<p>Voluntary HIV Counseling and Testing Among Commercial Motorcyclist Youths: An Exploration of Ethical Challenges and Coping Mechanisms in Dar es Salaam</p>

Abstract

Background Regardless, the known benefits of voluntary testing and counseling (VCT) in the fight against HIV/AIDS, its uptake is still low among youth. This study explored ethical challenges facing voluntary counseling and testing for HIV/AIDS among youth engaged in commercial motorcycling in Kinondoni municipality, Dar es Salaam city. Methods Qualitative exploratory study was carried out to 35 people using key informants’ interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). Key informants were purposefully selected based on their roles in VCT services, while the FGD participants and in-depth interview respondents were purposefully selected among youth commercial motorcyclists. Qualitative content data analysis was used to analyze the gathered information. Findings Results of this study show that lack of privacy during counseling and treatment, fear of HIV status disclosure to others by counselors and difficulties in counseling are the main ethical challenges facing VCT services among youth in Kinondoni municipality. Shortage of counselors to match the number of VCT services’ clients and lack of on-job training on HIV/AIDS testing and counseling among counselors partly contributed to the revealed ethical challenges. In an attempt to address the ethical challenges, youth peer educators and routine supervision were the available initiatives on improving VCT services among youth. Conclusion VCT services face ethical challenges which are either health facility-based, community-based or are at the national level. Addressing the ethical challenges is necessary in order to improve the uptake of VCT services and thus strengthen the fight against HIV/AIDS. Deployment of enough counselors, refresher training to counselors, and raising community awareness on HIV/AIDS and the negative impacts of stigma are among the initial strategies for remedying the situation.

Defining ethical challenge(s) in healthcare research: a rapid review

“…Of the 72 included records, 53 were empirical studies [ 34 – 86 ], 10 non-systematic reviews [ 87 – 96 ], 7 systematic reviews [ 12 – 14 , 97 – 100 ], 1 systematic review protocol [ 101 ], and 1 non-systematic review protocol [ 102 ]. Of the 53 empirical studies, 42 (79%) were qualitative studies [ 34 – 36 , 38 – 44 , 47 , 48 , 50 – 52 , 54 – 58 , 60 , 62 – 67 , 69 , 71 – 77 , 79 – 81 , 83 – 86 ], 6 (12%) used a mixed methods approach [ 45 , 46 , 53 , 59 , 61 , 68 ], and 5 (10%) were quantitative [ 37 , 49 , 70 , 78 , 82 ]. 7/56 empirical studies, all qualitative interview studies, recruited participants internationally with no specific location stated [ 40 , 54 , 55 , 58 , 60 , 63 , 73 ].…”

“…7/56 empirical studies, all qualitative interview studies, recruited participants internationally with no specific location stated [ 40 , 54 , 55 , 58 , 60 , 63 , 73 ]. Of the remaining studies, all but one were single-country studies: Botswana [ 75 ], Canada [ 41 , 65 ], China [ 57 ], Denmark [ 39 , 43 ], Dominican Republic [ 44 ], Germany [ 51 , 84 ], India [ 61 ], Iran [ 38 , 46 , 49 , 68 , 70 – 72 , 78 , 82 , 98 ], Italy [ 45 ], Mexico [ 87 ], the Netherlands [ 76 ], New Zealand [ 47 ], Norway [ 42 , 52 , 56 , 64 , 80 , 81 , 83 ], Saudi Arabia [ 34 – 37 ], Tanzania [ 69 , 74 ], Uganda [ 67 ], UK [ 86 ], and USA [ 50 , 53 , 59 , 62 , 66 , 77 , 79 , 85 , 85 ]. The remaining study was undertaken in both Sierra Leone and the UK [ 48 ].…”

“…12/72 (17%) of retrieved studies offered an explicit definition for ‘ethical challenge(s)’ [ 12 – 14 , 48 , 50 , 56 , 57 , 66 , 69 , 81 , 98 , 101 ]. Definitions were more likely to be found in more recent publications, with 4/12 included studies published in 2016–2018 [ 14 , 48 , 56 , 81 ], and 8/12 published in 2019–2021 [ 12 , 13 , 50 , 57 , 66 , 69 , 98 , 101 ].…”

“…12/72 (17%) of retrieved studies offered an explicit definition for ‘ethical challenge(s)’ [ 12 – 14 , 48 , 50 , 56 , 57 , 66 , 69 , 81 , 98 , 101 ]. Definitions were more likely to be found in more recent publications, with 4/12 included studies published in 2016–2018 [ 14 , 48 , 56 , 81 ], and 8/12 published in 2019–2021 [ 12 , 13 , 50 , 57 , 66 , 69 , 98 , 101 ]. The included study locations were evenly distributed, matching the overall pattern of retrieved studies, with studies from high- [ 48 , 50 , 56 , 66 , 81 ], middle- [ 57 , 98 ], and low-income settings [ 48 , 69 ].…”

“…Definitions were more likely to be found in more recent publications, with 4/12 included studies published in 2016–2018 [ 14 , 48 , 56 , 81 ], and 8/12 published in 2019–2021 [ 12 , 13 , 50 , 57 , 66 , 69 , 98 , 101 ]. The included study locations were evenly distributed, matching the overall pattern of retrieved studies, with studies from high- [ 48 , 50 , 56 , 66 , 81 ], middle- [ 57 , 98 ], and low-income settings [ 48 , 69 ]. The identified studies included eight qualitative studies [ 48 , 50 , 56 , 57 , 66 , 69 , 81 , 98 ], 3 systematic reviews [ 12 – 14 ], and 1 systematic review protocol [ 101 ].…”