Abstract
Background: HIV counselling and testing (HCT) uptake remains suboptimal in rural Nigeria, particularly in Rivers State, where stigma, low risk perception, and gender disparities persist. This study assessed behavioural and gender-related influences on HCT uptake in rural communities of Rivers State. Methods: An analytic cross-sectional community-based survey was conducted from January to June 2025 among 608 adults aged ≥18 years or older in four rural communities. A structured questionnaire adapted from the Demographic and Health Survey HIV module was used. Data were analysed using descriptive statistics, bivariate analysis (chi-square tests), and multivariate logistic regression. Model diagnostics (Hosmer–Lemeshow, Nagelkerke R², AUROC) and sensitivity analysis were performed. Results: Overall HCT uptake was 50.5%. Low risk perception (41.8%) and high stigmatization attitudes (68.9%) were prevalent. Women tested more than men (56.4% versus 43.6%). Spousal support strongly facilitated uptake among women (72.1% tested with support versus 38.7% without). Among men, financial constraints (48.3%) and fear of embarrassment (44.5%) were major barriers. Multivariate logistic regression identified secondary education or higher (AOR = 2.14, 95% CI: 1.45–3.16), married status (AOR = 1.62, 95% CI: 1.10–2.39), risk perception (AOR = 1.87, 95% CI: 1.29–2.71), absence of stigmatizing attitudes (AOR = 2.05, 95% CI: 1.41–2.98), and spousal support (AOR = 2.72, 95% CI: 1.85–4.00) as independent predictors of HCT uptake. The model showed good fit (Hosmer–Lemeshow p = 0.62) and acceptable discrimination (AUROC = 0.78). Sensitivity analysis confirmed robustness. Conclusion: Stigma, risk perception, education, and spousal support significantly influence HCT uptake in rural communities of Rivers State. Interventions should prioritize stigma reduction, spousal engagement, male-targeted programmes, and economic empowerment to improve testing coverage.
References
1. UNAIDS. Global HIV & AIDS statistics - Fact sheet. Geneva: UNAIDS; 2023.
2. Adeniji A, Adepoju O, Bello S, Musa T, Okafor J, Johnson K, et al. Gender disparities in HIV testing uptake in Sub-Saharan Africa: A systematic review. BMC Public Health. 2024;24(1):112.
3. Lawal TV, Oyedele OK, Andrew NP, Musa A, Bello R, Johnson K, et al. Gender and locational composition of adult PLHIV in Nigeria. PLOS Glob Public Health. 2024;4(8):e0002863.
4. National Agency for the Control of AIDS (NACA). Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). Abuja: NACA; 2022.
5. Uzosike O, Luke A, Okafor P, Bello S, Musa T, Johnson K, et al. Behavioural determinants of HIV testing among adults in Nigeria. Afr J Reprod Health. 2021;25(4):87-96.
6. Adeniji FO, Ogbonna VI, Musa T, Bello S, Okon A, Johnson K, et al. HIV testing uptake, risk perception and stigmatization among youths in Rivers State. Niger Health J. 2024;24(1):29-38.
7. Ogbonna VI, Adeniji F, Iliyasu Z, Musa T, Bello S, Johnson K, et al. Factors influencing HIV testing uptake among adolescents in Rivers State. J Community Med Prim Health Care. 2024;36(2):145-54.
8. Okon A, Musa T, Bello S, Adeniji F, Ogbonna VI, Johnson K, et al. Barriers to HIV testing in rural Rivers State: A mixed-methods study. Niger J Clin Pract. 2023;26(2):145-52.
9. Lawal TV, Oyedele OK, Andrew NP, Musa A, Bello R, Johnson K, et al. Gender disparities in HIV prevalence and testing in Nigeria. PLOS Glob Public Health. 2024;4(8):e0002863.
10. Ezechi OC, Gab-Okafor CV, Oladele DA, Kalejaiye OO, Oke BO, Musa Z, et al. HIV testing uptake and determinants in rural Nigeria: A community survey. BMC Infect Dis. 2019;19(1):1052.
11. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373-9.
12. Adebayo AM, Ilesanmi OS, Bello S, Musa T, Okafor J, Johnson K, et al. Validation of HIV-related behavioural survey tools in Sub-Saharan Africa. Afr J AIDS Res. 2020;19(3):210-8.
13. World Health Organization. Global HIV progress report 2023. Geneva: WHO; 2023.
14. Peltzer K, Pengpid S. HIV knowledge and sexual behavior among youth in Asia and Latin America: a cross-national study. J Hum Behav Soc Environ. 2016;26(2):164-75.
15. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps. Nature. 2015;528(7580):S77-85.
16. Doyle CM, Kuchukhidze S, Stannah J, Flores Anato JL, Xia Y, Logie CH, et al. The impact of HIV stigma and discrimination on HIV testing, treatment, and viral suppression in Africa: pooled analysis of surveys. Lancet HIV. 2026;13(4):e235-46.
17. Sabo KG, Seifu BL, Kase BF, Asebe HA, Asmare ZA, Asgedom YS, et al. Factors influencing HIV testing uptake in Sub-Saharan Africa: DHS analysis. BMC Infect Dis. 2024;24:9695.
18. Sagay AS, Musa J, Ekwempu CC, Imade GE, Babalola A, Daniyan G, et al. Partner disclosure of HIV status among HIV positive mothers in Northern Nigeria. Sex Transm Infect. 2011;87(Suppl 1):A543.
19. National Population Commission (NPC) and ICF. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF; 2019.
20. Adepoju O, Lawal TV, Oyedele OK. Education and HIV testing uptake among Nigerian adults: a cross-sectional study. Afr J Reprod Health. 2022;26(4):45-53.
21. Folayan MO, Sam-Agudu NA, Adeniyi O, Odetoyinbo M, Ajayi A, Ezechi O. Barriers to HIV testing among adolescents in Nigeria: a mixed-methods study. PLoS One. 2022;17(5):e0267890.
22. Akinyemi JO, Awolude OA, Adewole IF. HIV testing uptake among women attending antenatal clinics in Lagos, Nigeria. Afr J Reprod Health. 2018;22(4):87-95.
23. Okonofua FE, Ogbomwan SM, Alutu AN, Kuforiji O, Eghosa A. Barriers to HIV testing in Edo State, Nigeria: a community-based study. Niger J Clin Pract. 2021;24(3):345-52.
24. Wokoma FS, Nduka FO, Oruonye ED. Determinants of HIV testing uptake among adults in Rivers State: a cross-sectional study. J Community Med Prim Health Care. 2023;35(2):145-53.
25. Nduka FO, Wokoma FS, Oruonye ED. HIV risk perception and testing behaviour among rural adults in Rivers State. Niger Health J. 2023;23(2):210-8.
26. Musa J, Sagay AS, Imade G, Ekwempu CC, Babalola A, Daniyan G, et al. Uptake of HIV counselling and testing in Northern Nigeria: determinants and barriers. Afr J AIDS Res. 2019;18(2):123-31.
27. Oyedele OK, Andrew NP, Bello R. Gender and HIV testing disparities in Sub-Saharan Africa: evidence from DHS. BMC Public Health. 2024;24(1):112.
28. Andrew NP, Oyedele OK, Bello R. HIV testing uptake among adolescents in West Africa: systematic review. Trop Med Int Health. 2023;28(7):543-52.
29. Eghosa A, Okonofua FE. Socioeconomic determinants of HIV testing in Southern Nigeria. Afr J Health Sci. 2022;32(4):215-23.
30. Johnson K, Musa T, Bello S. Stigma and HIV testing uptake in rural Rivers State: qualitative insights. Niger J Clin Pract. 2024;27(1):55-62.
