Abstract
BackgroundCampaigns have been conducted in a number of low HIV prevalence African settings, as a strategy to expand HIV testing, and it is important to assess the extent to which individual rights and quality of care are protected during campaigns. In this article we investigate provider and client perceptions of ethical issues, including whether they think that accessibility of counseling and testing sites during campaigns may hinder confidentiality.MethodsTo examine how campaigns have functioned in Burkina Faso, we undertook a qualitative study based on individual interviews and focus group discussions with 52 people (providers and clients tested during or outside campaigns and individuals never tested). Thematic analysis was performed on discourse about perceptions and experiences of HIV-testing campaigns, quality of care and individual rights.ResultsRespondents value testing accessibility and attractiveness during campaigns; clients emphasize convenience, ripple effect, the sense of not being alone, and the anonymity resulting from high attendance. Confronted with numerous clients, providers develop context-specific strategies to ensure consent, counseling, confidentiality and retention in the testing process, and they adapt to workplace arrangements, local resources and social norms. Clients appreciate the quality of care during campaigns. However, new ethical issues arise about confidentiality and accessibility. Confidentiality of HIV-status may be jeopardized due to local social norms that encourage people to share their results with others, when HIV-positive people may not wish to do so. Providers’ ethical concerns are consistent with WHO norms known as the ‘5 Cs,’ though articulated differently. Clients and providers value the accessibility of testing for all during campaigns, and consider it an ethical matter. The study yields insights on the way global norms are adapted or negotiated locally.ConclusionsFuture global recommendations for HIV testing and counseling campaigns should consider accessibility and propose ways for testing services to respond to new ethical issues related to high demand.
Highlights
Campaigns have been conducted in a number of low HIV prevalence African settings, as a strategy to expand HIV testing, and it is important to assess the extent to which individual rights and quality of care are protected during campaigns
Since the beginning of the global HIV/AIDS epidemic, HIV testing has raised a number of issues regarding ethics and human rights
‘3 Cs’: Confidentiality, Counseling and informed Consent [2]. These global norms for HIV testing were applied in Sub-Saharan Africa with local particularities regarding interpretations in policies and practices [3]
Summary
Campaigns have been conducted in a number of low HIV prevalence African settings, as a strategy to expand HIV testing, and it is important to assess the extent to which individual rights and quality of care are protected during campaigns. International organizations endorsed informed and voluntary testing and disclosure, requiring three components known as the ‘3 Cs’: Confidentiality, Counseling and informed Consent [2]. These global norms for HIV testing were applied in Sub-Saharan Africa with local particularities regarding interpretations in policies and practices [3]. These requirements were maintained even as the balance of the risks and benefits of HIV testing progressively changed during the early 2000s due to greater availability of antiretrovirals and lower stigma. The ‘3 Cs’ were re-affirmed as a safeguard [4], and efforts to expand testing services were marked by a continuing tension between the drive to diagnose HIV-positive people and the need to protect individual autonomy, privacy and access to care
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