Increased uptake of HIV testing in sub-Saharan Africa: demographic divergence and opportunities for future growth

HIV testing is an integral component to HIV prevention strategies and a gateway to treatment and care. Over the past decade, the MEASURE DHS project has noted a substantial increase in HIV testing uptake across sub-Saharan African countries, sometimes by more than ten-fold. Drawing from repeated cross-sectional DHS/AIS data in Cameroon, Congo-Brazzaville, Ethiopia, Ghana, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Nigeria, Rwanda, Senegal, Tanzania, Uganda, and Zimbabwe, this paper analyzes demographic divergence in HIV testing uptake within and across countries, with special attention to HIV positive adults. While testing uptake has increased in all 15 countries with repeated DHS/AIS surveys, gains have been uneven. Using logistic decomposition on pooled cross-national data we differentiate factors associated with being tested that relate to time period of survey and to country-level endowments related to access and outreach from individual socio-demographic characteristics associated with having ever been tested for HIV. Despite dramatic increases in testing uptake, the majority of HIV-positive adults in six countries have no way of knowing their HIV serostatus. Continued expansion of outreach and access to HIV testing will help determine future demand for medical treatment and support for persons living with HIV/AIDS.