Bhagwanjee Anil, Petersen Inge, Akintola Olagoke, George Gavin
Afr J AIDS Res. 2008 Nov;7(3):271-9. doi: 10.2989/AJAR.2008.7.3.4.651.
This qualitative study sought to understand users' perceptions of the voluntary counselling and testing (VCT) and HIV-treatment services offered by a mining company in South Africa, with the intention of making recommendations to improve the rates of uptake. A purposive sample of 75 employees was interviewed and three focus groups were conducted with VCT users as well as with HIV-positive employees currently enrolled in the company's treatment programme. The relatively high uptake of VCT at the workplace appeared to be a function of the convenience afforded by rapid testing and the on-site nature of the company's annual campaign, the group nature of the campaign, and increased HIV awareness facilitated by pre-test counselling. Notwithstanding this, the study revealed barriers to uptake of VCT in the workplace, including: perceived violations of confidentiality by healthcare staff and doubts about the voluntary basis of HIV testing; organisational factors, including the visible group nature of the VCT campaign; and fear of a HIV-positive result and discrimination in that event. In contrast to VCT uptake, there was a relatively low rate of enrolment in the treatment programme: a significant proportion of HIV-positive employees identified in the VCT campaign did not present to the company's clinic for treatment. Impediments to treatment uptake included fears of being identified in the workplace as HIV-positive, which arose from perceived confidentiality violations on the part of the healthcare staff as well as organisational factors they believed allowed easy identification of the programme's users; limited time to attend the clinic; poor quality of post-test counselling and follow-up; difficulties in coping with the diagnosis; and traditional explanatory models of illness, which precluded medical care. A combination of the current annual, opt-in VCT campaign and a provider-initiated opt-out approach to VCT should be carefully considered in order to bridge the gap between the current levels of VCT and HIV-treatment uptake by employees at the company.
这项定性研究旨在了解南非一家矿业公司提供的自愿咨询检测（VCT）和艾滋病毒治疗服务的用户认知情况，以便提出改进接受率的建议。研究选取了75名员工作为有目的的样本进行访谈，并与VCT使用者以及目前参加公司治疗项目的艾滋病毒呈阳性员工进行了三次焦点小组讨论。工作场所VCT相对较高的接受率似乎得益于快速检测的便利性、公司年度活动的现场性质、活动的群体性质以及检测前咨询提高了艾滋病毒知晓率。尽管如此，研究仍揭示了工作场所接受VCT的障碍，包括：认为医护人员违反保密原则以及对艾滋病毒检测自愿性的怀疑；组织因素，包括VCT活动明显的群体性质；以及对艾滋病毒检测呈阳性结果的恐惧和由此可能遭受的歧视。与VCT接受率形成对比的是，治疗项目的登记率相对较低：在VCT活动中确定的相当一部分艾滋病毒呈阳性员工未前往公司诊所接受治疗。接受治疗的障碍包括担心在工作场所被识别为艾滋病毒呈阳性，这源于认为医护人员违反保密原则以及他们认为允许轻松识别项目使用者的组织因素；前往诊所的时间有限；检测后咨询和随访质量差；应对诊断困难；以及传统的疾病解释模式阻碍了医疗护理。应仔细考虑将当前的年度、自愿参与的VCT活动与由提供者发起的VCT退出方式相结合，以弥合公司员工目前的VCT水平与艾滋病毒治疗接受率之间的差距。
