Are men testing? Sex differentials in HIV testing in Mpumalanga Province, South Africa

HIV testing is the centerpiece of the national AIDS program in South Africa and many HIV-endemic countries, yet there is surprisingly little published data on who uses testing services. In 2006, we conducted a census of HIV-testing records in all 282 public and non-governmental voluntary counseling and testing (VCT) sites in Mpumalanga (MP), South Africa, the province with the highest HIV prevalence in the country. We secured data on the age and sex of all those tested in 260 sites since the year testing was initiated, as far back as 1998 in some sites. For the year 2006, we also secured data on whether a client came to VCT through self-referral, antenatal services (prevent mother-to-child transmission (PMTCT)), or medical referral. The results characterize the rapid uptake of testing as facilities increased, with the number of people testing in MP more than doubling each year between 2002 and 2006. However, there is a persistent 3:1 differential of females:males testing, with 72.7% of all testing among females. When pregnancy-related testing (via PMTCT) is excluded, females still account for 65.1% of all testing in MP. The data also suggest men are more likely to test at older ages and as a result of medical referral. In summary, females in MP are far more likely to use HIV testing than males, even after accounting for increased access to testing during pregnancy. Sex differentials in HIV testing warrant closer policy attention.