Kiene, S.M., Sileo, K., Wanyenze, R.K., et al. Journal of Health Psychology (September 2013), E-publication ahead of print.
The authors conducted formative research to identify factors affecting the HIV prevention behaviors of Ugandan men and women receiving provider-initiated testing and counseling (PITC) in a public hospital. They conducted focus group discussions with 56 clients and 23 hospital staff, and key informant interviews with four additional staff, to obtain perspectives about the community’s HIV prevention behaviors and how to improve PITC services. The findings revealed important individual, interpersonal, and structural or community-level factors that influenced HIV prevention behaviors and PITC acceptability. While clients were knowledgeable about the benefits of HIV testing and counseling, information gaps and misconceptions were common. Attitudes toward PITC were generally favorable; however, motivation to test was hindered by fear of testing, finding out one’s status, and disclosing results to a partner. Fear of lack of confidentiality and poor provider counseling skills also limited clients' motivation. Structural factors also exerted significant impacts. Gender inequity influenced behavior, including women’s ability to negotiate safe sex. Stigma towards HIV-positive persons comprised a barrier to PITC and prevention behaviors, and affected confidentiality and trust in client-provider relationships, which emphasized the need to conduct PITC privately. Interventions must address structural-level factors, e.g., stigma and gender norms, to increase HIV prevention behaviors. Client-centered, non-judgmental counseling during PITC may increase positive prevention behaviors among clients.