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Uptake of HIV testing among 

women of reproductive age in 

Tajikistan: An assessment of 

individual determinants 

 

Salima Kasymova1 
 
1Independent Researcher and Consultant  

 

 

 

 

 

 

 

 

 

 

 
 

Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2020.370 |   http://cajgh.pitt.edu 

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part  

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Press. 

 

Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.370|http://cajgh.pitt.edu 

 

 

Abstract 

Introduction: Over the past decade, the incidence of human immunodeficiency virus (HIV) infections in Tajikistan increased 

significantly, with women particularly vulnerable to acquiring HIV. This research assessed individual determinants associated with 

HIV testing among women of reproductive age. 

Methods: Secondary data analysis was done using data from 5,867 females aged 15–49 years. Chi-square test, t-test, and 

multivariate analysis were applied to find associations between women's socio-demographic characteristics, reproductive health 

variables, and HIV testing uptake.  

Results: Overall, only 26% (1,501) of women in the present research reported HIV testing in the past. Multiple regression indicated 

that HIV testing was significantly associated with participants' age (25–34 age group: OR 0.7, p ≤ 0.001; 35–49 age group: OR 0.2, 

p ≤ 0.001), education (OR 2.2, p ≤ 0.001), area of residence (OR 0.6, p ≤ 0.001), marital status (OR 2.4, p ≤ 0.001), HIV knowledge 

(OR 1.1, p ≤ 0.001), and pregnancy history (OR 6.7, p ≤ 0.001).  

Conclusion: Results of this research suggest that there is a need for culturally acceptable interventions, including outreach to 

increase the overall HIV testing rate among women in Tajikistan. 

Keywords: HIV; HIV testing; Individual determinants; Tajikistan; Women 

Uptake of HIV testing among women 

of reproductive age in Tajikistan: An 

assessment of individual 

determinants 

 

Salima Kasymova1 
 
 
1Independent Researcher and Consultant 

Research 

Introduction 

Tajikistan is one of the few countries in the 

world where the incidence of HIV infections is on the rise 

at a concerning rate. Between 2008 and 2017, the new 

HIV diagnosis rate increased in Tajikistan from 5.0 to 

13.5 per 100,000 population. Particularly concerning is 

the growing number of new HIV cases attributable to 

heterosexual contact. The total number of people who 

acquired HIV via heterosexual contact increased between 

2008 and 2017 by 640 cases (460%).1 Currently, about 

half of the country's population of nine million people is 

women. Evidence suggests that multiple structural and 

socio-cultural factors contribute to HIV risk for women 

in Tajikistan. Gender inequality, limited abilities to 

discuss fidelity and negotiate condom use, early marriage 

practices, and domestic violence may lead to increased 

HIV exposure. Women's vulnerability is also exacerbated 

by poverty, migration, and limited access to education 

and economic opportunities.2-4 The reported HIV 

prevalence rate in females increased in the country 

between 2008 and 2017 from 2.2 to 10.6 per 100,000 

population, and AIDS diagnosis rate in females increased 

from 0.2 to 1.8 per 100,000 population. It is estimated 

that the cumulative total number of HIV cases among 

women in Tajikistan is 3,334.1 

HIV testing is one of the most effective ways to 

halt the transmission of HIV. Pre- and post- test 

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counseling sessions that occur during HIV testing 

services provide an opportunity for primary prevention.5 

HIV testing also allows the provision of psychosocial 

support and links HIV positive individuals to 

antiretroviral therapy sites. Currently, HIV testing is 

mandatory for pregnant women in Tajikistan. Evidence 

suggests that HIV testing services are underutilized in the 

country and limited research explored this problem.6,7 

Considering that Tajikistan has been experiencing one of 

the fastest growing HIV epidemics in the world, there is 

an urgent need to study the factors that govern individual 

choice to seek HIV testing services. Therefore, the goal 

of this study was to address this need by examining 

individual determinants associated with HIV testing 

among women in Tajikistan. Results of this research will 

potentially inform the development of future HIV 

prevention policies in Tajikistan aimed at reducing 

individual risk and vulnerability to HIV infection.  

 

Methods 

Data source 

The current research used cross-sectional data 

from the Demographic and Health Survey (DHS)8, a 

nationally representative sample survey. The survey was 

conducted in Tajikistan in 2012 with an aim to collect 

data on maternal and child health, fertility and 

contraceptive use, domestic violence, tuberculosis, HIV, 

and other sexually transmitted infections (STIs) from 

women of reproductive age. The survey randomly 

selected 9,794 women aged 15–49 years from 6,674 

households, of whom 9,656 were interviewed; the 

response rate for DHS was 99%.9  

Measures 

For the HIV testing variable, participants' 

responses to the question "Have you ever been tested to 

see if you have the AIDS virus" were used; it was scored 

dichotomously (yes vs. no). Independent variables 

included several demographic and socioeconomic 

characteristics, as well as reproductive health variables, 

which were selected based on results of previous 

research.10-13 Demographic measures included 

respondents' age (15–24, 25–34, and 35–49), area of 

residence (urban vs. rural) and marital status 

(married/living with partner vs. unmarried/widowed/ 

divorced/separated). Socioeconomic variables included 

education (no education/primary, secondary, and higher) 

and household income (low, middle, and high). HIV 

knowledge was assessed through an eight-item scale (α = 

0.76) with response options of “yes”, “no”, and “I do not 

know”. HIV knowledge was defined as knowing two 

primary methods of HIV prevention (consistent condom 

use and staying faithful to one uninfected partner), 

rejecting four misconceptions about HIV transmission 

(HIV cannot be transmitted by mosquito bites, by sharing 

food, or by kissing, and a healthy-looking person can be 

infected with HIV) and knowing two facts about mother-

to-child (i.e., vertical) HIV transmission (HIV can be 

transmitted during pregnancy and delivery). Women 

received one point for each correct answer, and all points 

summed to create an HIV knowledge score (range 0–8). 

Higher scores indicated higher levels of knowledge about 

HIV. Reproductive health variables included pregnancy 

history (had ever been pregnant vs. had never been 

pregnant) and had STIs in last 12 months (yes vs. no/do 

not know).  

Statistical analysis 

As the first step of statistical analysis, 

descriptive approaches such as frequencies for binary and 

categorical variables, as well as means and standard 

deviations for continuous variables, were generated to 

describe the samples and understand the data distribution. 

Then, separate simple logistic regression equations with 

corresponding 95% confidence intervals (CIs) were 

conducted to identify the odds of having HIV testing for 

each of the independent variables: age, area of residence, 

marital status, education, income, HIV knowledge, 

pregnancy history, and had STIs in the last 12 months. 

Finally, a multivariate logistic regression model that 

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included the HIV testing variable and all independent 

variables was estimated. A significance level of 0.05 was 

used during statistical analysis. The statistical analysis 

was conducted using STATA 13. 

 

Variable 

Not tested 

n (%) 

Mean (SD) 

Had been tested  

n (%) 

Mean (SD) 

Total  

n (%) 

Mean (SD) 

p-value 

Age      

15–24 1,583 (36) 395 (26) 1,978 (34) 

 ≤ 0.001¹ 25-34 1,107 (25) 645 (43) 1,752 (30) 

35-49 1,676 (38) 461 (31) 2,137 (36) 

Area of residence      

Urban    1,577 (36) 743 (50) 2,320 (40) 
 ≤ 0.001¹ 

Rural  2,789 (64) 758 (50) 3,547 (60) 

Marital status      

Married/living with partner  2,795 (64)  1,345 (90) 4,140 (71) 
 ≤ 0.001¹ 

Unmarried/widowed/divorced/separated 1,571 (36)   156 (10) 1,727 (29) 

Education      

No education/primary    116 (3)        36 (2) 152 (3) 

 ≤ 0.001¹ Secondary  3,278 (75)      913 (61) 4,191 (71) 

Higher  972 (22)        552 (37) 1,524 (26) 

Wealth index     

Low    1,374 (31)        337 (22) 1,711 (29) 

 ≤ 0.001¹ Middle  761 (17)        226 (15) 987 (17) 

High  2,231 (51)      938 (62) 3,169 (54) 

HIV knowledge 4.7 (2.4) 5.4 (2.1) 4.9 (2.3)  ≤ 0.001² 

Pregnancy history     

Had ever been pregnant  2,744 (63)     1,359 (91) 4,103 (70) 
 ≤ 0.001¹ 

Had never been pregnant    1,622 (37)        142 (9) 1,764 (30) 

Had STI in last 12 months       

Yes    14 (0.3)        7 (0.5) 21 (0.4) 
0.415¹ 

No/Do not know    4,352 (99.7)      1,494 (99.5) 5,846 (99.6) 

¹Chi-Square test; ²t-test. 

Table 1. Demographic and Socioeconomic Characteristics of Participants by HIV Testing History (n = 5,867) 

Results 

Of the 9,656 women surveyed, 3,587 reported 

not having heard of HIV and they were excluded from 

analysis. In addition, 202 cases with missing data were 

also excluded. Thus, the final sample for this research 

was 5,867 women. Sample characteristics are presented 

in Table 1. Age of the respondents ranged from 15 to 49 

years, with a mean (SD) of 31 (9.8) years. Most women 

reported their marital status as married/living with 

partner (71%). The majority of respondents resided in 

rural areas (60%), had at least secondary education 

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(97%), and were in the high wealth quintile (54%). 

Approximately 70% of the sample had been pregnant, 

and only 21 women (0.4%) indicated that they had an STI 

in the last 12 months. Lastly, HIV knowledge score 

ranged from 0 to 8, with participants’ mean total HIV  

Variable  Unadjusted  Adjusted  

OR 95% CI OR 95% CI 

Age     

15–24 (ref.) 1.0  1.0  

25-34 2.3*** 2.0-2.9 0.7*** 0.6-0.9 

35-49 1.1 0.9-1.3 0.2*** 0.2-0.3 

Area of residence      

Urban (ref.) 1.0  1.0  

Rural  0.6*** 0.5-0.6 0.6*** 0.5-0.7 

Marital status      

Unmarried/widowed/ 

divorced/separated (ref.) 

1.0  1.0  

Married/living with partner  4.8*** 4.1-5.8 2.4*** 1.9-3.0 

Education      

No education/primary (ref.) 1.0  1.0  

Secondary  0.9 0.6-1.3 1.0 0.7-1.6 

Higher  1.8** 1.2-2.7 2.2*** 1.4-3.4 

Household wealth       

Low (ref.) 1.0  1.0  

Middle  1.2* 1.0-1.5 1.0 0.8-1.2 

High  1.7*** 1.5-2.0 1.0 0.9-1.3 

HIV knowledge 1.2*** 1.1-1.2 1.1*** 1.1-1.2 

Pregnancy history     

Had never been pregnant (ref.) 1.0  1.0  

Had ever been pregnant 5.7*** 4.7-6.8 6.7*** 5.1-8.8 

Had STI in last 12 months       

No/Do not know (ref.) 1.0  1.0  

Yes  1.5 0.6-3.6 0.7 0.3-1.9 

*p ≤ 0.05; **p ≤ 0.01; ***p ≤ 0.001 

Table 2. Unadjusted and Adjusted Estimates from Logistic Regression Models Predicting HIV Testing among Women 

(n = 5,867) 

knowledge score at 4.9 (SD = 2.3), indicating moderate 

levels of overall HIV knowledge. 

Overall, 1,501 (26%) of respondents reported 

HIV testing in the past. Table 2 presents unadjusted and 

adjusted estimates from logistic regression models 

predicting the odds of having HIV testing for each of the 

independent variables with corresponding 95% CIs. The 

odds of being HIV tested were significantly lower among 

rural women, unmarried/widowed/divorced/separated 

women, and those with lower education and income. In 

addition, women with HIV testing history had 

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significantly higher HIV knowledge scores as compared 

with their counterparts who had not been tested. Lastly, 

the likelihood of HIV testing was correlated with 

respondents' age and pregnancy history. 

In the adjusted logistic regression model, six 

significant predictors of HIV testing: age, area of 

residence, marital status, education, HIV knowledge, and 

pregnancy history. The strongest predictor of HIV testing 

was pregnancy history; women who had ever been 

pregnant were almost seven times (OR 6.7, 95% CI 5.1–

8.8, p ≤ 0.001) more likely to report that they had been 

tested for HIV in the past. In addition, married women 

and women who lived with a partner were more than 

twice (OR 2.4, 95% CI 1.9–3.0, p ≤ 0.001) as likely to 

report HIV testing uptake as compared to unmarried 

women and women who were divorced, separated, and 

widowed. The odds of ever testing for HIV were also 

significantly higher among urban women (OR 0.6, 95% 

CI 0.5–0.7, p ≤ 0.001), women with higher education 

(OR 2.2, 95% CI 1.4–3.4, p ≤ 0.001), and women with 

higher levels of HIV knowledge (OR 1.1, 95% CI 1.1–

1.2, p ≤ 0.001). Lastly, the odds of ever being tested for 

HIV decreased with women's age (for 25–34 age group: 

OR 0.7, 95% CI 0.6–0.9, p ≤ 0.001 and for 35–49 age 

group: OR 0.2, 95% CI 0.2–0.3, p ≤ 0.001).  

 

Discussion 

This research was motivated by the need to learn 

more about uptake of HIV testing among women of 

reproductive age in Tajikistan. Results of this research 

suggested that within the sample, approximately three out 

of four women aged 15–49 years had never been tested 

for HIV. Respondents' age, area of residence, marital 

status, education, HIV knowledge, and pregnancy history 

were significant predictors of undergoing HIV testing.  

Taking into consideration that according to the 

national legislations, pregnant women are subject to 

mandatory HIV testing, it is not surprising that pregnancy 

history was the strongest HIV testing predictor. This 

result corroborates the idea that antenatal care is an 

important gateway to HIV testing among women in 

Tajikistan. On the other hand, it raised the concern of 

access to HIV testing for women who had never been 

pregnant and older women who are less likely to seek 

antenatal care services.  

Findings also indicate that urban women were 

more likely to have been tested for HIV than rural 

women. Lower HIV testing uptake among rural women 

may be related to lower accessibility to HIV testing 

services in rural areas of Tajikistan.3 This finding could 

also be related to the geography of the HIV epidemic, 

since the prevalence of HIV in Tajikistan is higher in 

urban areas.4  

Consistent with the results of previous 

research10, marital status was one of the significant 

determinants of HIV testing. This finding may reflect the 

fact that the HIV testing promotion strategies fail to reach 

women who are unmarried, widowed, divorced, and 

separated. In addition, as previously documented11-13, 

higher level knowledge about HIV was associated with 

higher odds of HIV testing. This finding could be an 

indication that women with more accurate HIV 

knowledge acknowledge their risk for contracting HIV 

and seek opportunities to know their HIV serostatus.   

Lastly, the unadjusted logistic regression 

models indicate HIV testing uptake increased with 

women’s wealth status. However, in the adjusted 

regression model, the relationship between these 

variables was positive but not significant. This finding 

contradicts results of studies conducted in other 

developing countries.10,11,14,15 This result may suggest 

that epidemiological and contextual factors play a more 

significant role for seeking HIV testing services than 

individual determinants. Nevertheless, further studies are 

needed to understand how individual, epidemiological, 

and contextual factors influence HIV testing uptake in 

Tajikistan.  

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The following limitations should be considered 

in interpretation of these research findings. Due to the 

cross-sectional design of this research, it was not possible 

to determine causal inferences about relationships among 

HIV testing and independent variables. Another 

limitation is that the research sample consisted of women 

aged 15–49 years and more than half of them were from 

households with high income, which makes it difficult to 

generalize the findings to females of other age and 

income groups. In addition, DHS data were self-reported, 

which may have introduced social desirability and recall 

bias. This research focused on how individual 

characteristics affect uptake of HIV testing; however, 

available literature suggests that community-level 

determinants may play a significant role in HIV testing 

uptake. For example, previous research14 has shown that 

women from more educated and higher income 

communities had higher odds of HIV testing. Moreover, 

Kuehne and colleagues12 found that respondents who 

lived in the communities that discussed HIV were twice 

as likely to have been tested for HIV. Hence, future 

research should consider the incorporation of broader 

arrays of variables, including community-level 

determinants, which can affect women's behaviors to 

seek HIV testing services. Finally, for this research, data 

collected in 2012 was used, and its applicability today 

may be a matter of concern. Therefore, when 2017 DHS 

data becomes available, future research should replicate 

the analysis to determine any changes in factors that play 

a significant role in HIV testing behaviors among women 

of Tajikistan.  

In view of results of this research, to increase 

HIV testing uptake among women in Tajikistan, several 

policies and interventions can be considered. There is a 

need for innovative and culturally acceptable 

interventions that include outreach efforts targeting 

adolescent females; older women; women from rural 

areas; unmarried, widowed, divorced, and separated 

women; as well as women who had never been pregnant. 

Special attention should also be given to the promotion 

of HIV testing among pregnant women. Every year, 

approximately 200,000 women in Tajikistan become 

pregnant3 with a high proportion never receiving 

antenatal care. According to the 2012 Tajikistan DHS 

report9, 21% of women did not receive any antenatal care 

for their most recent pregnancy. Moreover, between 2010 

and 2013, the number of new HIV infections diagnosed 

among pregnant women increased from 53 to 112 cases.4 

Available literature suggests that home-based HIV 

testing and mobile-clinic HIV testing can contribute to 

improving coverage and accessibility to HIV testing.16,17 

In addition, provider-initiated testing can help to increase 

the overall HIV testing rate13, and it should be promoted 

in the future. Finally, previous research reported that 

many women do not seek HIV testing services because 

their brothers or mothers-in-law forbid them to do so.3 

Moreover, available data suggests that spouses rarely 

discuss HIV testing between each other.18 Asking a 

husband/partner to test for HIV is particularly difficult 

for a woman due to power dynamics within the 

relationship. Therefore, HIV prevention interventions 

should focus on increasing general knowledge about 

HIV, addressing community norms about HIV testing, 

and eliminating HIV-related stigma. In addition, 

communication with a spouse/partner should be included 

in HIV prevention efforts.  

To conclude, the findings of this research add to 

the scant literature on determinants of HIV testing uptake 

among women aged 15–49 years in Tajikistan.  Results 

of this research suggest that there is a need for culturally 

acceptable interventions, including outreach to increase 

the overall HIV testing rate among women in Tajikistan. 

 

Acknowledgements  

I would like to thank the DHS Program for 

granting access to the Tajikistan DHS data. 

 

References  

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