Our study is the first to investigate VCT uptake services and sexual behaviour among HCWs in a representative sample in West Africa. The findings revealed a low rate of HIV testing among HCWs in Burkina Faso. Nevertheless, this rate of testing for HIV was slightly higher than that of the general population as reported in the Burkina Faso Demographic and Health Survey in 2003  Zungu Li et al.  reported that 91% of HCWs in South Africa had been tested for HIV. Such findings in South Africa are in line with other studies that reported a high level of HIV counselling and testing uptake among healthcare workers [20, 21]. However, a study in Zambia among HCWs founded a low level of HIV counselling and testing uptake (33%) .
Fear of HIV test results was the major reason stated by participants for not undergoing HIV testing. Similarly, a UK-based study showed that that fear of results and fear of colleagues’ reactions were the main reasons for not undergoing HIV testing . Proximity to a clinic , perception of being at risk of HIV infection, [25, 26] psychosocial factors such as HIV/AIDS-related stigma and discrimination, [24, 25] and concerns about confidentiality [24, 25] are possible factors associated with VCT uptake.
There is a high female-to-male difference in the use of HIV testing in Burkina Faso HCWs. Male HCWs were more likely to have been tested for HIV than female HCWs. Data from the demographic and health surveys on prior HIV testing experience, suggest higher testing among females in West African countries, [18, 27–29] and in South Africa [30–32]. However, according to the 2005 Ethiopia Demographic Health Survey, 4% of women and 6% of men had ever been tested for HIV . Studies conducted in Zambia, Zimbabwe and the UK reported that acceptance of HIV testing was lower among women than men [20, 34, 35]. The Zimbabwean study specifically reported that women were allegedly more worried about their HIV status and more fearful of HIV testing than men .
Our study also showed that VCT service utilization among HCWs in Burkina Faso was the highest among laboratory workers. Laboratory workers are exposed to occupational injuries, exposing to blood-borne pathogens. In the study among HCWs in South Africa, the majority of HCWs stated that they went for HIV counselling and testing afterwards, mainly to determine their HIV baseline status . In fact, in this study, the group which is less exposed to occupational injury, the administrative and manual workers are less likely have tested to HIV infection.
The results of this study also showed a significant association between undergoing HIV counselling and testing, and participants working experience. Not surprisingly, the more experienced were HCW, the more they had been tested for HIV.
HCWs with sexually risky behaviours were more likely to have used VCT services, as reported by previous studies,  suggesting a good self-perception of HIV risk in this group.
Among HIV-infected individuals, more than half never tested for HIV. Studies investigating the outcome of VCT in Africa demonstrated a beneficial impact of VCT in HIV-related sexual risk behaviours [36–39]. In a meta-analysis, the odds of reporting increased number of sexual partners were reduced when comparing participants who received VCT with those who did not . When stratified by serostatus, these results remained significant for those who tested HIV-positive. Additionally, people living with HIV who received VCT exhibited increased odds of using condoms and engaging in protected sex than people living with HIV who did not receive VCT . Moreover, previous studies suggested that HIV counselling and testing of individuals and couples is a cost-effective primary HIV prevention strategy [11, 40, 41]. In our study, the proportion of high-risk sex tended to be lower among HIV-infected HCWs compared those who were not infected or with no urine sample, but without reaching statistical significance.
Sex with non regular and/or multiple partners was considered as risky sexual behaviours. About one out of five interviewed HCWs reported having had sex with a non regular partner within the 12 months preceding the survey. Regional disparities revealed also that sex with non regular partners was reported mostly in rural areas, a situation that could be attributed to the separation from families and poor social support throughout the year. Younger people are involved in more sexually risky behaviours than adults. Gender, age, and marital status were significantly related to high-risk sex behaviours, which is consistent with previous findings among the general population .
The non-response rate was low, which ensures that the sample is representative of the target population. All data in the survey were self-reported. Therefore, some degree of under-reporting of socially unacceptable behaviours and over-reporting of socially desirable behaviours are likely. It should also be noted that this study has been based on data collected in 2003, and since then the absolute level of HIV testing experience among HCWs is likely to have changed substantially along with improved access to HIV testing in the country. However, these data is the first epidemiological survey in West Africa addressing HIV testing and risky behaviours among HCWs.