Marseille 2007
Marseille 2007
Abstract book
Go Back

Abstract #354  -  HIV test or diagnosis? impact of a distinction on the experience of seropositivity and the quality of care
Session:
  6.84: Posters A (Poster) on Monday   in  Chaired by
Authors:
  Presenting Author:   Mrs Blandine Bila - IRSS/CNRST, Burkina Faso
 
  Additional Authors:  Mrs Blandine Bila, Mr Marc Egrot, Mr Abdoulaye Traor, Mrs Alice Desclaux,  
Aim:
In Burkina Faso, anthropological studies carried out in the ANRS 1281 program in 20032006 examined diagnostic and therapeutic itineraries for PLWHA. Analysis particularly addressed the conditions for determining HIV serostatus and the existing relationships between the conditions of this initial test and the construction of itineraries for medical care and treatment.
 
Method / Issue:
The results are drawn from ethnographic surveys combining direct observation, group interviews and semi-structured interviews of 53 PLWHA and 37 actors from the health system in the region of Ouagadougou.
 
Results / Comments:
The interviews with health professionals and patients show confusion and various interpretations in defining HIV testing, voluntary testing, HIV serology, HIV diagnosis and screening. Yet, the life stories of PLWHA show the importance of making a distinction between obtaining HIV serologies within the logic of voluntary testing and within the logic of diagnosis. Most people underwent HIV testing when they were already sick or convinced of their seropositivity (on the basis of self- or medical diagnosis). Consequently to this delay in HIV diagnosis, they were often in precarious situations, and even distress, when finding out their HIV-positive status. These situations jeopardized their ability to face the consequences of their diagnosis, from a medical perspective (major deterioration in health, costly and long pre-test therapeutic itineraries) as psychological (illness or death of a spouse or child) or social (family economic depletion, loss of job, exclusion and discrimination, particularly for widows, etc.). The delay had an important impact on the experience and efficacy of care provided after diagnosis. The analysis of factors for the late practice of HIV test shows many reasons: some PLWA were reluctant to undertake HIV test, others were not aware of their at-risk situation; many of them had already attended health services for minor or major ailments, but HIV tests had not been done nor advised to them. Consequences of being orientated towards testing, sometimes in voluntary testing centers, when in a clinical situation of disease (sometimes at the stage of AIDS) were not limited to delay in care: patients management of their health was precarious, relying more on sociability networks opportunities than on health-providers advices and prescriptions.
 
Discussion:
The results of this analysis shows the importance of providing HIV test in health-care services, in diagnosis or screening situations, beyond requesting voluntary testing. Besides the issue of delayed diagnosis of HIV infection, differences between services provided with HIV-test in either situation should be discussed in the light of their consequences on patients experience. Linguistic issues remain regarding the distinction between situations, and the present confusion in health-providers perceptions must be addressed. By reconsidering the importance of a semantic distinction between testing, screening and diagnosis, the proposed analysis will feed the debate recently ignited by UNAIDS and WHO a propos the principles governing HIV testing.
 
Go Back

  Disclaimer   |   T's & C's   |   Copyright Notice    www.AIDSImpact.com www.AIDSImpact.com