Department of Sociology and Population Research Center, University of Texas at Austin, 1 University Station-A 1700 Austin, Texas 78712, United States.
Soc Sci Med. 2010 Sep;71(5):986-93. doi: 10.1016/j.socscimed.2010.05.020. Epub 2010 Jun 4.
The delivery of HIV counseling and testing programs throughout Sub-Saharan Africa relies on the work performed by trained HIV counselors. These individuals occupy a critical position: they are intermediaries between the rule-making of international and national policymakers, and the norms of the communities in which they live and work. This paper explains when, how and why HIV counselors adapt Western testing guidelines (the "3Cs"--consent, confidentiality and counseling) to local concerns, attempting to maintain the fidelity of testing principles, while reducing the harm they perceive may arise as a consequence of strict adherence to them. Data for this study come from Malawi: a poor, largely rural African country, where HIV prevalence is ranked 9th highest in the world. The analysis is based on 25 interviews with HIV counselors and a unique set of field journals, and captures local experiences and the moral quandaries that counselors in rural Sub-Saharan Africa face. The findings of this inquiry provide new insights into the implementation of HIV testing in rural African settings, insights that may guide HIV prevention policy.
撒哈拉以南非洲的艾滋病毒咨询和检测项目的实施依赖于经过培训的艾滋病毒咨询人员的工作。这些人处于一个关键的位置：他们是国际和国家政策制定者的规则制定者与他们生活和工作的社区规范之间的中介。本文解释了艾滋病毒咨询人员如何以及为何将西方检测准则（“3C”——同意、保密和咨询）适应当地的关注点，试图在保持检测原则的保真度的同时，减少他们认为由于严格遵守这些准则而可能产生的伤害。这项研究的数据来自马拉维：一个贫穷的、以农村为主的非洲国家，其艾滋病毒流行率在世界上排名第九。该分析基于对 25 名艾滋病毒咨询人员的访谈和一组独特的实地日记，记录了农村撒哈拉以南非洲地区咨询人员的当地经验和道德困境。这项调查的结果为在农村非洲环境中实施艾滋病毒检测提供了新的见解，这些见解可能为艾滋病毒预防政策提供指导。
