Factors Associated with Reluctance to Test for HIV among Male Construction Workers in Western Cape, South Africa

Undiagnosed HIV infection remains a key driver of transmission in South Africa, and male construction workers are among the least likely to know their status. To explore the factors associated with HIV testing reluctance in this sub population, we conducted a cross-sectional survey of 450 site-based male construction workers, recruited through purposive sampling - first selecting construction companies that had participated in earlier HIV research and a sampling frame which consisted of all male workers present during the site visits. Binomial logistic regression identified five independent predictors of reluctance to test for HIV. The odds of HIV testing reluctance were higher among respondents with low levels of HIV/AIDS knowledge (OR = 1.61), those with negative attitudes toward condom use (OR = 1.13) and among respondents who frequently used alcohol/drugs before and/or during sex (OR = 1.07). Temporary employees had 38% lower likelihood of presenting with HIV testing reluctance compared to permanent employees (OR = 0.62) and prior social exposure to people living with HIV (PLHIV) reduced the odds of HIV testing reluctance by 22% (OR = 0.78). Although the purposive sampling design limits statistical generalisability, the study findings are nevertheless analytically generalisable and highlight the role of modifiable factors such as HIV/AIDS knowledge, attitudes toward condom use, and behavioural factors (e.g., alcohol/drug use). More importantly, given that HIV is now a manageable chronic condition, with the number of PLHIV steadily increasing, the findings also highlight the potential effect of social exposure to PLHIV in reducing HIV testing reluctance.