Background: HIV testing is the entry point to HIV prevention and treatment. The Joint United Nations Programme on HIV/AIDS set the 90-90-90 targets with the first-90 expecting 90% of PLHIV to know their status by 2020. Swaziland has 220,000 PLHIV but lacks a population-based first-90 estimate. Therefore, we used the 2016-17 Swaziland HIV Incidence Measurement Survey2 (SHIMS2) to describe and determine factors associated with knowledge of HIV-positive status (awareness/aware).
Methods: Completed in 2017, SHIMS2 was a cross-sectional, nationally representative, and population-based, two-stage randomized cluster-sampled household survey. Interviews and rapid HIV testing were conducted on adults aged ≥15 years. Using weighted Jackknife survey data in Stata 14, frequencies, weighted proportions, Chi-square and logistic regression analyses were conducted. Potential factors were analyzed in two blocks, namely socio-demographic and behavioral. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were reported.
Results: Of the 13,339 adults, 10,934 (81.97%) responded to the HIV-testing questionnaire, with 2,031 (32.51%) females and 972 (20.39%) males confirmed HIV sero-positive. Among those confirmed, 1,811 (88.56%) females and 776 (77.46%) males knew their HIV-positive status (p-value(p)< 0.001).
Awareness was less likely among those reporting no condom usage compared to those who used condoms at last sexual encounter within the preceding year in both females (aOR=0.48 (95% CI:[0.34-0.67]),p< 0.001) and males (aOR=0.33 [0.22-0.50],p< 0.001). Awareness was more likely in females (aOR=5.26 [2.75-10.05],p< 0.001) and males (aOR=2.65 [1.58-4.44],p< 0.001) reporting previous tuberculosis-clinic visits compared to those reporting no previous visits. Among females, awareness was more likely in those aged 25-49 years compared to those 15-24 (aOR=2.23 [1.53-3.26],p< 0.001), and those reporting previous antenatal-clinic visit (aOR=1.76 [1.20-2.58], p=0.004) compared to those reporting no previous visits. Awareness increased with increasing number of pregnancies (see Table). Among males, awareness was more likely among those aged 25-49 (aOR=2.16 [1.19-3.91], p=0.012) and 50+ (aOR=3.88 [1.75-8.57], p=0.001), compared to those aged 15-24 years. Awareness was more likely among married (aOR=2.09 [1.38-3.16], p=0.001) and divorced (aOR=2.32 [1.26-4.26], p=0.007) men compared to never married men.

Table: Multivariate analysis of factors affecting awareness of HIV positive status among adults aged 15+
[Table: Multivariate analysis of factors affecting awareness of HIV positive status among adults aged 15+]

Conclusions: In Swaziland, females are close to reaching the first-90 whilst males are >10% behind. Providing male-friendly, male-targeted services may unlock more testing opportunities required to bridge this gap.

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