Abstract
BackgroundThere is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy. However, to benefit from these services, knowledge of one's HIV status is critical. Partner notification for HIV is an important component of HIV counselling because it is an effective strategy to prevent secondary transmission, and promote early diagnosis and prompt treatment of HIV patients' sexual partners. However, counsellors are often frustrated by the reluctance of HIV-positive patients to voluntarily notify their sexual partners. This study aimed to explore tuberculosis (TB)/HIV counsellors' perspectives regarding confidentiality and partner notification.MethodsQualitative research interviews were conducted in the Northwest Region of Cameroon with 30 TB/HIV counsellors in 4 treatment centres, and 2 legal professionals between September and December 2009. Situational Analysis (positional map) was used for data analysis.ResultsConfidentiality issues were perceived to be handled properly despite concerns about patients' reluctance to report cases of violation due to apprehension of reprisals from health care staffs. All the respondents encouraged voluntary partner notification, and held four varying positions when confronted with patients who refused to voluntarily notify their partners. Position one focused on absolute respect of patients' autonomy; position two balanced between the respect of patients' autonomy and their partners' safety; position three wished for protection of sexual partners at risk of HIV infection and legal protection for counsellors; and position four requested making HIV testing and partner notification routine processes.ConclusionCounsellors regularly encounter ethical, legal and moral dilemmas between respecting patients' confidentiality and autonomy, and protecting patients' sexual partners at risk of HIV infection.This reflects the complexity of partner notification and demonstrates that no single approach is optimal, but instead certain contextual factors and a combination of different approaches should be considered. Meanwhile, adopting a human rights perspective in HIV programmes will balance the interests of both patients and their partners, and ultimately enhance universal access to HIV services.
Highlights
There is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy
About how confidentiality issues are handled in the study settings, followed by a description of how partner notification for HIV is addressed
Our study revealed that the participants were sometimes frustrated when patients objected to voluntary partner notification especially if the participants were loyal to the sexual partners
Summary
There is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy. This is especially so in sub-Saharan Africa which bears the overwhelming brunt of the epidemic For this to be feasible, knowledge of one’s HIV-positive status is pregnant women), provider-initiated testing and counselling (PITC), which is counselling recommended by health care providers to every person attending health care facilities has since 2007 been recommended as a supplement to VCT [3]. HIV disclosure is defined as a ‘complex and multifaceted process of making a voluntary or involuntary decision about whom to inform about one’s serostatus, why, when, where and how’ [5] This is challenging when it comes to informing patients’ sexual partners, referred to as partner notification. The increasing emphasis on partner notification in HIV control programmes is backed by empirical evidence that it is an effective strategy of preventing HIV transmission to sexual partners at risk, and promoting early diagnosis and prompt treatment to those found infected [7,8]
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