Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm, Paris, France.
Institut de Pédagogie Universitaire, Bamako, Mali.
Front Public Health. 2021 May 19;9:653543. doi: 10.3389/fpubh.2021.653543. eCollection 2021.
The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners. This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis. HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status. It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.
在马里，艾滋病毒感染者向其性伴侣透露艾滋病毒状况的比例很低，马里是一个西非国家，全国艾滋病毒流行率为 1.2%。艾滋病毒自检（HIVST）可以提高艾滋病毒感染者（PLHIV）性伴侣的检测覆盖率。2019 年至 2021 年期间，在西非启动了 ATLAS 项目，目标是在科特迪瓦、马里和塞内加尔分发近 50 万份艾滋病毒自检。ATLAS 项目整合了几项研究活动。本文介绍了在马里开展的 ATLAS 项目的定性研究初步结果。该研究旨在增进我们对向 PLHIV 分发艾滋病毒自检的做法、限制因素和问题的了解，以便他们可以向其性伴侣提供这些检测。这项定性研究于 2019 年在巴马科的一家艾滋病毒护理诊所进行。它包括：(i) 对参与艾滋病毒自检分发的 8 名卫生专业人员进行的个人访谈；(ii) 对包括社会服务咨询在内的 591 次 PLHIV 医疗咨询的观察；(iii) 对由同伴教育者领导的 PLHIV 小组讨论的 7 次观察。对卫生专业人员的访谈和观察记录进行了内容分析。在观察到的 591 次咨询中，仅讨论了 9%（51/591）次 HIVST。当讨论 HIVST 时，讨论几乎总是由卫生专业人员而不是 PLHIV 发起的。很少讨论 HIVST，因为在大多数咨询中，向 PLHIV 的性伴侣提出 HIVST 并不合适（例如，当 PLHIV 丧偶、没有伴侣或已委托他人续处方时）。一些 PLHIV 尚未向其伴侣透露其 HIV 状况。分发艾滋病毒自检需要花费大量时间，而医疗咨询时间非常短。当未向伴侣透露 HIV 状况时，确定了阻碍 HIVST 分发的三个主要障碍：(1) 几乎所有卫生专业人员在认为或知道 PLHIV 未向伴侣透露其 HIV 状况时，都避免向 PLHIV 提供 HIVST；(2) 如果 PLHIV 尚未向其伴侣透露其 HIV 阳性状况，他们不愿向其伴侣提供 HIVST；(3) 支持 HIV 状况披露的策略有限。必须加强支持 HIV 阳性状况披露的策略。需要重新考虑利益相关者的参与，为 PLHIV 的性伴侣提供艾滋病毒自检制定特定方法。该方法应为他们提供针对与 HIV 状况披露和性别不平等相关的问题的培训，并改进对 PLHIV 的咨询。
