Ethical challenges of HIV/AIDS testing among women in Uganda: A case study of The Aids Information Center, Mbarara District

Abstract

The study sought to establish ethical challenges curtailing HIV/AIDS testing among women in Uganda focusing on AIC in Mbarara district. In Uganda, while efforts to scale up voluntary HIV / AIDS testing have been undertaken, uptake of HIV / AIDS testing services remains poor and women in particular are predisposed to HIV infection as a consequence. The purpose of the study was to establish ethical and other factors hindering HIV / AIDS testing among women in Uganda. Primary data was collected using interviews, questionnaires and focused group discussions. Secondary data were generated through content analysis. Primary data was generated from 94 respondents who were selected using stratified and purposive sampling techniques. The study established that ensuring autonomy of clients and seeking their consent among others are basic principles of medical ethics critical to the uptake of HIV / AIDS testing services by women. Couple testing clubs, voluntary counseling and testing, community sensitization and how clients of different socio – economic status were handled by HIV / AIDS service providers influenced access and utilization of HIV / AIDS testing services. Various ethical factors including confidentiality concerns, segregation and bias by some personnel undermined uptake of HIV / AIDS testing services. Stigmatization, discouragement, fear of separation, domestic violence, poverty, ignorance and other factors also hindered women from under taking HIV/AIDS tests. Educational attainment was not a major factor that hindered women’s uptake of HIV / AIDS testing services. HIV / AIDS testing service providers demonstrated inadequate knowledge of the relevant HIV/ AIDS policies and laws. Easy access to HIV testing centres; sensitization campaigns, appropriate counseling services and the requirement for pregnant women to undergo HIV / AIDS tests enhanced uptake of HIV / AIDS testing services especially in urban areas. Application of medical ethics by medical practitioners also encouraged female clients to undertake HIV / AIDS tests. Respondents expressed mixed reactions about the adequacy of existing HIV / AIDS testing standards. Some respondents said by emphasizing confidentiality, HIV / AIDS testing polices had encouraged women to undertake HIV tests unlike others who said inadequate enforcement of the policies had rendered them ineffective. To enhance uptake of HIV / AIDs testing services, the need to train personnel on ethical aspects critical to HIV / AIDS tests and for them to be deployed in rural areas, the need for service providers to monitor their staff to ensure they comply with HIV / AIDS testing standards and undertaking regular sensitization campaigns in rural areas using innovative approaches were recommended. An appropriate HIV / AIDS law that will help enforce the Uganda National Policy Guidelines for HIV Counseling and Testing needs to be expeditiously enacted after extensive stakeholder consultations. Existing HIV / AIDS testing standards also need to be widely disseminated for stakeholders to appreciate their content. Successful HIV / AIDS testing experiences should be replicated in different parts of Uganda and the National HIV & AIDS Strategic Plan 2007/8 – 2011/12 should be adequately financed and implemented by Government and other stakeholders.