|
|
 |
Abstract
The national scale-up of voluntary counseling and testing (VCT) in Kenya has potential for abuse in the counseling room
C. Hamilton1, D. Okoko2, R. Tolhurst3, N. Kilonzo2, S. Theobald4, M. Taegtmeyer5
1Liverpool School of Tropical Medicine, Interantional Health, Mwanza, Tanzania, United Republic of, 2Liverpool VCT and Care, Kenya, Nairobi, Kenya, 3Liverpool School of Tropical Medicine, International Health, Liverpool, United Kingdom, 4REACH Trust, Technical Adivsor, Lilongwe, Malawi, 5Liverpool VCT and Care, Kenya, Liverpool, United Kingdom
Background:
The rapid scale-up of HIV counselling and testing programs in Africa has led to quality concerns, including the potential for abuse that the private, confidential setting of Voluntary Counselling and Testing (VCT) provides. Following two allegations of sexual abuse within VCT in Kenya, a small qualitative study was conducted to explore stakeholders’ perceptions of the potential for abuse and factors contributing towards this.
Methods:
Qualitative interviews and observation were conducted in Kisumu, Malindi, and Nairobi. Interviews were carried out with at total of 26 VCT service providers and 41 service users across all locales, in addition to 13 key informant interviews.
Results:
The majority of users and providers reported positive counselling experiences. However, despite quality assurance measures, first and second hand accounts of negative counselling experiences for both service providers and users were documented, including emotional, physical and sexual abuse. Interviewees identified the privacy of counselling rooms and the limited training and supervision of counsellors, as factors contributing towards abuse. Providers also perceived clients’ inability to accept test results and the difficult issues in their lives, as causes of abuse by clients. Most participants related causes of abuse to wider gender and power imbalances, and perceived that inadequate prosecution systems perpetuated the perpetration of abuse. When there was a gender difference between the counsellor and client discussion of topics of sex and sexuality were particularly sensitive and led to vulnerability.
Conclusions:
Despite a strong focus on quality assurance and supervision in many VCT sites, the study demonstrates the potential for abuse in the VCT process. This has important implications for policymakers. Further debate around this issue and the application of ethical guidelines and codes of conduct are urgently needed to ensure the protection of clients and providers in the scale-up of VCT and wider HIV/AIDS treatment and care programmes.
Back
|