Wringe, A., Moshabela, M., Nyamukapa, C., Sexually Transmitted Infections (September 2017), 0: 1–5, doi:10.1136/sextrans-2016-052969
This qualitative study examined how clients' HIV testing experiences influenced their subsequent engagement in care. Interviews were conducted with 5–10 counselors and 28–59 people living with HIV in each of six countries. HIV-positive respondents found provider-initiated testing acceptable, but neither counselors nor clients always viewed it as optional. Several counselors provided messages based upon their beliefs about appropriate sexual behaviors, whereas clients sought testing simply to learn their HIV status. However, some clients reported that counseling gave them hope and energized them to continue seeking HIV services. Some clients returned multiple times for testing, even after testing positive. This was considered part of the process of accepting one’s diagnosis, but also served to increase familiarity with health workers and the health facility, further encouraging clients to continue care-seeking behaviors. Providers addressed consent and confidentiality inconsistently; sometimes justifying a breach based on a client’s physical status, including illness and pregnancy, because they thought it could benefit an unborn child or ensure that clients did not die because they gave their medication to relatives. However, the authors noted that removing clients' testing autonomy may result in reduced trust in HIV services and providers, which is needed to optimize adherence and therapeutic outcomes.