Pregnant Realities: Experiences of Routine HIV Testing and Counseling in an Antenatal Clinic in Rural Uganda
Uganda was one of the first resource-poor countries to introduce Routine Counseling and Testing (RCT) and Prevention of Mother-to-Child Transmission (PMTCT) programs countrywide since 2004. Whilst recognizing the great potential of scaling up testing and treatment and simultaneously preventing babies from acquiring the HIV infection, scholars have voiced concern over the complexities of RCT in resource-poor settings. Resource-poor settings are often plagued by poverty, gender inequalities, HIV-related stigma, weak health care infrastructure and poor access to antiretroviral treatment. Motivated by shared concerns this qualitative case-study addressed the following research question; “How is RCT being offered by health providers and experienced by pregnant women within an antenatal clinic in a resource-poor context in rural Uganda?” Data was obtained over a period of three months, from March to June 2008, through a combination of qualitative research methods including observations, semi-structured interviews, group discussions and thorough reviews of existing documents. The study population consisted of three groups: health personnel at the antenatal clinic, pregnant women being offered RTC in the antenatal clinic and members of the post-test club. The multi-level perspective provided the theoretical structure for comparing the policies with local practices.
My findings show how health providers interpret the policy of RCT based on their professional logic and role in the program. Power relations within the clinic illustrate an antenatal ethics of care in which one does not question the health worker’s advice. Therefore HIV testing in antenatal care is regarded as a given rather than a choice. Asking for consent to test and the possibility to opt-out are hardly there in practice. Yet women were satisfied with their experience of being tested though RCT and often deliberately used the opportunity of going for antenatal care to get to know their status. By being tested through RCT, the HIV test is undone of the stigma of being suspected and blamed of infidelity and is instead related to being pregnant. The interviews with pregnant women and post-test club members indicated that following up HIV-positive women and offering ongoing counseling are essential to achieve the goals of preventing further HIV transmission. With the prospects of scaling-up the PMTCT program in resource-poor settings the local realities of health providers and recipients need to be taken into account for they influence the outcomes of the program.
Pregnant Realities: Experiences of Routine HIV Testing and Counseling in an Antenatal Clinic in Rural Uganda
Uganda was one of the first resource-poor countries to introduce Routine Counseling and Testing (RCT) and Prevention of Mother-to-Child Transmission (PMTCT) programs countrywide since 2004. Whilst recognizing the great potential of scaling up testing and treatment and simultaneously preventing babies from acquiring the HIV infection, scholars have voiced concern over the complexities of RCT in resource-poor settings. Resource-poor settings are often plagued by poverty, gender inequalities, HIV-related stigma, weak health care infrastructure and poor access to antiretroviral treatment. Motivated by shared concerns this qualitative case-study addressed the following research question; “How is RCT being offered by health providers and experienced by pregnant women within an antenatal clinic in a resource-poor context in rural Uganda?” Data was obtained over a period of three months, from March to June 2008, through a combination of qualitative research methods including observations, semi-structured interviews, group discussions and thorough reviews of existing documents. The study population consisted of three groups: health personnel at the antenatal clinic, pregnant women being offered RTC in the antenatal clinic and members of the post-test club. The multi-level perspective provided the theoretical structure for comparing the policies with local practices.
My findings show how health providers interpret the policy of RCT based on their professional logic and role in the program. Power relations within the clinic illustrate an antenatal ethics of care in which one does not question the health worker’s advice. Therefore HIV testing in antenatal care is regarded as a given rather than a choice. Asking for consent to test and the possibility to opt-out are hardly there in practice. Yet women were satisfied with their experience of being tested though RCT and often deliberately used the opportunity of going for antenatal care to get to know their status. By being tested through RCT, the HIV test is undone of the stigma of being suspected and blamed of infidelity and is instead related to being pregnant. The interviews with pregnant women and post-test club members indicated that following up HIV-positive women and offering ongoing counseling are essential to achieve the goals of preventing further HIV transmission. With the prospects of scaling-up the PMTCT program in resource-poor settings the local realities of health providers and recipients need to be taken into account for they influence the outcomes of the program.
