Dealing with a positive result: routine HIV testing among pregnant women in Vietnam
Résumé
HIV testing is an essential component of PMTCT. It can be offered to pregnant women through different testing models, ranging from voluntary counseling and testing (VCT) to routine and mandatory testing. This study was conducted in Hanoi, Vietnam, where HIV prevalence is low among the general population, but high among young, urban, sexually active male intravenous drug users. Women who want to deliver in a state hospital are routinely tested for HIV, in the absence of well-defined opt-out procedures. In-depth interviews with a convenience sample of 38 seropositive pregnant women and mothers and 53 health workers explored the acceptability of routine testing. Patients and health care workers appeared to accept routine “blood” tests (including HIV tests), because they feel uncomfortable discussing issues specific to HIV/AIDS. To avoid having to inform women directly about their HIV status, health workers at routine testing sites rely on the official notification system, shifting the responsibility from the hospitals to district and commune health staff. The notification system in Hanoi informs these local officials about the HIV status of people living in their catchment area without patients' consent. Our study shows that this non-confidential process can have serious social, economic and health consequences for the HIV positive women and their children. Programs that train health workers in the various PMTCT options, make them more sensitive to the reproductive rights of women, and improve their counseling skills are urgently needed. Such programs need to be sensitive to the Vietnamese cultural tendency to avoid talking about a stigmatizing disease, but should also provide acceptable approaches for informing women of their HIV+ status.
Origine : Fichiers produits par l'(les) auteur(s)
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