AJPH -- eLetters for Bassett, 92 (3) 347-351

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GLOBAL HIV/AIDS:
Mary Travis Bassett
Ensuring a Public Health Impact of Programs to Reduce HIV Transmission From Mothers to Infants: The Place of Voluntary Counseling and Testing
Am J Public Health 2002; 92: 347-351 [Abstract] [Full text] [PDF]

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the necessity to reinforce confidentiality of the HIV voluntary counseling and testing: joel ladner, luc dauchet, michel cartoux, pierre czernichow (7 June 2002)

the necessity to reinforce confidentiality of the HIV voluntary counseling and testing 7 June 2002

joel ladner,
senior lecturer
epidemiology and public health department university hospital of rouen france,
luc dauchet, michel cartoux, pierre czernichow
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Re: the necessity to reinforce confidentiality of the HIV voluntary counseling and testing

joel.ladner{at}chu-rouen.fr joel ladner, et al.

We read with interest the article by Mary Travis Bassett who reviewed the barriers to voluntary counseling and testing (VCT). The author points out that the main barriers to VCT are the lack of counselors, delays in offering test results, lack of treatment availability and social factors (1).
We conducted a case-control study to identify factors associated with refusal for HIV VCT in sex workers (SWs) in Bobo-Dioulasso (Burkina Faso). Between December 1997 and September 1998, 748 female SWs were included in a cross sectional study, which aimed at analyzing their social and anthropological characteristics. According to their practices characteristics, SWs were classified into six different categories and each group was organized with recognized leaders (2). Data regarding socio -demographic characteristics, medical histories of STI, knowledge regarding the transmission of HIV and prostitution practices were recorded by the six leaders. Each SW included in the cross sectional study was systematically offered an HIV screening test (free of charge), after a face-to-face pre-counseling. A case, defined as a SW who accepted the VCT (VCT+) was matched by age and leader to two controls SWs, who refused the VCT (VCT-).
In the 748 SW included in the cross-sectional study, 135 women were tested (18.0%). A total of 116 VCT+ and 232 VCT- were included in the case -control study. There was no significant difference between the two groups for the level of education, the duration of prostitution, at least a history of treated STI in the past year, the level of knowledge regarding the transmission of HIV, the number of clients and the report at least a sexual act without using a condom during the last week. The fear of a non- respect of the HIV test confidentiality result was the only variable significantly associated with the refusal of VCT (odds ratio=2.08, 95% confidence interval=1.10-4.07; p=0.02).
Despite the encouragement of the peers-counselors and the infrastructure available, only 18.0% of the SWs were tested. Provision factor such as confidentiality of health workers contributed to this low acceptance rate (3, 4). The lack of confidentiality is one of the factors responsible for the stigma, which are acknowledged as being major barriers to HIV prevention and care (5). Our results suggest that urgent reflection is required about the adaptation of VCT and health care services to maximize their behavioral impact and to target confidential supportive VCT for the SWs, a high risk group of population for HIV in sub-Saharan Africa.
References
1 - Basset MT. Ensuring a public health impact of programs to reduce HIV transmission from mothers to infants : the place of Voluntary Counseling Testing. Am J Public Health, 2002; 92:347-51.
2 - Nagot N, Ouangré A, Cartoux M, Huygens P, Ouedraogo A, Defer MC, Meda N, Van de Perre P. Spectrum of commercial sex activity in Burkina Faso: validation of a classification model in relation to HIV exposure. J Acquire Immune Defic Syndr 2002; 29:517-21.
3 - Fylkesnes K, Haworth A, Rosensvard C, Kwapa PM. HIV counselling and testing: overemphasizing high acceptance rates a threat to confidentiality and the right not to know. AIDS 1999; 13:2469-74.
4 - Cartoux M, Meda N, Van de Perre P, Newell ML, De Vincenzi I, Dabis F. Acceptability of voluntary HIV testing by pregnant women in developing countries: an international survey. Ghent International Working Group on mother-to-child transmission of HIV. AIDS 1998; 12:2489-93.
5 - Fortenberry J, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley D et al. Relationship of stigma and shame to gonorrhea and HIV screening. Am J Public Health 2002; 92:378-81.