Introduction:
HIV testing serves as a crucial gateway to HIV prevention, care, and treatment. To ensure equitable access to these vital services across all social groups, continuous evaluation of HIV testing uptake is essential. Addressing disparities in HIV testing among different socioeconomic groups is paramount for an effective and efficient response to HIV prevention efforts. Despite the recognized importance of this issue, comprehensive studies examining socioeconomic inequality in HIV testing over time in Ethiopia have been lacking. This research aims to bridge this gap by investigating socioeconomic inequality in individuals undergoing HIV testing in Ethiopia across different periods, identifying both persistent and emerging determinants of this inequality.
Methods:
The data for this study was drawn from the 2011 and 2016 Ethiopian Demographic Health Surveys. The 2016 survey is particularly significant as it formed the basis for Ethiopia’s national AIDS response strategies. At the time of the study, no more recent surveys with comparable HIV/AIDS-related indicators were available for Ethiopia. The study included a substantial sample size, with 28,478 participants in 2011 and 25,542 in 2016. To assess socioeconomic inequality in HIV testing, the concentration curve and the Erreygers’ concentration index were employed. Decomposition analysis was subsequently conducted to pinpoint persistent and emerging factors contributing to this inequality. A generalized linear regression model utilizing a logit link function was used to estimate the marginal effect, elasticity, Erreygers’ concentration index (ECI), and the absolute and percentage contributions of each covariate.
Results:
The concentration curve consistently remained below the line of equality in both 2011 and 2016. This indicates a pro-rich inequality in HIV testing, meaning that individuals with higher socioeconomic status were more likely to undergo HIV testing. This inequality was evident in both 2011 (ECI = 0.200) and 2016 (ECI = 0.213), showing a slight increase over time. Household wealth rank emerged as the most significant contributor to inequality in HIV testing. In 2011, it accounted for 49.2% of the inequality, and this contribution further increased to 61.1% in 2016. Other notable factors included access to media, specifically listening to the radio (contributing 13.4% in 2011 and 12.1% in 2016), education status (8.1% in 2011 and 6.8% in 2016), and place of residence (shifting from -2.0% in 2011 to 6.3% in 2016).
Several factors consistently influenced individuals undertaking HIV testing across both survey years. These persistent determinants included age (specifically the 20-34 years age group), geographic region, education status, marital status, religion, income level, media exposure (listening to the radio, reading newspapers, and watching television), knowledge about HIV/AIDS, and attitudes towards people living with HIV. Interestingly, age between 35 and 44 years and urban residence emerged as newly associated factors in 2016, suggesting evolving dynamics in HIV testing access.
Conclusions:
The study’s findings highlight a significant disparity in HIV testing coverage in Ethiopia, with individuals of higher socioeconomic status having greater access to testing services. This socioeconomic inequality in HIV testing widened between 2011 and 2016. Household wealth rank, exposure to mass media, education level, and place of residence were identified as the primary drivers of this disparity between lower and higher income groups. To achieve equitable HIV testing coverage, interventions must specifically address these key determinants. Public health strategies should focus on reducing socioeconomic barriers to HIV testing to ensure that all segments of the Ethiopian population have equal access to these critical services, regardless of their wealth or location.
