Desclaux Alice, Ky-Zerbo Odette, Somé Jean-François, Obermeyer Carla Makhlouf
Institut de Recherche pour le Développement, TransVIHMI UMI 233 (IRD, Université Montpellier 1, Université Cheikh Anta Diop de Dakar, Université de Yaoundé 1), Dakar, Senegal.
BMC Int Health Hum Rights. 2014 Oct 16;14:27. doi: 10.1186/1472-698X-14-27.
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.
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.
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.
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.
在一些艾滋病毒低流行率的非洲地区开展了相关活动，作为扩大艾滋病毒检测的一项策略，评估在这些活动期间个人权利和护理质量受到保护的程度很重要。在本文中，我们调查了服务提供者和服务对象对伦理问题的看法，包括他们是否认为活动期间咨询和检测点的可及性可能会妨碍保密性。
为了研究布基纳法索的活动开展情况，我们进行了一项定性研究，对52人（活动期间或活动之外接受检测的服务提供者和服务对象以及从未接受检测的个人）进行了个人访谈和焦点小组讨论。对有关艾滋病毒检测活动的看法和经历、护理质量和个人权利的话语进行了主题分析。
受访者重视活动期间检测的可及性和吸引力；服务对象强调便利性、连锁反应、不孤单的感觉以及高参与度带来的匿名性。面对众多服务对象，服务提供者制定了因地制宜的策略，以确保在检测过程中获得同意、进行咨询、保护保密性并留住服务对象，他们还会适应工作场所安排、当地资源和社会规范。服务对象赞赏活动期间的护理质量。然而，出现了有关保密性和可及性的新伦理问题。由于当地社会规范鼓励人们与他人分享检测结果，而艾滋病毒呈阳性的人可能并不希望这样做，因此艾滋病毒感染状况的保密性可能会受到损害。服务提供者的伦理关切与世界卫生组织的 “5C” 规范一致，尽管表述方式不同。服务对象和服务提供者重视活动期间所有人都能获得检测服务，并将其视为一个伦理问题。该研究揭示了全球规范在当地如何进行调整或协商。
未来关于艾滋病毒检测和咨询活动的全球建议应考虑可及性，并提出检测服务应对与高需求相关的新伦理问题的方法。
