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Education and Gender Equality Are Inconsistently Associated with HIV Testing in Eastern Africa

In a study that assessed education, gender equality and HIV testing in nationally representative samples of married or cohabiting women in Kenya, Zambia and Zimbabwe, 15-24-year-olds had an elevated likelihood of having ever had an HIV test or having had one in the past year if they had at least some secondary education (odds ratios, 1.8-3.4), but their role in making household financial decisions and attitude toward wife beating were not related to testing. (1) Among women aged 25-34, education was not consistently related to HIV testing, but the belief that wife beating is never justified was associated with having had an HIV test in the past year for those living in Kenya and Zambia (1.3 for each), and involvement in financial decision making was associated with a history of testing in Zimbabwe (1.7). Although reducing gender inequality and promoting females' education have been cited as potentially useful strategies for preventing HIV, studies have not consistently linked levels of inequality and education to receipt of HIV prevention and treatment services, and none has examined both characteristics. The present study simultaneously assessed the relationship between these variables and testing by analyzing Demographic and Health Survey data from Kenya (2008-2009), Zambia (2007) and Zimbabwe (2005-2006), where national HIV prevalence is high (6%, 14% and 18%, respectively), and rates of HIV testing among women aged 15-49 are relatively low (58%, 40% and 26%, respectively). Analyses focused on married or cohabiting females aged 15-34; because gender inequality may influence HIV testing differentially by age, the samples were stratified into two age-groups (15-24 and 25-34). Weighted samples consisted of 3,221 respondents in Kenya, 3,049 in Zambia and 3,706 in Zimbabwe. The main outcome measures were having ever been tested for HIV and having been tested in the past year; the two gender equality variables were financial decision making (i.e., "Who usually decides how your husband's/partner's earnings will be used?") and whether respondents believed that a husband is justified in hitting or beating his wife in five different scenarios (e.g., if she goes out without telling him, argues with him or refuses to have sex). Multivariate logistic regression analysis was used to identify associations between HIV testing and measures of respondents' gender equality and background characteristics. Women in Kenya and Zambia had similar education levels, as only a fifth to a third of those in the 15-24 and 25-34 age-groups had at least some secondary education; in contrast, two-thirds of all respondents in Zimbabwe had some secondary schooling. Most women in the younger cohorts had given birth (79-86%), and nearly all of those in the older groups had had a child (97-98%). A majority of respondents lived in rural areas (64-75%), and fewer than one in 10 reported having had an STI in the last year. There was little difference in rates of HIV testing between age-groups in any country: In Kenya, 78-79% of females had ever been tested and 40-43% had been tested in the past year; in Zambia, 46-47% and 25%, respectively, had been tested in these time periods; and in Zimbabwe, 34-37% and 9-11%, respectively, reported such testing. …