Increasing the acceptability of HIV counseling and testing with three C's: Convenience, confidentiality and credibility

Abstract

Agencies engaged in humanitarian efforts to prevent the further spread of HIV have emphasized the importance of voluntary counseling and testing (VCT), and most high-prevalence countries now have facilities that offer testing free of charge. The utilization of these services is disappointingly low, however, despite high numbers reporting that they would like to be tested. Explanations of this discrepancy typically rely on responses to hypothetical questions posed in terms of psychological or social barriers; often, the explanation is that people fear learning that they are infected with a disease that they understand to be fatal and stigmatizing. Yet when we offered door-to-door rapid blood testing for HIV as part of a longitudinal study in rural Malawi, the overwhelming majority agreed to be tested and to receive their results immediately. Thus, in this paper, we ask: why are more people not getting tested? Using an explanatory research design, we find that rural Malawians are responsive to door-to-door HIV testing for the following reasons: it is convenient, confidential, and the rapid blood test is credible. Our study suggests that attention to these factors in VCT strategies may mitigate the fear of HIV testing, and ultimately increase uptake in rural African settings.

Knowledge, attitudes and acceptability to provider-initiated HIV testing and counseling: patients’ perspectives in Moshi and Rombo Districts, Tanzania

“…Issues regarding the importance of informed consent, counseling and confidentiality emerged in most discussions in both rural and urban settings. Ethical issues related to HIV counseling and testing are very sensitive and providers are expected to be aware of ethical and legal implications while discharging PITC services (Angotti et al, 2009;Ostermann et al, 2011). This is necessary because of the sensitive nature of HIV infection, associated stigma and vulnerability of clients.…”

Earlier HIV diagnosis - are mobile services the answer?

“…15 The convenience and accessibility of the mobile service compared with stationary services may account for the difference. 9,10,12 Combining HIV testing with screening for other chronic conditions may reduce stigma, hence encouraging testing in a wider population including males and the elderly.…”

“…In addition, these stationary services may not appeal to most of the population, owing to issues of accessibility, acceptability and confidentiality. [9][10][11][12] Mobile HCT services overcome some of these shortcomings 9 but little is known about the differences between individuals accessing mobile HCT services compared with those tested at health care facilities.…”

Community-Based Rapid Oral Human Immunodeficiency Virus Testing for Tuberculosis Patients in Lima, Peru

“…Whether HIV-positive persons were able to connect with HIV services was not described. 33 A third study in an island community on Lake Malawi offered rapid blood-based HIV testing and counseling to 1,030 adults and their spouses to determine whether the homebased provision of HIV testing and counseling had the potential to reduce socioeconomic-based HIV testing inequalities as compared with site-based testing. Facility-based HIV testing was available at no charge on the island.…”