Access denied? Consent for HIV testing at antenatal clinics in rural Malawi

Nicole Angotti, University of Texas at Austin
Kim Dionne, University of California, Los Angeles
Lauren Gaydosh, Invest in Knowledge Initiative (IKI)

HIV Voluntary Counseling and Testing has been an important technology in efforts to control HIV in the West. Central to this approach is that HIV testing is voluntary, and the results confidential. During the last decade, VCT has been exported by humanitarian aid organizations to settings that are quite different in terms of health infrastructure and social and cultural practices. The literature on technology transfer suggests that when new technologies diffuse, they are also adapted by their users to local circumstances. This paper examines one aspect of the way that HIV testing has been implemented in rural Malawi: the extent to which testing is voluntary. We consider the perceptions of two sets of women: those who had been tested at antenatal clinics; and those who had not but may nonetheless share these perceptions. Preliminary results indicate that women perceive HIV testing as compulsory and necessary to receive antenatal care.