Community perspectives towards mandatoty testing for HIV in Macha
Sitali, Doreen Chilolo
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Zambia's national HIV policy does not support mandatory testing of individuals on public health grounds. However, due to the low uptake of voluntary counseling and testing which is only 20% of the population, there have been recent proposals by the Ministry of Health to introduce mandatory HIV testing for individuals attending health facilities. This proposal has triggered various views from various backgrounds in society. The aim of this study was to explore community perspectives on mandatory testing. The study also'acted as a model through which the community was involved in decision making for public policy which is an important aspect of community involvement that enhances policy formulation and helps to avoid social engineering.The study was a cross-sectional descriptive design. The study used both qualitative and quantitative approaches. Multistage sampling was used to select households for interviews. Adults above 18 years, of age were interviewed from the selected households using a structured interview questionnaire. The questionnaire was translated into the local language to enhance understanding of the subject. Purposive sampling was instituted to select key informants for in-depth interviews. The study was undertaken within the Diffusion of Innovation Theory. The theory enhances understanding of the factors that influence ccJmmunities to embrace new ideas or practices.Quantitative data was analyzed using SPSS version 16 for windows. Preliminary analyses were done followed by cross tabulations to measure associations between variables. Logistic regression was applied to determine independent predictors for supporting mandatory HIV testing. In-depth interviews were translated and transcribed into computer files; common themes were identified, after which data was categorized using the Nvivo statistical package. Interpretation of qualitative data was done manually.A total of 809 respondents and 12 (twelve) key informants participated in the study. The age range for the cohort was 18-80 years, with mean age of 35.8 years. Of the whole study population, 42.8% were males while 57.2% were females. The study found that the majority of respondents (61.9%)) had never heard about mandatory HIV testing before. Despite this scenario, the majority (80.3%) of respondents and all the key informants supported the policy. Furthermore; most (89.5%) respondents indicated that they would accept to be tested without consent if they were to be hospitalized. Support for the policy was on the premise that the community has realized the importance of HIV testing as an entry point to HIV care, treatment, and support. Concerning issues of stigma and discrimination it was found that the majority of respondents (76.2%) felt that this is likely to reduce if mandator^^ HIV testing is introduced. In -depth interviews revealed that stigma and discrimination in the community had tremendously reduced due to increased awareness of HIV disease and the introduction of ARV's.The study established that while 52.6% of the cohort thought that mandatory testing is not a violation of human rights, 47.4% felt so. The majority of respondents (71.8%) indicated that they still valued their right to privacy and autonomy, although they were ready to forego the same for the sake of knowing their status. Prior knowledge about the policy and relative advantage were found to be very significant independent predictors for supporting mandatory HIV testing. It was found that those who had heard about the policy before were 1.5 times more likely to support the policy than those who had not (p value 0.044). On the other hand, those who thought that the policy will offer more benefits than risks were ten times more likely to support the policy than those who thought otherwise (p value 0.001). The study established that the cornmunity was in support of mandatory HIV testing policy. It was also established that the commun|ty had realized the vital role that testing plays in accessing HIV care and treatoient and was more willing to be tested. However, issues of human rights are still debatable and need to be explored more in the light of the new policy. Furthermore, it has been established that the community had began to respond more favorably to testing using other strategies such as mobile VCT which need to be strengthened. It was also evident from the study that the poor response to VCT is not exclusively due to fear of being tested but largely due to the African culture of not wanting to be screened when one is not sick. This therefore explains why there was an increased response to mobile VCT.lt is therefore evident that strengthening mobile VCT and increasing access to testing centers can significantly increase uptake of testing in the communities. Sensitization of communities is also key in increasing awareness and changing attitudes towards HIV testing and reducing stigma and discrimination.