AOR 2.12, 1.16–3.87) |
Ratcliffet al. [32] | U.S.A. Rural area Rapid HIV testing Female Using shelter services for intimate partner violence | Cross-sectional Convenience sampling. n = 112 Age range 1865 years. 21 (19 %) Caucasian, 85 (76 %) African American, 1 (0.8 %) Hispanic, 5 (4.5 %) other ethnicity |
HBM constructs
Perceived susceptibility to HIV
4 items on Likert scale
Perceived severity. 4 items on Likert scale. From [169]
Perceived benefits. 4 items on Likert scale. From [170]
α = 0.75 [171]
Perceived barriers. 4 items on Likert scale. Adapted [170]
Self-efficacy 10 items on Likert scale From [172], α = 0.76–0.90 | Acceptance of rapid HIV test at time of study |
HBM constructs
Perceived susceptibility to HIV
Significant association with testing (AOR 1.13, 1.13–1.27, p = 0.05)
Perceived severity
Ns (AOR 1.03, 0.86–1.06, p = 0.63)
Perceived benefits
Ns (AOR 0.95, 0.83–1.17, p = 0.56)
Perceived barriers
Ns (AOR 1.07, 0.93–1.20, p = 0.36)
Self-efficacy
Ns (AOR 1.00, 0.95–1.08, p = 0.82) |
References | Location and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Sabato et al. [61] | U.S.A. Students on health courses at selected universities | Cross-sectional
n = 1874. 552 (29.5 %) males, 1322 (70.5 %) females. 16–54 years 1539 (82.1 %) Caucasian, 109 (5.8 %) African American, 120 (6.4 %). Asian- Pacific Islander, 106 (5.7 %) other |
Depression 8 items on Likert scale
Locus of control for sexual activities Extent that participants see their sexual activities regulated by internal vs. external control. 11 items. Likert. From [175]. α = 0.76 | Self-reported previous HIV testing |
HIV-related knowledge
Ns in men (AOR 1.05, 0.94–1.17, p = 0.35). Significant positive association with testing in women (t = −3.64, p < 0.01; AOR 1.15, 1.12–1.20, p = 0.03)
Depression
Ns in men (AOR 0.99, 0.92–1.07, p = 0.94), and women (p < 0.05; AOR 1.01, 0.96–1.04, p = 0.80).
Attribution style
Ns in men (AOR 1.01, 0.96–1.05, p = 0.70) and women AOR 0.97, 0.95–1.00, p = 0.08)
Locus of control for sexual activities Greater internal control associated with greater likelihood of testing in men (p < 0.05; AOR 0.89, 0.82–0.97, p = 0.01) and women (p < 0.01; AOR 0.96, 0.91–1.00, p = 0.05) |
Sambisa et al. [62] | Zimbabwe Rural and urban areas. Self/provider-initiated testing. Resident in selected households. Women aged 15–49 years Men aged 15–54 years Sexually active | Cross-sectional Stratified random sampling by cluster. Household response rate 95 %, individual response rate 90 % for women, 82 % for men
n = 12154 5315 (43.7 %) males, 6839 (56.3 %) females |
Stigma towards PLWHA
Social rejection
3 items on Likert scale
Prejudiced attitudes
2 items on Likert scale
Disclosure concerns
2 items on Likert scale Developed for current study
Observed enacted stigma
Whether participant knows PLWHA and has observed discrimination against them 4 items on Likert scale Developed for current study
HIV-related knowledge
Abstinence
Being faithful
Condom use
Healthy-looking person can have HIV
4 items with dichotomous response options Developed for current study
Perceived future risk of HIV
1 item on Likert scale | Self-reported previous HIV testing: Self-initiated (SIT) Provider-initiated (PIT) |
Stigma towards PLWHA.
Social rejection. Female: associated with SIT [ref.
never testing] (RRR 0.75, 0.63–0.89, p < 0.001), PIT (RRR 0.72, 0.62–0.85, p < 0.001). Male: Ns SIT (RRR 0.91, 0.75–1.11), PIT (RRR 0.78, 0.60–1.02, p > 0.05). Prejudiced attitudes F: Ns SIT (RRR 1.00, 0.83–1.20), PIT (RRR 0.98, 0.83–1.14). M: Ns SIT (RRR 0.93, 0.75–0.15), PIT (RRR 1.27, 0.98–1.67, p < 0.10). Disclosure concerns. F: Ns SIT (RRR 0.99, 0.80–1.19) PIT (RRR 1.07, 0.90–1.28). M: Ns SIT (RRR 0.89, 0.71–1.10) PIT (RRR 1.24, 0.89–1.73). Observed enacted stigma. Knowing PLWHA but not observing discrimination against them (ref. knows no PLWHA). F: association with SIT (RRR 1.32, 1.06–1.63, p < 0.01). Ns for PIT (RRR 1.11, 0.91–1.35). M: association with SIT (RRR 1.40, 1.12–1.74, p < 0.001). Ns for PIT (RRR 1.15, 0.85–1.57). Knowing PLWHA and observing discrimination (ref. knows no PLWHA) F: association with SIT (RRR = 1.43, 1.17–1.75, p < 0.001) and PIT (RRR 1.24, 1.04–1.49, p < 0.05). M: association with SIT (RRR 1.41, 1.22–1.77, p < 0.01) and PIT (RRR 1.57, 1.17–2.10, p < 0.01). HIV-related knowledge. Abstinence. F: knowledge abstinence prevents transmission ns for SIT (RRR 0.94, 0.74–1.81). Association with PIT (RRR 1.28, 1.04–1.58, p < 0.05). M: Ns for SIT (RRR 0.94, 0.69–1.27) and PIT (RRR 1.08, 0.71–1.64). Being faithful. F: Knowledge faithfulness prevents transmission ns for SIT (RRR 0.92, 0.74–1.16) and PIT (RRR 1.08, 0.88–1.32). M: association with SIT (RRR 1.45, 1.08–1.96, p < 0.05). Ns PIT (RRR 0.80, 0.56–1.13). Condoms F: knowledge condoms prevent transmission ns SIT (RRR 1.10, 0.89–0.37). Association with PIT (RRR = 1.26, 1.04–1.54, p < 0.05). M: Ns for SIT (RRR 0.78, 0.61–1.02, p > 0.05) PIT (RRR 1.20, 0.82–1.73). Healthy-looking person can have HIV. F: Ns for SIT (RRR = 1.06, 0.78–1.44). Ns for PIT (RRR 1.13, 0.88–1.46). M: Ns SIT (RRR 1.17, 0.72–1.89) PIT (RRR 0.77, 0.47–1.27). Perceived future risk of HIV. Small risk (ref. no risk). F: Ns for SIT (RRR 0.87, 0.71–1.07). Association with PIT (RRR 0.71, 0.59–0.85, p < 0.001). M: Ns SIT (RRR 0.88, 0.66–1.03) PIT (RRR 0.69, 0.51–0.92, p < 0.05). Moderate risk (ref. no risk). F: Ns SIT (RRR 0.83, 0.67–1.06) PIT (RRR 0.94, 0.77–1.14). M: Association with SIT (RRR 0.67, 0.51–0.89, p < 0.01) PIT (RRR 0.65, 0.45–0.94, p < 0.05). High risk (ref. no risk). F: Ns SIT (RRR 0.97, 0.72–1.31) PIT (RRR 0.91, 0.70–1.19). M: Ns SIT (RRR 1.15, 0.83–1.62), PIT (RRR 1.11, 0.72–1.72) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Song et al. [63] | China Urban area MSM aged18–29 years | Cross-sectional Convenience and snowball sampling Response rate 98 %
n = 307 Mean age 23.7 years (SD = 2.8) |
HIV-related knowledge 20 items with dichotomous response options. Developed for current study. α = 0.68
Perceived future risk for HIV
1 item on Likert scale
Homosexuality-related stigma
10 items on Likert scale. Developed for current study α = 0.93
Willingness to test for HIV in future. 1 item on Likert scale | Self-reported previous HIV testing |
HIV-related knowledge
Ns (AOR 1.04, 0.93–1.15).
Perceived future risk for HIV
Ns (AOR 0.85, 0.59–1.25).
Homosexuality-related stigma
Ns (AOR 1.03, 0.98–1.08).
Willingness to test for HIV in future
Ns (AOR 1.73, 0.87–1.58) |
Stein and Nyamath [84] | U.S.A. Homeless (living in shelter 1 week or longer) Aged 15–65 years. Having a significant other willing to participate in study | Cross-sectional Response rate 90 %. n = 1049 428 (40.8 %) males, 621 (59.2 %) females 617 (58.8 %) African American, 176 (16.8 %) White, 243 (23.2 %) Hispanic, 13 (1.2 %) other ethnicity |
Self-esteem 50 items with dichotomous response options. From [176]
HIV-related knowledge 21 items with dichotomous response options. From [177]
Perceived future risk for HIV 4 items on Likert scale. From [167]
Coping strategies in response to physical/emotional/other problems in last 6 months
Positive (problem-focused) coping
Negative (emotion-focused) coping
17 items on Likert scale. From [178] | Self-reported previous HIV testing and return for results |
Self-esteem In women, significant correlation with testing (r = 0.08, p < 0.05). In men, ns (r = 0.01)
HIV-related knowledge
In women, significant correlation with testing (r = 0.20, p < 0.001). In men, significant correlation with testing (r = 0.18, p < 0.001)
Perceived future risk for HIV
In women, significant correlation with testing (r = 0.11, p < 0.05). In men, significant correlation with testing (r = 0.20, p < 0.001)
Coping strategies
Positive (problem-focused) coping
In women, significant correlation with testing (r = 0.19, p < 0.001). In men, significant correlation with testing (r = 0.13, p < 0.05)
Negative (emotion-focused) coping
In women, ns (r = 0.06). In men, ns (r = 0.05) |
Thierman et al. [85] | Zambia Urban area Provider-initiated antenatal testing Women attending antenatal clinics in selected health centres | Cross-sectional Convenience sampling Response rate >99 %. n = 1064 Age range 16–46 years |
Perceived risk of HIV
Developed for current study | Acceptance of antenatal HIV testing at time of study |
Perceived risk of HIV
Women with no reported risk less likely to accept testing than women reporting some risk (p < 0.001) Within group reporting some risk, women with low perceived risk significantly more likely to accept testing than women with moderate (p < 0.001) and high perceived risk (p < 0.001) |
References | Location, inclusion/exclusion and testing context | Design and sampling | Measurement of psychological variables | Measure of testing behaviour | Associations between psychological variables and testing |
---|---|---|---|---|---|
Thomas et al. [86] | U.S.A. Individuals on historically black college and university (HBCU) campuses Not known to be HIV-positive Meeting age of consent for testing (in particular state) | Cross-sectional Convenience sampling. n = 5291. 1788 (33.8 %) males, 3499 (66.1 %) females. Age range 14–84 years (median 20 years) 5066 (95.6 %) African American, 41 (2.2 %) Hispanic, 127 (2.4 %) other ethnicity |
Perceived future risk of HIV
1 item on Likert scale | Self-reported previous HIV testing |
Perceived future risk of HIV
High perceived risk associated with increased likelihood of testing (OR 2.00, 1.40–2.70) Medium perceived risk associated with increased likelihood of testing (OR 1.90, 1.50–2.30) Low perceived risk associated with increased likelihood of testing (OR 1.50, 1.30–1.70) |
Tun et al. [64] | South Africa Urban area MSM aged ≥18 years Living in or <20 km outside Pretoria | Cross-sectional Respondent-driven sampling
n = 307. Age range 18–42 years 288 (93.7 %) Black, 19 (6.3 %) other ethnicity |
HIV-related conspiracy beliefs
12 items on Likert scale From [179]. α = 0.73
Attitudes to condom use
13 items on Likert scale From [150]. α = 0.84
Perceived risk of HIV
| Self-reported previous HIV testing |
HIV-related conspiracy beliefs
Endorsement of conspiracy beliefs associated with never testing in adjusted (AOR 2.40, 1.10–5.70, p < 0.05), but not crude analysis (OR 2.20, 0.90–5.00)
Attitudes to condom use
Ns association between unfavourable attitudes towards condom use and never testing (OR 0.90, 0.40–2.00)
Perceived risk of HIV
Ns (OR 0.60, 0.20–1.50) |
Wagner et al. [87] | Canada Urban area University students | Cross-sectional
n = 770 167 (21.7 %) males, 603 (78.3 %) females Mean age 18.7 years (SD = 1.2) |
Fear of being judged negatively for HIV testing. 32 items on Likert scale
HIV self-relevance Feeling of whether HIV can or will affect the participant | Self-reported previous HIV testing |
Fear of being judged negatively for HIV testing
Fear of being judged negatively by parents associated with decreased likelihood of testing (AOR 0.53, 0.33–0.87, p = 0.01).
Social anxiety Social anxiety associated with decreased likelihood of testing (AOR 0.97, 0.95–1.00, p = 0.02)
HIV self-relevance. Low HIV self-relevance associated with decreased likelihood of testing (AOR 1.08, 1.02–1.15, p = 0.02) |
Wang et al. [65] | China Urban areas Rural-to-urban migrants | Cross-sectional Quota sampling
n = 1938 1300 (67.1 %) males, 638 (32.9 %) females Mean age 25.7 years (SD = 3.5) 1880 (97 %) Han, 58 (3 %) non-Han |
Perceived peer sexual risk 4 items on Likert scale. Developed for current study. α = 0.82
Perceived vulnerability
Perceived vulnerability to negative consequences of risky behaviour 2 items on Likert scale. From [181]
α = 0.80
Satisfaction with work/life
2 items on Likert scale. Developed for current study, α = 0.74 | Self-reported previous HIV testing |
Perceived peer sexual risk
Positively associated with testing (p < 0.01; AOR 1.62, 1.17–2.24).
Depression
Individuals with depression more likely to have tested for HIV (p < 0.001)
Perceived vulnerability
Higher perceived vulnerability associated with higher likelihood of testing (p < 0.01).
Perceived severity
Ns
Satisfaction with work/life
Higher satisfaction positively associated with testing (p < 0.01; AOR 1.55, 1.22–1.97).
HIV-related knowledge
Ns
|
Wilkerson et al. [66] | USA Urban areas Collegiate MSM Aged 18–24 years HIV-negative | Cross-sectional Convenience sampling. n = 930. Mean age 20.7 years. 653 (72.2 %) White, 29 (3.2 %) Black, 133 (14.7 %) Hispanic, 90 (9.9 %) Other |
Internalised homonegativity
7 items on Likert scale From [166]. α = 0.74
Openness of homosexuality
1 item on Likert scale
Community acceptance of homosexuality
7 items on Likert scale
α = 0.69 | Self-reported annual HIV testing |
Internalised homonegativity
Ns association with annual testing uptake (AOR 1.00, 0.80–1.20)
Openness of homosexuality
Significant association with annual testing uptake (AOR 1.30, 1.10–1.50, p < 0.05)
Community acceptance of homosexuality
Ns association with annual testing uptake (AOR 0.90, 0.70–1.20) |
Yi et al. [88] | Cambodia VCT. Tuberculosis patients attending selected hospitals. Aged 15–49 years | Cross-sectional Response rate 98.9 %. n = 154 75 (49 %) males, 79 (51 %) females Mean age 34.6 years (SD = 7.9) |
HIV-related stigma
13 items with dichotomous response options, From [77] | Self-reported previous uptake of VCT |
HIV-related stigma
‘PLWHA are dirty’—associated with never testing (OR 2.30, 1.04–5.40)
‘PLWHA must have done something wrong’—associated with never testing (OR 4.2, 1.65–11.11)
‘I
would be uncomfortable with a neighbour who has AIDS’—associated with never testing (OR 3.00, 1.26–7.42) |
Participants
Measurement of Testing Behaviour
Measurement of Psychological Factors
Relationships Between Psychological Variables and Testing
HIV Testing-Related Psychosocial Variables
Perceived Benefits of Testing/Pro-testing Attitudes
Perceived Barriers to Testing/Cons of Testing
Perceived Accessibility and Knowledge of Testing Site
Perceived Behavioural Control/Self-efficacy
Perceived Norms of Testing
Fear of Testing
Intention to Test in the Future
Non Testing HIV-Related Psychosocial Variables
HIV-Related Knowledge
Perceived Risk of HIV
HIV-Related Stigma
Perceived Susceptibility to HIV
Perceived Severity of HIV
Fear of HIV Infection
Belief in HIV-Related Conspiracy Theories
Knowing Someone with HIV
Sexual Behaviour Cognitions
Peer Sexual Norms
Attitudes to Condom Use
Sexual Self-efficacy/Sexual Locus of Control
General Psychological Variables
Depression
Coping Mechanisms
Self-efficacy for Handling Difficult Situations
Perceived Health Status
Societal Cognitions
Perceived Social Support
Institutional Mistrust/Perceived Discrimination
Homosexuality-Related Stigma
Methodological Quality
References | External validity | Internal validity | ||||
---|---|---|---|---|---|---|
Representativeness of sample | Percentage of selected individuals who agreed to participate | Measurement of testing behaviour | Measurement of psychological factors | Attrition rate: percentage of participants included in final analysis | How far confounding variables are measured/analysed appropriately | |
× | × | × | ✔ | – | ✔ | |
Andrinopoulos et al. [33] | ✔ | ✔ | ✔ | ✔ | – | ✔ |
Berendes and Rimal [34] | ✔ | × | × | × | – | × |
Berkley-Patton et al. [35] | × | × | × | ✔ | – | ✔ |
Bogart et al. [67] | × | × | × | ✔ | – | ✔ |
Bohnert and Latkin [68] | × | × | × | ✔ | – | ✔ |
Burchell et al. [69] | ✔ | ✔ | × | × | – | ✔ |
Corno and de Walque [36] | ✔ | × | × | ✔ | – | ✔ |
Creel and Rimal [37] | ✔ | × | × | ✔ | – | ✔ |
Cremin et al. [38] | ✔ | ✔ | × | × | – | ✔ |
Das et al. [39] | ✔ | ✔ | × | ✔ | – | ✔ |
Delva et al. [70] | ✔ | × | × | × | – | ✔ |
Desai et al. [71] | × | × | × | ✔ | ✔ | ✔ |
Dorr et al. [92] | × | × | ✔ | ✔ | – | ✔ |
Earnshaw and Chaudoir [101] | × | × | × | ✔ | – | × |
Fenton et al. [72] | × | × | × | × | – | ✔ |
Flowers et al. [41] | ✔ | × | × | × | ✔ | |
Ford et al. [73] | × | ✔ | × | ✔ | – | × |
Ford et al. [74] | × | ✔ | ✔ | ✔ | – | ✔ |
Ford et al. [42] | ✔ | × | × | ✔ | – | ✔ |
Gu et al. [43] | × | ✔ | × | × | – | ✔ |
Hendriksen et al. [75] | ✔ | × | × | ✔ | – | × |
Hong et al. [44] | ✔ | × | × | × | – | ✔ |
Hoyt [45] | × | × | × | ✔ | × | ✔ |
Huang et al. [46] | × | × | × | ✔ | – | ✔ |
Johnston et al. [47] | × | × | ✔ | × | – | ✔ |
Kakoko et al. [76] | × | ✔ | × | ✔ | – | ✔ |
Kalichman and Simbayi [77] | × | × | × | ✔ | – | ✔ |
Kaufman et al. [115] | ✔ | × | × | ✔ | × | ✔ |
Kellerman et al. [78] | × | × | × | × | – | × |
Knox et al. [49] | × | × | × | ✔ | – | ✔ |
Koku [50] | ✔ | × | × | × | – | ✔ |
Lau and Wong [79] | × | × | × | × | – | × |
Lofquist [51] | ✔ | ✔ | × | × | – | ✔ |
Ma et al. [52] | × | × | × | ✔ | – | × |
Mack and Bland [91] | ✔ | × | × | × | – | ✔ |
MacPhail[90] | ✔ | × | × | × | – | ✔ |
Maguen et al. [80] | × | × | × | ✔ | – | ✔ |
Massari et al. [53] | ✔ | × | × | ✔ | – | ✔ |
Matovu et al. [54] | ✔ | × | × | × | – | ✔ |
McGarrity and Huebner [55] | × | × | × | × | – | × |
McNaghten et al. [81] | ✔ | × | ✔ | × | – | × |
Melo et al. [93] | ✔ | ✔ | × | ✔ | – | ✔ |
Menser [97] | × | × | × | ✔ | – | × |
Mirkuzie et al. [58] | × | ✔ | ✔ | × | ✔ | ✔ |
Norman and Gebre [89] | × | × | × | × | – | ✔ |
Norman, [82] | ✔ | × | × | × | – | ✔ |
Norman et al. [83] | × | × | × | × | – | ✔ |
Pettifor et al. [59] | × | × | × | ✔ | – | ✔ |
Prati [60] | × | × | × | × | – | ✔ |
Ratcliff et al. [32] | × | × | ✔ | ✔ | – | ✔ |
Sabato et al. [61] | × | × | × | ✔ | – | ✔ |
Sambisa et al. [62] | ✔ | ✔ | × | × | – | ✔ |
Song et al. [63] | × | ✔ | × | ✔ | – | ✔ |
Stein and Nyamathi [84] | × | ✔ | × | ✔ | – | × |
Thierman et al. [85] | × | ✔ | ✔ | × | – | × |
Thomas et al. [86] | × | × | × | × | – | × |
Tun et al. [64] | × | × | × | ✔ | – | ✔ |
Wagner et al. [87] | × | × | × | ✔ | – | ✔ |
Wang et al. [65] | × | × | × | ✔ | – | ✔ |
Wilkerson et al. [66] | × | × | × | ✔ | – | ✔ |
Yi et al. [88] | × | ✔ | × | ✔ | – | × |