Ethical considerations of providers and clients on HIV testing campaigns in Burkina Faso

BMC International Health and Human Rights

Carla Makhlouf Obermeyer³  Jean-François Somé¹  Odette Ky-Zerbo²  Alice Desclaux⁴ 

[1] UNDP, Lomé, Togo;Programme d’Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso;Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon;IRD/CRCF, BP 1386, 18524, Dakar, Senegal

关键词: Africa;    Stigma;    Global norms;    Individual rights;    Burkina Faso;    Ethics;    Testing campaign;    HIV;   

Others  :  1113315
DOI  :  10.1186/1472-698X-14-27

 received in 2014-05-12, accepted in 2014-09-24,  发布年份 2014

【 摘 要 】

Background

Campaigns have been conducted in a number of low HIV prevalence African settings, as a strategy to expand HIV testing, and it is important to assess the extent to which individual rights and quality of care are protected during campaigns. In this article we investigate provider and client perceptions of ethical issues, including whether they think that accessibility of counseling and testing sites during campaigns may hinder confidentiality.

Methods

To examine how campaigns have functioned in Burkina Faso, we undertook a qualitative study based on individual interviews and focus group discussions with 52 people (providers and clients tested during or outside campaigns and individuals never tested). Thematic analysis was performed on discourse about perceptions and experiences of HIV-testing campaigns, quality of care and individual rights.

Results

Respondents value testing accessibility and attractiveness during campaigns; clients emphasize convenience, ripple effect, the sense of not being alone, and the anonymity resulting from high attendance. Confronted with numerous clients, providers develop context-specific strategies to ensure consent, counseling, confidentiality and retention in the testing process, and they adapt to workplace arrangements, local resources and social norms. Clients appreciate the quality of care during campaigns. However, new ethical issues arise about confidentiality and accessibility. Confidentiality of HIV-status may be jeopardized due to local social norms that encourage people to share their results with others, when HIV-positive people may not wish to do so. Providers’ ethical concerns are consistent with WHO norms known as the ‘5 Cs,’ though articulated differently. Clients and providers value the accessibility of testing for all during campaigns, and consider it an ethical matter. The study yields insights on the way global norms are adapted or negotiated locally.

Conclusions

Future global recommendations for HIV testing and counseling campaigns should consider accessibility and propose ways for testing services to respond to new ethical issues related to high demand.

【 授权许可】

   
2014 Desclaux et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bayer R, Edington C: HIV testing, human rights, and global AIDS policy: exceptionalism and its discontents. J Health Polit Policy Law 2009, 34:301-323.
• [2]UNAIDS, WHO: UNAIDS/WHO Policy Statement on HIV Testing. Geneva; 2004. [http://www.who.int/hiv/pub/vct/statement/en/ webcite]
• [3]Bott S, Obermeyer CM: The social and gender context of HIV disclosure in sub-Saharan Africa: a review of policies and practices. SAHARA J 2013, 10(Suppl 1):S5-S16.
• [4]Yeatman SE: Ethical and public health considerations in HIV counseling and testing: Policy implications. Stud Fam Plann 2007, 38:271-278.
• [5]WHO: Service Delivery Approaches to HIV Testing and Counseling (HTC): A Strategic Policy Framework. Geneva; 2012. [http://www.who.int/hiv/pub/vct/htc_framework/en/index.html webcite]
• [6]WHO/PEPFAR/CDC/USAID/LSTM: Planning, Implementing and Monitoring Home-Based HIV Testing and Counseling. Geneva; 2012. [http://www.who.int/hiv/pub/vct/home_based_care/en/index.html webcite]
• [7]Obermeyer CM, Neuman M, Desclaux A, Wanyenze R, Ky-Zerbo O, Cherutich P, Namakhoma I, Hardon A: Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries. PLoS Med 2012, 9(10):e1001329.
• [8]Fylkesnes K, Sandøy IF, Jürgensen M, Chipimo PJ, Mwangala S, Michelo C: Strong effects of home-based voluntary HIV counseling and testing on acceptance and equity: a cluster randomised trial in zambia. Soc Sci Med 2013, 86:9-16.
• [9]Kyaddondo D, Wanyenze R, Kinsman J, Hardon A: Home-based HIV counseling and testing: client experiences and perceptions in Eastern Uganda. BMC Public Health 2012, 12:966. BioMed Central Full Text
• [10]Jürgensen M, Sandøy IF, Michelo C, Fylkesnes K: Effects of home-based voluntary counseling and testing on HIV-related stigma: findings from a cluster-randomized trial in Zambia. Soc Sci Med 2013, 81:18-25.
• [11]Obermeyer CM, Bott S, Bayer R, Desclaux A, Baggaley R, The MATCH Study Group: HIV testing and care in Burkina Faso, Kenya, Malawi and Uganda: ethics on the ground. BMC Int Health Hum Rights 2013, 13(1):6. BioMed Central Full Text
• [12]UNAIDS: HIV and AIDS Estimates Burkina Faso. Geneva; 2013. [http://www.unaids.org/en/regionscountries/countries/burkinafaso/ webcite]
• [13]UNAIDS: Global Report, UNAIDS Report on the Global AIDS Epidemic. Geneva; 2012. [http://www.unaids.org/en/resources/publications/2012/name,76121,en.asp webcite]
• [14]SP/CNLS-IST: Pamac. Rapport annuel d’activités : programme d’appui au monde associatif et communautaire 2008. Ouagadougou: PAMAC; 2008:106.
• [15]SP/CNLS-IST: Normes et Directives nationales de conseil dépistage volontaire. Ouagadougou: SP/CNLS-IST; 2003.
• [16]SP/CNLS-IST: Normes et Directives nationales de conseil dépistage volontaire. Ouagadougou: SP/CNLS-IST; 2008.
• [17]Somé JF, Desclaux A, Ky-Zerbo O, Lougué M, Kéré S, Obermeyer C, Simaga F: Les campagnes de dépistage du VIH, une stratégie efficace pour l’accès universel à la prévention et au traitement? L’expérience du Burkina Faso. Médecine et Santé Tropicales 2014, 24:73-79.
• [18]Institut National de la Statistique et de la Démographie (INSD), ICF International: Enquête Démographique et de Santé et à Indicateurs Multiples (EDSBF-MICS IV) Burkina Faso 2010. Ouagadougou: INSD; 2012.
• [19]Hennink M, Hutter I, Bailey A: Qualitative Research Methods. Los Angeles: Sage; 2012. 328 p
• [20]Pool R, Geissler W: Medical Anthropology. Berkshire, UK: Open University Press; 2005. 184 p
• [21]Desclaux A, Ky-Zerbo O, Somé JF, Makhlouf-Obermeyer C: Les campagnes communautaires de promotion du dépistage VIH en Afrique de l’ouest: ce qu’en disent les usagers au Burkina Faso. Glob Health Promot 2014. online first, doi:1757975914527325
• [22]Lugada E, Millar D, Haskew J, Grabowsky M, Garg N, Vestergaard M, Kahn J, Muraguri N, Mermin J: Rapid implementation of an integrated large-scale HIV counseling and testing, malaria, and diarrhea prevention campaign in rural Kenya. PLoS One 2010, 5(8):e12435.
• [23]Salomon C, Lert F, Enel C, Loubaki G: Quatre jours de dépistage mobile à Base Agip, un quartier de Pointe Noire: D’une recommandation de l’OMS à sa mise en oeuvre dans une grande ville d’Afrique centrale. Anthropologie & Santé 2013., 7[http://anthropologiesante.revues.org/1208 webcite]
• [24]Desclaux A, Raynaut C: Le dépistage VIH et le conseil en Afrique au Sud du Sahara. Karthala, Paris: Karthala; 1997:328.
• [25]Gausset Q, Mogensen HO, Yameogo WME, Berthé A, Konaté B: The ambivalence of stigma and the double-edged sword of HIV/AIDS intervention in Burkina Faso. Soc Sci Med 2012, 74(7):1037-1044.
• [26]Winskell K, Hill E, Obyerodhyambo O: Comparing HIV-related symbolic stigma in six African countries: social representations in Young people’s narratives. Soc Sci Med 2011, 73:1257-1265.
• [27]Neuman M, Obermeyer C: Experiences of stigma, discrimination, care and support among people living with HIV: a four country study. AIDS Behav 2013, 17:1796-1808.
• [28]Brodwin P: Everyday Ethics Voices from the Front Line of Community Psychiatry. Berkeley: University of California Press; 2013.
• [29]Human Rights Watch: A Testing Challenge: the Experience of Lesotho’s Universal HIV Counseling and Testing Campaign. Geneva; 2008. [http://www.refworld.org/docid/4922c5492.html webcite]
• [30]Hancart Petitet P: Maternités en Inde du Sud: des savoirs autour de la naissance au temps du sida. Paris: Edilivre; 2008.
• [31]Ky-Zerbo O, Somé J-F, Simaga F: Le conseil post-test encourage-t-il les PVVIH à partager leur statut sérologique? Pratiques et suggestions des conseillers au Burkina Faso. SAHARA J 2013, 10(supp 1):S73-S80.
• [32]Angotti N, Bula A, Gaydosh L, Kimchi EZ, Thornton RL, Yeatman SE: Increasing the acceptability of HIV counseling and testing with three C’s: Convenience, confidentiality and credibility. Soc Sci Med 2009, 68:2263-2270.
• [33]Massé R: Les limites d’une approche essentialiste des ethnoéthiques: Pour un relativisme éthique critique. Anthropologie et Sociétés 2000, 24:13-33.
• [34]Angotti N: Testing differences: the implementation of western HIV testing norms in sub-Saharan Africa. Cult Health Sex 2012, 14:365-378.
• [35]Dieterlen G (Ed): La notion de personne en Afrique noire. Paris: L’Harmattan; 1993.
• [36]Ky-Zerbo O, Desclaux A, Somé JF, Asmar K, Makhlouf-Obermeyer C: La stigmatisation des PVVIH en Afrique: analyse de ses formes et manifestations au Burkina Faso. Sante Publiquein press
• [37]WHO: Delivering HIV Test Results and Messages for re-Testing and Counseling in Adults. Geneva: WHO; 2010. [http://www.who.int/hiv/pub/vct/hiv_re_testing/en/ webcite]