How Self-Efficacy and Perceived Risk of HIV Influence HIV Testing Avoidance Among Adolescents in Tanzania

Abstract

While the burden of HIV prevalence in Tanzania is concentrated in adults, the incidence in adolescents highlights significant concerns for the future. On a domain-specific basis (e.g. condom use), self-efficacy plays a role in influencing specific behaviors; however, it is unknown if self-efficacy can transcend domains and provide positive outcomes in health challenges like HIV. The primary aims of this study are 1) to examine the relationship between self-efficacy as measured by the Generalized Self-Efficacy scale (GSE) and HIV Testing Avoidance as measured by agreeing or disagreeing with the statement “I would rather not know if I have HIV", and 2) to examine whether this relationship varies by perception of HIV risk and other socio-demographic characteristics in order to identify potentially modifiable or targeted factors for intervention. This study analyzes baseline data collected from a cluster randomized controlled trial of 1095 adolescents recruited from 20 primary schools in the Bagamoyo District and Kinondoni District of Tanzania. A regression analysis was conducted relating Generalized Self-Efficacy and Perceived Risk with HIV Testing Avoidance. Adjusting for geographic district, age, and household composition, higher GSE scores were associated with decreased odds of HIV testing avoidance (OR=0.93, p=<0.001). Stratifying by perceived risk groups, the relationship was similar. Considering the interaction effect between Generalized Self-Efficacy and Perceived Risk, there appears to be very little difference in the relationship between Generalized Self-Efficacy and HIV Testing Avoidance for those with differing Perceived Risk. In our study population, self-efficacy appears to be a key to reducing HIV Testing Avoidance and should be a target of intervention for all in this cohort, regardless of differing risk perceptions.