A.15.Challenges of voluntary HIV counseling and testing in rural Malawi
Bula A, Chilongozi D, Chimbiri A, Chavula K, Hoffman I, Thornton R, Martinson F, Kohler HP, Watkins S
Background: Opportunities for HIV voluntary counseling and testing (VCT) are currently only provided by a small number of VCT programs mostly found in major urban areas. The Government of Malawi is planning to expand the availability of VCT, yet little is known about the challenges of VCT in rural areas.
Objectives: The objective of this activity was to estimate the prevalence of HIV and treatable sexually transmitted infections for a population based sample in rural Malawi and document the challenges of implementing rural HIV VCT.
Methods: Approximately 3200 respondents in Mchinji, Balaka and Rumphi were offered VCT in their homes by nurses trained in pre and post-test counseling. Consent was obtained. Post-test counseling was performed in small, mobile VCT centers (tents) distributed around the survey sites. To preserve confidentiality, respondents were given a special biomarker ID and a Polaroid picture marked with their biomarker ID for identification when they return for their results.
Results/challenges: The foremost challenge to the nurse counselors in implementing VCT was the extensive number of rumors and misconceptions. In general, the community expected that most people who were tested would be found HIV positive, and at post-test counseling expected to see many visible signs of despair. When this did not happen, they became skeptical of the accuracy of the results. Other challenges were the long distance between respondent homes; difficulty of finding privacy for counseling in respondents’ homes, and long waits for results.
Conclusion: VCT is accepted in rural Malawi when skilled nurses conduct pre-test and post-test counseling and can be conducted in mobile clinics or tents. The Ministry of Health should train more counselors to support the proposed expansion of VCT to rural and peri-urban areas. Expanded VCT will help in sensitizing communities on issues pertaining to HIV/AIDS, and thus may also contribute to prevention and reduce rumors and misconceptions.