Ziraba et al. BMC Public Health 2011, 11:663 http://www.biomedcentral.com/1471-2458/11/663 R E S E A R C H A R T I C L E Open Access Determinants for HIV testing and counselling in Nairobi urban informal settlements Abdhalah K Ziraba1,2*, Nyovani J Madise3, James K Kimani1, Samuel Oti1, George Mgomella1, Mwau Matilu4 and Alex Ezeh1 Abstract Background: Counselling and testing is important in HIV prevention and care. Majority of people in sub-Saharan Africa do not know their HIV status and are therefore unable to take steps to prevent infection or take up life prolonging anti-retroviral drugs in time if infected. This study aimed at exploring determinants of HIV testing and counselling in two Nairobi informal settlements. Methods: Data are derived from a cross-sectional survey nested in an ongoing demographic surveillance system. A total of 3,162 individuals responded to the interview and out of these, 82% provided a blood sample which was tested using rapid test kits. The outcome of interest in this paper was HIV testing status in the past categorised as “never tested"; “client-initiated testing and counselling (CITC)” and provider-initiated testing and counselling (PITC). Multinomial logistic regression was used to identify determinants of HIV testing. Results: Approximately 31% of all respondents had ever been tested for HIV through CITC, 22% through PITC and 42% had never been tested but indicated willingness to test. Overall, 62% of females and 38% of males had ever been tested for HIV. Males were less likely to have had CITC (OR = 0.47; p value < 0.001) and also less likely to have had PITC (OR = 0.16; p value < 0.001) compared to females. Individuals aged 20-24 years were more likely to have had either CITC or PITC compared to the other age groups. The divorced/separated/widowed were more likely (OR = 1.65; p value < 0.01) to have had CITC than their married counterparts, while the never married were less likely to have had either CITC or PITC. HIV positive individuals (OR = 1.60; p value < 0.01) and those who refused testing in the survey (OR = 1.39; p value < 0.05) were more likely to have had CITC compared to their HIV negative counterparts. Conclusion: Although the proportion of individuals ever tested in the informal settlements is similar to the national average, it remains low compared to that of Nairobi province especially among men. Key determinants of HIV testing and counselling include; gender, age, education level, HIV status and marital status. These factors need to be considered in efforts aimed at increasing participation in HIV testing. Background Although the HIV/AIDS epidemic is in its third decade, many more new infections continue to occur [1]. HIV transmission in sub-Saharan Africa is predominantly heterosexual and as such a lot of prevention efforts have focused on sexual behaviour change. However, for beha- viour change to happen, it is important that individuals know their HIV status so that they can take informed and appropriate action [2,3]. Voluntary Counselling and * Correspondence: akziraba@yahoo.com 1African Population and Health Research Center, Kirawa Road, off Peponi Road P. O. Box 10787, 00100, Nairobi, Kenya Full list of author information is available at the end of the article Testing (VCT) has been recommended as an effective entry point to prevention and care [4-7]. In Kenya, the official government position for HIV test- ing since the early days of the epidemic was premised on the client-initiated testing and counselling (CITC) model, which entails a client taking the initiative to be tested for HIV. The process involves provision of pre-testing coun- selling, testing and post-testing counselling with a lot of emphasis on maintaining client confidentiality. However, several years into the epidemic, the uptake of counselling and testing remained low [8-10]. For example, in an ear- lier survey in 2003, it was estimated that approximately 27% and 25.4% of females and males respectively, in © 2011 Ziraba et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.