Factors Determining Voluntary Counseling and Testing (VCT) for the Human Immunodeficiency Virus (HIV) among Low Income Women: Focus Group Findings from Rural, Urban, and Peri-Urban Women Groups in Lilongwe District-Malawi
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Keywords

 VCT, Preventative health device, Diagnostic tool, Couple testing, Lilongwe, home-based service provision.

How to Cite

Marisen Mwale. (2014). Factors Determining Voluntary Counseling and Testing (VCT) for the Human Immunodeficiency Virus (HIV) among Low Income Women: Focus Group Findings from Rural, Urban, and Peri-Urban Women Groups in Lilongwe District-Malawi. Journal of Basic & Applied Sciences, 10, 306–316. https://doi.org/10.6000/1927-5129.2014.10.40

Abstract

Most high prevalence sub-Saharan African countries tend to over-emphasize fidelity and condom use as major preventative measures relative to HIV and AIDS prevention. Studies of behavior change that focus exclusively on these strategies of most interest to the prevention community bias examinations of behaviour change downward by ignoring other potentially effective ways of limiting the epidemic. Regardless of the dearth in efficacy, as well as tolerance bottlenecks; the prevailing debate over provider initiated testing in Malawi may depict a shift towards HIV Testing and Counseling (HTC) in Acquired Immunodeficiency Syndrome (AIDS) prevention. The current study examines factors that determine VCT uptake among low income women in the Lilongwe district. A qualitative paradigm- the Focus Group Discussion (FGD) was utilized to inform the study. Convenient sampling was used to isolate three women groups namely; St John Nsamba, Women of Action, and National Association of People Having AIDS in Malawi (NAPHAM) support group as participants. The first two groups were sampled as primary groups, the former representing the urban domain with the later representing the rural domain respectively. Between 10 – 15 participants from each group, approximately within the age category 20-49 were involved. Findings suggest socio-cultural gender stereotypes inhibiting negotiating testing with partners as well as the social comparison or optimistic bias motivating ordinary women to underestimate their risk of contracting HIV relative to significant others as major barriers. Recurrent illnesses was considered the major motivator, downplaying the empirical impression about access to treatment as major incentive. The methodical conclusion drawn from the study is that VCT has the potential to mitigate the spread of HIV but for the preventative measure to be successful there is need to surmount various ethnographic and socio-cultural constraints currently impeding the intervention.

https://doi.org/10.6000/1927-5129.2014.10.40
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References

UNAIDS. Voluntary Counseling and Testing. UNAIDS Technical update, Geneva, Switzerland 2012.

Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing (Review), The Cochrane Collaboration, Wiley 2007; Issue 3.

Weinhardt L, Carey M, Jonson B, Bickham N. Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985-1997. Am J Public Health 1999; 89(9): 1397-405. http://dx.doi.org/10.2105/AJPH.89.9.1397

Miller A. Behavioral risk for HIV infection associated with HIV-testing decision. AIDS Educ Prev 1996; 8(5): 394-402.

CDC. Revised Guidelines for HIV counseling, testing and Referral and Revised Recommendations for HIV Screening of Pregnant women. Morbidity and Mortality Weekly Report 2012; (50): 304-370.

NAC. National HIV Prevention Strategy (2009-2013), NAC Secretariat, Lilongwe 2009.

UNAIDS/WHO. Initiating second generation HIV surveillance systems: Practical and logistical guidelines. Geneva, Switzerland 2002.

Coates TJ, Grinstead O, Gregorich S. Efficacy of voluntary HIV-1 counseling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomized trial. Lancet 2008; (356): 103-112.

Demographic Health Survey. Malawi Statistical Office. Zomba, Malawi 2011.

UNAIDS/WHO. Initiating second generation HIV surveillance systems: Practical guidelines. Geneva, Switzerland 2008.

NAC. Biological and Behavioral Surveillance Survey 2006 and Comparative analysis of 2004 BSS and 2006 BBSS, NAC Secretariat, Lilongwe 2006.

MACRO. Annual Reports (2007-2010), MACRO Secretariat, Lilongwe 2010.

NAC. National HIV/AIDS Policy- A call to renewed action (SUMMARY), NAC Secretariat, Lilongwe 2008.

Marcus R. Gender and HIV/AIDS in sub-Saharan Africa: The cases of Uganda and Malawi. Bridge 1993; (13): 452-81.

WHO. Testing and Counseling. (serial on the internet) 2003 November 10(cited 2012 December 6) Available from http://www.who.int/hiv/topics/vct/testing/en/print.html

UNAIDS. Tools for Evaluating HIV Voluntary Counseling and Testing. Joint United Nations Programme on HIV/AIDS. Geneva, Switzerland 2000.

UNICEF. How does HIV affect young people? (serial on the internet) 2006 October 4 (cited 2012 November 12) Available from http://www.unicef.org

WHO. Guidance on Ethics and Equitable Access to HIV Treatment and Care (serial on the internet). 2006 June 20 (cited 2012 January 7) http://www.who.int/hiv/pub/advocacy/ en/guidanceethics

UNAIDS/WHO. Initiating second generation HIV surveillance systems: Practical guidelines. Geneva, Switzerland 2008.

Kimchi E. Reactions to At-Home Voluntary Counseling and Rapid HIV Testing in Rural Malawi. Student Summer Fellowship report. PARC, Pennsylvania 2005

Slovic P. Perception of risk. Science 1987; (236): 280-85.

Demographic Health Survey. Malawi Statistical Office. Zomba, Malawi 2000.

Boyatzis R. Transforming qualitative information: Thematic analysis and code development. Thousand Oaks, CA: Sage 1998.

Merriam SB. Qualitative research and case study applica-tions in education. San Francisco, CA: Jossey-Bass 1998.

Seidman I. Interviewing as qualitative research. A guide for researchers in education and the social sciences (2nd ed.). New York City, NY: Teachers College, Columbia University 1998.

Dillnessa E. Couple voluntary counseling and testing among VCT clients in Addis Ababa, Ethiopia. Ethiopia Med J 2010; 48(2): 95-103.

Matovu JK. Preventing HIV transmission in married and cohabiting HIV- discordant couples in sub-Saharan Africa through combination prevention. Curr HIV Res 2010; 8(6): 430-440. http://dx.doi.org/10.2174/157016210793499303

Orne-Gliemann J, Tchendjou PT, Miric M, Gadgil M. Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study. BMC Public Health 2010; (10): 197- 241.

Conkling M, Shutes EL, Karita E, Chomba E. Couples’ voluntary counseling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study. J Interven AIDS Sociol 2010; 13(10): 1758-806.

Aarnio P, Olsson P, Chimbiri A, Kulmala T. Male involvement in antenatal HIV counseling and testing: exploring men’s perceptions in rural Malawi. AIDS Care 2001; 21(12): 1537-46. http://dx.doi.org/10.1080/09540120902903719

Lowy J. Monogamous women risk diseases. Scripps Howard 1999.

Rajaraman D, Surender R. HIV testing in Botswana: Lessons for Policy and Practice 2009.

Maman S, Mbwambo J, Hogan N, Kilonzo G, Sweat M. Women’s barriers to HIV-testing and disclosure: challenges for HIV-1 voluntary testing and counseling. AIDS Care 2001; (13): 595-603.

DePaoli M, Manongi R, Klepp K. Factors influencing acceptability of Voluntary counseling and HIV-testing among pregnant women in Northern Tanzania. AID Care 2004; (16): 411-25.

Van der Straten A, King A, Grinstead A, Selufilira A, Allen S. Couple Communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS 1995; 9(8): 935-44. http://dx.doi.org/10.1097/00002030-199508000-00016

Katz DA, Kiarie JN, John-Stewart GC. Male perspectives on incorporating men into antenatal HIV counseling and testing. Plos One 2009; 4(11): 709-68. http://dx.doi.org/10.1371/journal.pone.0007602

Wolff B, Nyanzi B, Katongole G. Evaluation of a home-based voluntary and counseling and testing intervention in rural Uganda. Health Policy Planning 2005; (20): 109-16.

Castle S. Doubting the existence of AIDS: a barrier to voluntary HIV testing and counseling in urban Mali. Health Policy Planning 2003; (18): 146-55.

Lie G, Biswalo P. Perceptions of the appropriate HIV/AIDS counselor in Arusha and Kilimanjaro regions of Tanzania: Implications for hospital counseling. AIDS Care 1994; (6): 139-51.

Bracher M, Santow G, Watkins SC. ‘Moving’ and Marrying: Modelling HIV Infection among Newly-weds in Malawi. Demographic Res 2003; 1(7): 207-45. http://dx.doi.org/10.4054/DemRes.2003.S1.7

Lutalo T, Kidugavu M, Wawer M. Contraceptive use and HIV counseling and testing in rural Rakai district, SW Uganda. Abstract C246. Paper presented at the 13th International Conference on HIV/AIDS, Durban, South Africa 2000.

Buzwell S, Rosenthal D. Exploring the sexual world of the unemployed adolescent. J Commun Appl Social Psychol 1995; (5): 161-66.

Rosenthal D, Shepherd H. A six month follow-up of adolescents. Sexual risk-taking, HIV/AIDS knowledge, and attitudes to condoms. J Commun Appl Social Psychol 1993; (3): 53-65.

Weinstein A. Why it won’t happen to me: Perception of risk factors and susceptibility. Health Psychol 1984; (3): 431-57.

Helleringer S, Kohler HP, Frimpong J, Mkandawire J. Increasing Uptake of HIV Testing and Counseling among the poorest in sub-Saharan countries through home-based service provision. J AIDS 2009; (51): 185-93.

Glick H. Scaling up HIV Voluntary Counseling and Testing in Africa: What can evaluation studies tell us about potential prevention impacts? Evaluat Rev 2005; 29(4): 331-57. http://dx.doi.org/10.1177/0193841X05276437

Allen S, Serufilira A, Bogaerts J, et al. Confidential HIV testing and condom promotion in Africa: Impact on HIV and gonorrhea rates. J Am Med Assoc 1992; 268(23): 3338-43. http://dx.doi.org/10.1001/jama.1992.03490230068030

Kamenga M, Ryder R, Jingu M, et al. Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: Experience at an HIV counseling center in Zaire. AIDS 1991; (5): 61-67.

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Copyright (c) 2014 Marisen Mwale