Negotiating multiple barriers: health workers' access to counselling, testing and treatment in Malawi

Namakhoma, Ireen; Bongololo, Grace; Bello, George; Nyirenda, Lot; Phoya, Anne; Phiri, Sam; Theobald, Sally; Obermeyer, Carla Makhlouf

doi:10.1080/09540121003607241

Cited by 27 publications

(31 citation statements)

References 10 publications

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“…The impact of stigma on uptake of HIV testing has been reported in other studies [6, 11, 17, 32, 38]. In this study, fear of enacted stigma [39] was not found to be a barrier to HIV testing, even after probing for its influence.…”

Section: Discussionsupporting

confidence: 59%

Why do marital partners of people living with HIV not test for HIV? A qualitative study in Lusaka, Zambia

Merten

Bond

2016

BMC Public Health

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BackgroundKnowledge of HIV status is crucial for HIV prevention and management in marital relationships. Yet some marital partners of people living with HIV decline HIV testing despite knowing the HIV-positive status of their partners. To date, little research has explored the reasons for this.MethodsAn exploratory qualitative study was undertaken in Lusaka, Zambia, between March 2010 and September 2011, nested within a larger ethnographic study. In-depth interviews were held with individuals who knew the HIV-positive status of their marital partners but never sought HIV testing (n = 30) and HIV service providers of a public sector clinic (n = 10). A focus group discussion was also conducted with eight (8) lay HIV counsellors. Data was transcribed, coded and managed using ATLAS.ti and analysed using latent content analysis.ResultsThe overarching barrier to uptake of HIV testing was study participants’ perception of their physical health, reinforced by uptake of herbal remedies and conventional non-HIV medication to mitigate perceived HIV-related symptoms. They indicated willingness to test for HIV if they noticed a decline in physical health and other alternative forms of care became ineffective. Also, some study participants viewed themselves as already infected with HIV on account of the HIV-positive status of their marital partners, with some opting for faith healing to get ‘cured’. Other barriers were the perceived psychological burden of living with HIV, modulated by lay belief that knowledge of HIV-positive status led to rapid physical deterioration of health. Perceived inability to sustain uptake of life-long treatment – influenced by a negative attitude towards treatment – further undermined uptake of HIV testing. Self-stigma, which manifested itself through fear of blame and a need to maintain moral credibility in marital relationships, also undermined uptake of HIV testing.ConclusionsImproving uptake of HIV testing requires a multi-pronged approach that addresses self-stigma, lay risk perceptions, negative treatment and health beliefs and the perceived psychological burden of living with HIV. Strengthening couple HIV testing services, including addressing conflict and addressing gendered power relationships are also warranted to facilitate joint knowledge, acceptance and management of HIV status in marital relationships.

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Section: Discussionsupporting

confidence: 59%

Why do marital partners of people living with HIV not test for HIV? A qualitative study in Lusaka, Zambia

Merten

Bond

2016

BMC Public Health

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“…Researchers have documented that distance and limited health resources contribute to poor health care utilization in Malawi (Kambala et al, 2011; Namakhoma et al, 2010). To date, Malawi has had difficulty providing cervical cancer screening and treatment services (Fort et al, 2011; Taulo, 2008); however, HPV vaccination offers a promising solution, because widespread vaccine programs have already demonstrated to be successful within the context of Malawi.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to HPV Vaccination: Perspectives from Malawian Women

2013

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The aim of this research was to elucidate potential barriers and facilitators to human papillomavirus (HPV) vaccination in Malawi, a sub-Saharan country. In Malawi, approximately 31 out of every 100,000 women develop cervical cancer annually, and 80% of those affected die from this malignancy. HPV vaccination may provide a feasible strategy for cervical cancer prevention in Malawi. However, important questions and concerns regarding cervical cancer and HPV vaccination acceptance among individuals and their communities must be considered prior to vaccine delivery. Qualitative interviews were conducted with 30 Malawian mothers aged 18–49 years from Chiradzulu District. Women’s knowledge and beliefs about HPV, cervical cancer, and vaccination, and their social-ecological contexts were explored in-depth. Thematic analyses revealed that despite women’s limited knowledge, cervical cancer was perceived to be a serious disease. Participants believed that as women, they were responsible for their children’s health. Women unanimously reported that they would vaccinate their children against HPV, especially if a health professional recommended it. Malawi’s health care infrastructure could present challenges to HPV vaccine programs; however, participants did not typically report this to be a barrier to vaccination. These data shed light on factors that may influence HPV vaccination acceptance and uptake in Malawi.

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“…Physical deterioration of health [30,32,37,39,40,43,46,48],[55,67,69] and poor health/death of sexual partner or child [31,43,48,59,68] elevated the perceived risk of infection and a decision to test:…”

Section: Resultsmentioning

confidence: 99%

“…In other instances, HIV testing was undertaken as an essential part of preparation for marriage [31,39,40,42,46,50,58,61]. For instance, a study in Ghana [50] encapsulates the role that the church was playing in increasing the uptake of HIV testing as an integral part of marriage preparation and counselling.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa

et al. 2013

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BackgroundDespite Sub-Saharan Africa (SSA) being the epicenter of the HIV epidemic, uptake of HIV testing is not optimal. While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing, systematic reviews to provide a more comprehensive understanding are lacking.MethodsUsing Noblit and Hare’s meta-ethnography method, we synthesised published qualitative research to understand factors enabling and deterring uptake of HIV testing in SSA. We identified 5,686 citations out of which 56 were selected for full text review and synthesised 42 papers from 13 countries using Malpass’ notion of first-, second-, and third-order constructs.ResultsThe predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women’s decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing.ConclusionsImproving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs of seeking HIV testing could also contribute towards increasing uptake of HIV testing in SSA.

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Negotiating multiple barriers: health workers' access to counselling, testing and treatment in Malawi

Cited by 27 publications

References 10 publications

Why do marital partners of people living with HIV not test for HIV? A qualitative study in Lusaka, Zambia

Why do marital partners of people living with HIV not test for HIV? A qualitative study in Lusaka, Zambia

Barriers and Facilitators to HPV Vaccination: Perspectives from Malawian Women

A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa

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