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

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.

[HIV/AIDS stigma in Africa: analysis of its forms and manifestations in Burkina Faso]. / La stigmatisation des PVVIH en Afrique: analyse de ses formes et manifestations au Burkina Faso.

INTRODUCTION: Negative impact of stigma on HIV care and prevention is documented. Qualitative approaches were used to describe its importance in Burkina Faso (1% of HIV prevalence) and need to be completed by quantitative estimations of the main manifestations and categories of stigma. METHODOLOGY: During the MATCH study (Multi-country African Study on Testing and Counselling for HIV) conducted in 2007-2008, 219 people tested HIV positive (PLWHA) were interviewed by means of a quantitative questionnaire. One of the topics concerned their experience of the consequences of HIV positive results using 20 items on stigma manifestations, classified into 3 categories: stigma in health care services (7 items), interpersonal stigma (10 items) and internal stigma (3 items). RESULTS: Internal stigma is the major category experienced by PLWHA in Burkina Faso (46%) compared to 40% for interpersonal stigma and 11% for stigma in health care facilities). PLWHA who disclosed their HIV result, widows or separated persons, those with a lower level of education, PLWHA who joined community-based organizations are more likely to experience interpersonal stigma. Stigma in health care facilities is more frequently reported by PLWHA who joined community-based organizations. Internal stigma affects all PLWHA, with no significant differences in terms of age categories or gender. CONCLUSION: Antiretroviral scaling-up programmes must integrate more adapted psychology support aspects. Psychosocial activities, targeting persons and not groups, must be part of PLWHA care in Burkina Faso, especially in community-based organizations.

[Does post-test counseling support PLHIV in disclosing their HIV status? Practices and propositions by counselors in Burkina Faso]. / Le conseil post-test encourage-t-il les PVVIH à partager leur statut sérologique? Pratiques et suggestions des conseillers au Burkina Faso.

Disclosure of HIV test results is discussed during post-test counseling, following norms. However, while barriers to disclosing a positive HIV result have been documented, the literature is sparse on the way guidelines are applied in the field. The aim of this article is to describe and analyze counseling practices regarding HIV disclosure to 'significant others' (partner, family members, friends) reported by clients and providers of HIV voluntary counseling and testing in Burkina Faso. A cross-sectional survey was conducted in urban and rural areas in 2008 . A questionnaire incorporating semi-open questions was used. A total of 542 people who completed the test in 2007 and 111 service providers of HIV counseling and testing were interviewed. The data were analyzed using SPSS 12. Only 29% of those tested stated that disclosure to partner or family members was discussed with them during post-test counseling. This result is explained by providers' uncertainties and concerns regarding how to disclose, risks related to disclosure and adverse consequences of disclosure. Strategies are developed by counseling providers to support people who have been diagnosed HIV positive in disclosing to significant others, but they recognize that these actions are insufficient. Providers' suggestions are to keep fighting against the stigmatization of PLHIV, to improve counseling providers' competence in this area, and to adopt legal texts to make mandatory disclosure of the HIV result to partners. The study identified several ways to improve counseling practices regarding clients' disclosure of their HIV status in Burkina Faso. These findings could have significance for Africa as a whole.