Int J STD AIDS. 2013 Dec;24(12):957-68.

Epidemiologic correlates of willingness to be tested for HIV and prior testing among married men in India.

Das A, Babu GR, Ghosh P, Mahapatra T, Malmgren R, Detels R.

Department of Epidemiology, UCLA School of Public Health, Los Angeles, USA.



There has been limited research in India on determinants of seeking HIV testing by Indian married couples. We analyzed data obtained from husbands of married couples participating in the National Family Health Survey 2005-06. Socio-demographic and behavioural predictors for willingness to be tested and self-reported prior testing were explored, using multivariate logistic regression. Factor scores were used to summarize knowledge variables related to HIV prevention and places of testing. Sixty-nine percent of the husbands were willing to be tested as part of National Family Health Survey 2005-06, and 7% reported some form of prior testing. Our results indicate that knowledge about HIV testing in hospitals and other health/welfare centres, knowledge about transmission of HIV, poor education, religion, economic status, occupation, early sexual debut, and use of contraceptives other than barrier methods were significant predictors for reported willingness to be tested. Knowledge about routes of transmission of HIV, younger age, educational level, religion other than Hindu or Muslim, economic status, occupation, history of blood transfusion, and condom use were significant correlates of previously being tested. Strategies to improve knowledge about HIV testing sites and HIV prevention may encourage married men to be tested and reduce the spread of infection from them to their wives.

KEYWORDS: AIDS, HIV, HIV testing, India, National Family Health Survey-3, married men, screening

PMID: 23970619



The National Family Health Survey (NFHS) program in India was initiated in the early 1990s, with the goal to generate population estimates of important indicators pertaining to family welfare, maternal and child health, and nutrition.(1) The third iteration of this country-wide, household based survey (NFHS-3), conducted in 2005-06, incorporated several new indicators in the field of family life education, safe injections, perinatal mortality, adolescent reproductive health, high-risk sexual behavior, tuberculosis, and malaria. An unique attribute of NFHS-3 was inclusion of HIV testing of adult survey participants, making it the first such survey in India and allowed it to generate an estimate of HIV prevalence in general population.

Early detection of HIV, through testing, is now widely accepted as an important HIV prevention strategy. Testing is a necessary precursor of availing anti-retroviral therapy – timely initiation of which reduces likelihood of HIV transmission to the uninfected population. Further, diagnosis of HIV has also been known to modify risk behaviors among infected individuals when testing services are accompanied with risk-reduction counseling. Finally, early testing has been shown to reduce the economic burden on health systems, both in developed and developing nations, regardless of HIV epidemic scenario. India, despite having a low prevalence of HIV in the general population, has approximately 2.4 million HIV infected citizens, 61% of whom are male. Men are considered the ‘‘driver’’ of the epidemic among married couples and are probably the only risk factor for the large proportion of women who are monogamous. Thus, interventions for increasing testing among married men may be instrumental in lowering adult HIV transmission rates, even if serostatus disclosure rates are low, by guiding infected men into treatment. Little research has been conducted to determine the correlates for seeking HIV testing among Indian married couples, especially willingness to be tested. Because of perceived low risk among married couples, a very low proportion of them actually test for HIV or other sexually transmitted infections. Thus, finding the determinants of willingness to test among this population may help to formulate effective intervention strategies to prevent spread of HIV in the general population.

We analyzed data from husbands of married couples (comprised of 15–49 years old women and 15–54 years old men) who participated in NFHS-3. The objectives of our study were to determine the factors associated with willingness to be tested for HIV and self-reported prior HIV testing (measured as response to the question: ‘‘Have you ever been tested for AIDS?’’) among married men. In the absence of any survey question(s) regarding willingness to be tested, we decided to use the proportion of married men who agreed to undergo anonymous HIV testing as part of NFS-3 as a “proxy” indicator for this outcome. Our analysis revealed, out of 39,257 eligible married men, who were offered to participate in HIV testing, 27,080 (69%) actually underwent testing. On the other hand, among 33,975 husbands who answered the question about previous testing for HIV, only 2455 (7%) reported being tested at least once. Based on multiple logistic regression analysis, we found that age at sexual debut, religion, knowledge about HIV testing at hospitals and health/welfare centers, a history of genital sores, and contraceptive use other than condoms were significantly associated only with willingness to be tested. Meanwhile, age, religions other than Hindu or Muslim, ever receiving a blood transfusion, and condom usage were significant determinants of prior testing for HIV, but not willingness to be tested. Education level, higher economic status, knowledge about routes of HIV transmission, and type of occupation were significant for both willingness to be tested and prior testing, but the associations were not necessarily in the same direction.


Our findings suggest implementation of specific HIV-related interventions for Indian married men, with the aim to improve knowledge about HIV testing sites and overall knowledge regarding HIV/AIDS. Such interventions may aid chances of HIV testing among them, and, in turn, reduce the likelihood of transmission, especially from those engaging in potentially high-risk behaviors, to their wives and general population.



1.       Sciences IIfP. National Family Health Survey (NFHS-3), 2005-06: India: International Institute for Population Sciences; 2007.

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