HIV testing experiences in Nairobi slums: the good, the bad and the ugly

Eliud Wekesa

doi:10.1186/s12889-019-7975-7

Abstract

BackgroundHIV testing is an integral component of HIV prevention, treatment and care and, therefore, is crucial in achieving UNAIDS 90–90-90 targets. HIV testing in Kenya follows both the voluntary counselling and testing (VCT) and provider initiated testing and counselling (PITC) models. However, little is known about the individual experiences of undergoing an HIV test in the two testing models. This study provides experiential evidence of undergoing an HIV test in a resource poor urban slum setting.MethodsThe study explored testing experiences and challenges faced in respect to ensuring the 3 Cs (consent, counselling and confidentiality), using in-depth interviews (N = 41) with HIV-infected men and women in two slum settlements of Nairobi City. The in-depth interview respondents were aged above 18 years with 56% being females. All interviews were audio-recorded, transcribed and then translated into English. The transcribed data were analysed using thematic analysis method.ResultsThe respondent HIV-testing experiences were varied and greatly shaped by circumstances and motivation for HIV testing. The findings show both positive and negative experiences, with sporadic adherence to the 3Cs principle in both HIV testing models. Although some respondents were satisfied with the HIV testing process, a number of them raised a number of concerns, with instances of coercion and testing without consent being reported.ConclusionThe 3Cs (consent, counselling and confidentiality) principle must underlie HIV testing and counselling practices in order to achieve positive testing outcomes. The study concludes that adherence to the 3Cs during HIV testing contributes to both the individual and public health good – irrespective of whether testing is initiated by the individual or by the health provider.

Highlights

IntroductionHuman immunodeficiency virus (HIV) testing is an integral component of HIV prevention, treatment and care and, is crucial in achieving Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90-90 targets
Human immunodeficiency virus (HIV) testing is an integral component of HIV prevention, treatment and care and, is crucial in achieving Joint United Nations Programme on HIV/Acquired Immune Deficiency Syndrome (AIDS) (UNAIDS) 90–90-90 targets
Voluntary counselling and testing was introduced in sub-Saharan Africa in the 1990s, with international guidelines developed by UNAIDS [11]

Summary

Introduction

HIV testing is an integral component of HIV prevention, treatment and care and, is crucial in achieving UNAIDS 90–90-90 targets. HIV testing in Kenya follows both the voluntary counselling and testing (VCT) and provider initiated testing and counselling (PITC) models. HIV testing practises, principles and guidelines in Kenya (as elsewhere in sub-Saharan Africa) have been changing in response to low testing rates and the increasing availability of antiretroviral treatment (ART). Self-initiated voluntary testing is the hallmark of the VCT model [9]. In this approach the testing is done at the initiative of the individual to be tested, usually by voluntarily visiting a VCT centre [10]. Voluntary counselling and testing was introduced in sub-Saharan Africa in the 1990s, with international guidelines developed by UNAIDS [11]. Despite promotional efforts, uptake of VCT is relatively low and only 1/5 of Kenyan adults get tested in VCT centres [13]

Methods

Results

Discussion

Conclusion