Factors associated with awareness of HIV status among HIV positive men 25-39 years of age in Rakai. A mixed methods study

Abstract

Background. HIV/AIDS continues to be a significant public health challenge globally, with Sub-Saharan Africa being highly affected. In Uganda, particularly in the Rakai region, efforts to address the HIV epidemic have shown progress. However, men aged 25-39 years remain a group with low awareness of their HIV-positive status, contributing to higher transmission rates. Understanding the factors associated with awareness of HIV-positive status in this demographic group is crucial for achieving the UNAIDS 95-95-95 targets. Objectives. I aimed to determine the proportion of HIV-positive men aged 25-39 years in Rakai who are unaware of their HIV-positive status, explore the factors associated with awareness of HIV status, and examine their experiences and barriers with HIV testing services. Methods. A cross-sectional study design was employed, utilizing quantitative data from the Rakai community cohort study (RCCS) round 20 (December 2020 - March 2023) and qualitative data from in-depth interviews with HIV-positive men and key informants. The quantitative analysis included 349 HIV-positive men aged 25-39 years. Factors associated with awareness of HIV status were analysed using multivariate modified Poisson regression. Qualitative data were analysed thematically to explore barriers and facilitators related to HIV testing services. Results. The study found that 86.4% of HIV-positive men aged 25-39 years in Rakai were aware of their HIV status, while 13.6% remained unaware. Key factors associated with higher awareness included higher education levels 84.62%, urban residence 88.95% and consistent condom use 92.9%. Men engaged in agricultural or home-based work exhibited higher awareness levels 89.04% compared to those in manual 83.93% or professional occupations 80.56%. Qualitative findings highlighted barriers such as societal stigma, masculine norms affecting health-seeking behaviour, and limited accessibility to male-friendly HIV testing services, which hindered testing and awareness. Conclusion. Despite considerable progress, a significant proportion of men aged 25-39 years in Rakai remain unaware of their HIV-positive status, highlighting the need for targeted interventions. Improving access to male-friendly health services, addressing stigma, and promoting consistent condom use are critical to enhancing HIV testing and awareness in this population, contributing to the attainment of the UNAIDS 95-95-95 targets. Recommendations. Strengthening health systems to provide flexible and male-friendly HIV testing services, increasing community-based HIV education, and reducing stigma are essential steps to improve HIV status awareness among men aged 25-39 years in greater Rakai. Keywords: HIV/AIDS, awareness of HIV status, men aged 25-39, HIV testing services.